Diseases of the external ear

Dr. AJAY MANICKAMJR – DEPT OF ENTRG KAR MEDICAL COLLEGE

Diseases of pinna

Congenital Traumatic Inflamatory

Congenital

Bat ear – abnormally protruding ear. surgically corrected after 6 years of age

Preauricular appendages

Preauricular sinus Anotia Macrotia Microtia

Trauma

Haematoma of the auricle

Lacerations / avulsion of pinna

Frostbite Keloid of the

auricle

Inflamatory conditions

Perichondritis Relapsing

polychondritis Chondrodermatitis

nodularis chronica helicis

Perichondritis pinna

Inflamation of perichondrium with pus between perichondrium and cartilage

Pseudomonas / staphylococcus aureus

Burning sensation of ear, painful movement of the ear

Fever Body ache Pinna totally deformed –

cauliflower

Perichondritis management

Antibiotics based on C/S

Local aluminium acetate application

I & D, insertion of drainage tube with multiple openings

Pressure bandage

Diseases of external auditory canal Congenital Trauma Inflamation Tumours miscellaneous

Congenital and traumatic Congenital 1. Atresia of ear

canal2. Collaural fistula Traumatic 1. Lacerations minor

& major

Otitis externa Acute inflamation of skin lining EAC 2 aetiology Infective 1. Bacterial – furuncle / malignant OE2. Fungal – otomycosis3. Viral – herpes zoster oticus / OE

haemorrhagicaReactive 1. Eczematous 2. Seborrhoeic3. Neurodermatitis

Otomycosis Fungal infection

affecting external ear Diabetes &

immunocompromised factors – predisposes

MC- Aspergillus niger (black headed)–

others – candida albicans (white), aspergillus fumigatus (green/brown)

Presentation

Irritation Pain Deafness Itching Discharge

sometimes Ear swab – C/S,

blood sugar estimation

Otomycosis treatment

Thorough cleaning – syringing/ suction

Painting with 2% salicylic acid

Anti fungal drops eg – nystatin

Keep ear dry Treatment of

underlying disease (diabetes)

Furunculosis Inflamation of hair follicles

– staphylococcus aureus - pseudomonas & proteus

May spread subcutaneously – cause cellulitis

Etiology - Scratching ear canal , allergy , immunocompromised patients, diabetes , depression

Frunculosis Pain Deafness Discharge – purulent Tenderness on moving

pinna or pressing tragus

Treatment1. 10% icthymol glycerin

paint – 2 to 3 times 2. Antibiotics , analgesics3. Prevent recurrence

Malignant otitis externa Pseudomonas infection Diabetics /

immunosuppresed Facial nerve

involvement is common

May involve skull base, jugular foramen

CT scan – to know its extent

Management

IV antibiotics – tobramycin, ticarcillin, 3rd gen cephalosporins 6 – 8 weeks

Control diabetes Surgical

debridement of devitalised bone & tissue to be done judiciously.

Miscellaneous Wax / cerumen

Mixture of ceruminous and sebaceous gland with desquamated epithelium in EAC

Functions – anti bacterial action , traps dust and foreign body

Causes of excess wax collections

1. Excess formation2. Less oily3. Narrow canal4. Hot & dry climate5. Stiff hair in EAC6. Apprehensive patients

Impacted Cerumen symptoms & management Symptoms 1.Deafness 2. Irritation & itching3.Otalgia4.Tinnitus5.Cough reflex Treatment1.Waxolytic agents2.Syringing3.Hooking with hook

or forceps

Foreign bodies of ear

Non living Living Methods of removal 1. Forceps2. Syringing3. Suction4. Microscopic removal5. Post aural approach