DISEASES OF EXTERNAL EARBy Lt Col Saeed Ullah, FCPSClassified ENT, Head and Neck Surgeon

Anatomy

Anatomy

Diseases of pinna Congenital Traumatic Inflammatory Neoplastic

Congenital Bat ear Pre auricular appendiges Pre auricular sinus Anotia Microtia Macrotia

Bat earAbnormal protrudingPinna without land marksPoorly formed antihelix and scaphaCan be corrected surgicallyAfter 6 years of age

Pre auricular appendiges

Skin covered tagsMay contain cartilage Removed surgically

Pre auricular sinus/pitsRoot of the helixIncomplete fusion of tuberclesRepeated infectionAbscess may also formSurgical excision of the entire track

Anotia

Absence of pinnaFirst arch syndrome

Microtia

•Major developmental anomaly•Associated with other deformities•Unilateral or bilateral•Hearing loss

Microtia

Degrees of microtia

Macrotia

•Excessively large pinna •Can be corrected surgically

Traumatic Laceration Avulsion Frost bite Heamatoma Keloid

Laceration

•Sharpe trauma•Many types•Chances of avascular necrosis if perichondrium is lost •Immediate repair

Avulsion •If attached repair immediately•Reimplantation can be done by microvascular techniques•Skin can be removed and the pinna implanted under the postauricular skin for later implantation

Frost bite•Rewarm with moist cotton pledgets•Silver nitrate for superficial infection•Systemic antibiotics for deep infection•Analgesics for pain•Don’t rupture the bullae•Delayed Surgical debridement

Heamatoma •Blunt shearing force•Boxers, wrestlers, sports injuries•Collection of blood between perichondrium and cartilage•Early Incision and drainage•Consequences

Cauliflower ear

Consequences of non drainage or delayed drainage of heamatoma

Keloid •Common in Black coloured personal•After trauma•Ear piercing•Surgical excision•Recurrence •Steroids/radiation

Inflammatory Perichondritis Relapsing perichondritis Chondrodermatitis nodularis chronica

helicis

Perichondritis •Secondary infection

• Trauma • Infection • Pseudo

monas •Red, hot, painfull pinna•Abscess formation may occur•Systemic antibiotics•I & D of abscess

Relapsing perichondritis

•Autoimmune disorder•Any cartilage can be involved•Tender & swollen cartlige•Systemic steroids

Chondrodermatitis nodularis chronica helicis

•Small, painfull nodules along the free border of helix•Old age•Surgical excision

Neoplastic Benign tumors

Heamangioma Dermoid cyst Sebaceous cyst Papilloma Keratoacanthoma Neurofibroma

Hemangioma •Benign tumor of the vessels•Detected in childhood•Bleeds frquently•Get infected•Surgical excision•Local injections of sclerosing agents

Dermoid cyst

•Developmental cysts•Surgical excision

Sebaceous cyst

•Cysts of sebaceous glands•Contains cheesy material•Surgical excision

Malignant tumors of pinna SCC BCC Malignant melanoma

SCC

•Arising from squamous epithelium•Malignant •Lymph nodes involvement •Surgical excision

BCC

•Benign tumor of the basal layer of skin•Old age•Sun exposed areas•Surgical excision

Diseases of external auditory canal

Congenital Traumatic Inflammatory Neoplastic

Atresia of the canal•Congenital •Different degree of severity•Associated deformity•Ossicular and inner ear anomelies•Hearing loss•CT scan•Surgical repaire/reconstruction

Traumatic Laceration Cotton buds Common pins Pencils Foreign bodies

Inflammatory Infective Reactive

Infective otitis externa Viral

Herpes zoster oticus Otitis externa hemorrhagica

Becterial Furunculosis Diffuse otitis externa Malignant otitis externa

Fungal Otomycosis

Viral infection•Herpes zoster oticus•herpes zoster virus•Shingles•Extreme pain•Local application•Analgesics •Antifungal

Ramsay Hunt syndrome•Herpes zoster infection•Associated with facial palsy and sensorineural hearing loss•Poor prognosis of facial palsy•Permanent hearing loss •Antifungal •Systemic steroids•Analgesics

Viral infection

Otitis externa hemorrhagica

Bullae formation on TM

Influenza epidemics

Pain

Blood stained discharge

Antibiotics

Bacterial infection

Furunculosis •Hair follicles infection•Painfull•Antibiotics •Analgesics

Bacterial infectionDiffuse otitis externa•Swimmer’s ear•Traumatic •Swelling of canal•Scanty discharge•Painfull•Antibiotics •Local drops •Packing •Aural toilet

Bacterial infectionMalignant otitis externa•Diabetics•Immunocompromised •Pseudomonas Aurogenosa•Behaives like malignancy•Can spread in any direction•Granulation tissues at the junction of cartilage and bone•CT scan•Prolonged anti pseudomonal drugs•Analgesics•Antibiotics drops •Local aural toilet

Fungal infectionOto mycosis•Hot and humid environment•Different species•Severe itching•Blockage of ears•Blotting paper like material•White or black or yellow spores•Aural toilet•Antifungal drops•Protection from water

Reactive otitis externa Eczematous Seborrhoeic Neurodermatitis

Eczematous otitis externa•Hypersensitivity reaction

• Drpos • Ornam

ents • Ear

rings •Withdrawl of the causative agents•Steroid cream

Neurodermatitis

•Psychological disorder•Compulsive scrathing•Intense itching•Secondary infection

Wax •Ceruminous glands•Cerumin•Itching•Blockage•Pain •Suction•Mopping out•Ear syringing

Foreign body

•Organic •Inorganic •Position in EAC•Impaction•Removal

Foreign body

Inorganic

Neoplastic Squamous cell carcinoma Melagnant melanoma