Diseases of External Ear

DR.S.VIJAYASUNDARAMASSOC,PROF

DEPT. OF. ENT,HNSMGMC&RI

TerminologyTerminology

Otalgia- ear pain

Otorrhea- ear discharge

Tinnitus- sound perception without corresponding acoustic signal

Vertigo- hallucination of movement

Congenital

Acquired

Embryological development of the PinnaEmbryological development of the Pinna

Preauricular SinusPreauricular Sinus Accessory Accessory AuricleAuricle

Telephone Cupped Telephone Cupped EarEar

MicrotiaMicrotia

ProblemsProblems

Hearing

Cosmesis

Air Conduction Hearing AidAir Conduction Hearing Aid

Bone Conduction Hearing AidsBone Conduction Hearing Aids

Disadvantages of ConventionalDisadvantages of ConventionalBone AidsBone Aids

Poor quality of sound amplification

Discomfort & skin irritation

Stigma

CosmesisCosmesis

Conventional approach

No treatment

Prosthetic ear glued to the head

Surgical reconstruction of pinna

Universally poor results with rib cartilage graftsUniversally poor results with rib cartilage grafts

Osseointegrated ImplantsOsseointegrated Implants

Preauricular sinusPreauricular sinus

Asymptomatic: NO treatment

Infected: Antibiotics +/- Drainage if abscess

Definitive treatment: Excision

Acquired Diseases of AuricleAcquired Diseases of Auricle

Perichondritis/ perichondral Perichondritis/ perichondral abscessabscess

Infection involve the perichondrium

Severe pain, often associate with fever

Treated by i.v. antibiotics +/- drainage if pus

Can lead to ear deformity

Pinna lacerationPinna laceration

Wound cleaning, remove foreign body

Simple suture

Antibiotics if cartilage exposed

Need to rule out other injuries e.g. head injury

Hematoma aurisHematoma auris

Caused by trauma

-Treatment: incision, drainage +pressure dressing

Can lead to deformed ear if untreated—

The cauliflower ear

TumorsTumors

Benign

Malignant

Diagnosis: biopsy

Treatment: Surgery

RT

Surgery + RT

Diseases of External Ear CanalDiseases of External Ear Canal

Otitis externaOtitis externa

Clinical features:1. Otalgia/ Itchy ear2. Ear discharge3. Hearing loss- only in

severe cases4. Inflammed canal skin5. Canal exudates

TypesTypes

Bacterial: Acute diffuse otitis externa

1. Trauma2. Prolonged water exposure

Common causal micro-organisms: Pseudomonas

TreatmentTreatment

Aural toilet

Antibiotic ear drops

Systemic antibiotics usually not required

Fungal:

1. Prolonged antibiotic ear drops

2. Immuno-compromnised

Treatment of fungal OE

- remove predisposing factors

- Topical antifungal agent

Otitis externaOtitis externaIn immunocompromised patientsi.e. DM, steroid, HIV, Chemotherapy

Beware of Malignant Otitis Externainvolve bone of skull base,severe painpotentially fataltreat by prolonged high dose i.v. antibiotics+/- surgery

Impacted ear waxImpacted ear wax

Treatment needed when impaction causing symptoms:

1. Hearing loss

2. Otitis externa

3. Pain

Impacted ear waxImpacted ear wax

Treatment:

1. NaHCO3 ear drops2. Syringing3. microsuction

Foreign bodiesForeign bodies

• Syringing

• Removed under operating microscope

For living insects: killed with olive oil before retrieval attempt

Small exostosis

When large, can cause symptoms:

1. Impacted ear wax

1. Recurrent otitis externa

Treatment if symptomatic:

Surgical removal

Malignant ear canal tumor:

Clinical:1. Blood stained otorrhea2. Pain3. Nerve palsy4. Trismus

Management:1. Biopsy 2. Imaging to define extent3. Treatment: Surgery

RTSurgery+RT