DISEASES OF THE EAR

Congenital EXTERNAL EAR 1. Meatal Atresia 2. Preauricular fistula/cyst 3. Microtia 4. Bifid lobule 5. Accessory auricle 1. Auricular Hematoma 2. Foreign Body MIDDLE EAR Ossicular anomalies *may be uni/bilateral INNER EAR Syndromic/ Nonsyndromic

Trauma

1. Traumatic rupture of tympanic membrane 2. Otitic Barotrauma (Aero-otitis) 1. Acute Otitis Media (OM) - Acute Suppurative (bacterial) OM (ASOM) - Acute Necrotizing OM - Acute Viral OM 2. Chronic Suppurative OM (CSOM) - Non-Specific Safe Tubo-tympanic Unsafe Attico-antral (Cholesteatoma) - Specific Tuberculous OM 3. Complications of Suppurative OM - Cranial Acute Mastoiditis Petrositis Labyrinthitis Facial paralysis - Intracranial Extradural Abscess *most common Meningitis (Leptomeningitis) Lateral Sinus Thrombosis Brain Abscess Otitic Hydrocephalus - Extra cranial 4. Chronic Non-suppurative OM OM with effusion Chronic Adhesive OM

1. Noise trauma 2. Mechanical trauma

Inflammation 1. Auricular - Herpes Zoster Oticus - Perichondritis 2. ECA - Acute Diffue Otitis Externa - Chronic Difusse Otitis Externa - Malignant Otitis Externa - Furunculosis - Otomycosis 3. Tympanic membrane

Inner Ear 1. Labyrinthitis 2. Menieres Disease (Endolymphatic Hydrops) 3. Benign Paroxysmal Positional Vertigo (BPPV) Internal Auditory Canal 4. Acute Vestibular Neuronitis 5. Acoustic Neuroma (Vestibular Schwannoma)

etc Tumor

Impacted wax 1. Auricular - Basal Cell Carcinoma - Squamous Cell Carcinoma 2. ECA - Exostosis & Osteoma - Squamous Cell Carcinoma

Otosclerosis Glomus tumor

staphylococcal infection of hair follicles *limited to outer cartilaginous part of EAC *recurrent DM 1. Pain 2. HL (edema of EAC) 3. Purulent discharge (if rupture)

etiology

BACTERIAL INFECTION acute diffuse recurrent acute bacterial infection diffuse OE of the skin of EAC

severe pseudomonas infection of ext. ear * in elderly, uncontrolled DM patient *NOT a malignancy!

FUNGAL INFECTION Fungal infection of external ear - Aspergillus, Candida *predisposing factors - wetness of skin of ECA -excessive use of topical antibiotics 1. ITCHING, irritation 2. Mild pain 3. HL if blocked by fungal debris

BACTERIAL Usually following trauma

VIRAL INFECTION

1. Itching & irritation 2. Pain 3. Deafness if blocked by edema/discharge - Hyperemia, swelling & tenderness of EAC skin - Canal filled with debris & purulent exudates 1. Gentle cleaning 2. Topical antibiotics 3. Analgesics

symptoms

1. Itching, irritation 2. Blocked ear

infection in external ear parotid egionskull base facial & other CN palsies 1. Otagia 2. Purulent otorrhea - Granulation tissue at bony-cartilaginous junction of EAC - ESR

1. Severe pain 2. Fever (maybe)

1. Severe otalgia

Red tender soft swelling surrounded by hyperemia signs

- Narrowing of EAC - Scaling & fissures

Pale grayish fungal plug studded with dark spots (wet blotting paper)aspergillus Creamy coloured debris & musty odor - candida

Swollen tender auricle + loss or aurivular contour *uncontrolld infection + necrosis deform into CAULIFLOWER EAR 1. Systemic antibiotics 2. Drainage + irrigation with saline & local antibiotics

1. Herpetic vesicles 2.Ramsay-Hunt Syndrome - CN7-facial paralysis -CN8- SNHL, vertigo, tinnitus

treatment

* Differential diagnosis - Acute mastoiditis - Herpes Zoster oticus 1. Systemic antibiotics 2. Analgesics 3. Local antibiotic ear drops

1. Meticulous gentle cleaning 2. Local antibioticsteroid preparation 3. Control of predisposing factors ( eczema, allergy, Seborrheic state)

1. Control of diabetes 2. Antipseudomonas (quinolones ciprofloxacin)

1. Ear wash 2. Local antifungal preparations (clotrimazole)

1. Antiviral (acyclovir) 2. Systemic steroid 3. Symptomatic : - analgesics -labyrinthine sedative

CONGENITAL ANOMALIES

TRAUMA TO EXTERNAL EAR

TUMORS OF AURICLE

TUMORS OF EXTERNAL AUDITORY CANAL

IMPACTED WAX
Ceruminous plug formed dt: 1. excessive secretion of wax 2. improper way of cleaning pushing the wax inwards *cartilaginous part of EAC! 1. Deafness (MCC of CHL in adults!) 2. Discomfort 3. Pain Brownish mass partially/ completely obstructing the EAC Blunt trauma/ accident accumulation of blood under perichondrium in children Types: -animate : flies,ants -inanimate : vegetable :beans,nuts non-vegetable :beads Discomfort
type of patient

etiology

- CHL surgical widening

SCC - elderly - fair skin long time exposure to sunlight

BCC any patient

* both in bony EAC! EXOSTOSIS OSTEOMA hyperostosis benign tumor! * most common tumor in EAC * in divers a.k.a. Surfers ear ivory bone

predisposing factor

symptoms

plastic surgery

Otalgia

CP

nodule, ulcer or protrusion

long time exposure to sunlight + irradiation typical malignant ulcer regional LN metastasis

cancellous bone unilateral single small pedicle

bilateral multiple wide base (sessile)

Soft bluish swelling on lateral surface of auricle *maybe deform into CAULIFLOWER EAR

FB in external ear *vegetable FB may absorb water grows OM *insects discomfort when moving 1. Ear wash, except in: - impacted FB - vegetable (absorbs water swell) - insects must be drowned first 2. Hooks (beads) 3. Suction

extension

signs

locally malignant * rare metastasis limited surgical excision with safety margin + plastic reconstruction

treatment

treatment

Ear wash *if impacted soften by glycerine bicarbonate etc *perforated TM electric suction machine

Drainage under strict aseptic condition + Pressure bandage

radical surgical excision with safety margin + radical neck dissection

treatment = - if obstructing EAC surgical excision - if NOT NO treatment

EAR WASH ^^,

- by ear wash syringe - avoid directing water to the center of wax plug or tympanic membrane! INDICATIONS CONTRAINDICATIONS 1. WAX PLUG 1. Dry perforation of tympanic membrane avoid middle ear infection 2. FOREIGN BODIES *if not tightly impacted! 2. Recent trauma to ear/head (suspected skull base fracture) 3. OTOMYCOSIS 3. Impacted foreign bodies (esp vegetables) 4. Caloric test more impacted 4. Acute otitis externa painful COMPLICATIONS Physiological phenomena Cough & syncope stimulation of auricular br of vagus [vaso-vagal attack] - rough manipulation or cold water Vertigo, nausea, stimulation of lateral SCC [caloric stimulation of inner ear] vomiting - very cold (<30) or very hot (>44) water) Faulty techniques Traumatic rupture * with sharp pain in ear + slight bleeding + feeling of water of tympanic passing through the throat membrane treatment = keep ear dry + avoid nose blowing + antibiotics More wax impaction Trauma to the skin by syringe nozzle of EAC * also cause pain + bleeding, but INTACT TM! treatment = keep ear dry + antibiotics Faulty indications Otitis media ear wash in perforated TM Meningitis ear wash in skull base fracture Faulty after-care Otitis externa contaminated instruments Recurrence when etiology is untreated