Ear DiseaseSimon Lloyd

Consultant ENT Surgeon

Manchester Royal Infirmary

Anatomy

Tympanic MembraneLeft ear

Pars flaccida

Handle of malleus

Light reflex

Long process of incus

Pars tensa

Middle Ear

Inner Ear

Consists of: Semi-circular canals Vestibule Cochlea

Function: Balance Hearing

Clinical Assessment

Symptoms

5 symptomsOtalgiaOtorrohoeaHearing impairmentTinnitusVertigo

Investigation

Pure Tone Audiometry

Familiar Sounds

External Ear

Otitis externa

Inflammation of ear canal skin

Aetiology:Bacterial – Staph. aureus, Pseudomonas, ProteusFungal – Aspergillus niger, Candida albicansViral – Herpes simplex,Herpes zosterReactive – Eczema, Psoriasis

Predisposing factors:Bathing, humidityTraumaCanal stenosisEczema

Symptoms & Signs - Bacterial

Otalgia - severe

Purulent otorrhoea

Deafness

Inflammation of ear canal +/- pinna

Treatment

Swab for sensitivities

Aural toilet

Splinting of ear canal (Pope wick)

Topical antibiotics eg. Sofradex, Gentasone

Keep dry

Malignant Otitis Externa

Osteomylitis of temporal bone

Immunocompromised patients eg. Diabetes

Usually pseudomonas

Extremely painful

May be associated with cranial nerve palsy

Have a high index of suspicion

Treat aggressively with IV antibiotics for at least 6 weeks

Symptoms & Signs - Fungal

Itching

Mild otalgia

Fullness

Greyish white debris +/- fungal spores

Treatment

Aural toilet

Topical antifungal agents eg. Canestan

Furunculosis

Staph. infection of hair follicle causing abscess formation

Severe otalgia

Requires I&D

Ramsey Hunt Syndrome Herpes zoster

Geniculate ganglion of facial nerve

Vesicular rash of pinna and ear canal (+/- mouth and tongue)

Facial nerve palsy

Painful

Vertigo

Treatment Analgesia Antivirals eg. Acyclovir Protect the eye

Perichondritis

Inflammation of perichondrium

Aetiology: Ear piercing Laceration Surgery CT disease

Treatment: Antibiotics I & D (if abscess)

Sequelae: Cauliflower ear

Foreign body in ear

Hyperostosis

ExostosisMultiple bony swellings in

deep canalCold waterAsymptomatic

No treatment unless large

OsteomaSingle benign bony tumour

outer bony meatusNo treatment unless large

Embryology

First Branchial Cleft AnomaliesPre-auricular sinus

First Branchial Cleft AnomaliesAccessory Auricle

Benign Skin Pathology

Seborrhoeic Keratosis

Gouty Tophi

Solar keratosis

Benign Skin Pathology

Chondrodermatitis helicis nodularis chronica

Keloid ScarringDarwin’s tubercle

Malignant Skin Pathology of The Pinna

Basal Cell Carcinoma

Squamous Cell Carcinoma