Infections of EAR

COL
MUHAMMAD ALI
ENT SPEC CMH RWP
ANATOMY OF EAR
OE

 Infective
 Reactive
Infective diseases of External Ear

 Bacterial
 Localized otitis externa (Furuncle)
 Diffuse otitis externa
 Malignant otitis externa
 Fungal
 Otomycosis
 Viral
 Herpes zoster oticus
 Otitis externa haemorrhagica
Reactive diseases of External Ear

 Eczematous Otitis Externa

 Seborrhoeic Otitis Externa
 Neurodermatitis
Seborrhoeic Otitis Externa
Otomycosis (Aspergillus)
Granular Myringitis

Otalgia
Foul Smell Ear
Discharge
Granular Myringitis

 Localized chronic inflammation of pars tensa with granulation

tissue
 Toynbee described in 1860
 Sequela of primary acute myringitis, previous OE, perforation
of TM
 Common organisms: Pseudomonas, Proteus
 Foul smelling discharge from one ear
 Often asymptomatic
 Slight irritation or fullness
 No hearing loss or significant pain
 Careful and frequent debridement
 Topical anti-pseudomonal antibiotics
 Occasionally combined with steroids
 At least 2 weeks of therapy
 May warrant careful destruction of granulation tissue if no
response
Bullous Myringitis

Young Man
Severe pain ear
Bullous Myringitis

 Viral infection
 Confined to tympanic membrane
 Primarily involves younger children
Bullous Myringitis

 Inflammation limited to TM & nearby canal

 Multiple reddened, inflamed blebs
 Hemorrhagic vesicles
 Self-limiting
 Analgesics
 Topical antibiotics to prevent secondary infection
 Incision of blebs is unnecessary
Necrotizing External Otitis

•58 yrs diabetic

•Painful ear
discharge
•Uncontrolled
DM
Necrotizing External Otitis(NEO)

 Poorly controlled diabetic with h/o OE

 Deep-seated aural pain
 Chronic otorrhea
 Aural fullness
 Inflammation and granulation
 Purulent secretions
 Occluded canal and obscured TM
 Cranial nerve involvement
Diagnosis NEO

 Clinical
 Imaging
 CT Scan
 MRI
 Technetium-99 – reveals osteomyelitis
Treatment NEO

 I/V Antibiotics for 4 wks

 Local canal debridement until healed
 Pain control
 Use of topical agents controversial
 Hyperbaric oxygen experimental
 Surgical debridement for refractory cases
Perichondritis

 45 Yrs Man
 6 Months H/O Dull Pain
 Tenderness
 Thickening Pinna
Perichondritis

 Infection of perichondrium/cartilage
 Result of trauma to auricle
 May be spontaneous (overt diabetes)
 Pain over auricle and deep in canal
 Pruritus
Heamatoma Auris
Boxer’s Ear
Wax
FB Ear
Impacted FB
Exostosis
Herpes Zoster Oticus
 35 Yrs male
 Severe pain ear
 Vesicular eruption pinna
 VII N Paresis
Herpes Zoster Oticus
 Viral Infection affecting genicualte ganglion facial nerve
 Clinical Features
 Severe otalgia
 Vesicular rash on the concha or pinna
 Associated with VII Nerve Palsy (Ramsay Hunt Synd.)
 Labrynthine symptoms like vertigo
 Sensorineural hearing loss
 Vesicular eruption in the region of IX & X CN
 Hypopharynx,buccal mucosa & hard palate
 Rash initially is in form of tense blisters that dry 7-10 days
Impetigo
Disorders of Middle Ear

 Acute Suppurative Otitis Media

 Acute Necrotizing Otitis Media
 Otitis Media With Effusion
 Chronic Suppurative Otitis Media
 Tubercular Otitis Media
 Syphilitic Otitis Media
CSOM Tubotympanic
Atticoantral disease

Ear discharge 3 yrs

Foul Smell
OME

 Young Boy 8 yrs

 Slight pain
 Deafness
 Ear Discharge 4 months
 Painless
 Odourless