Diseases Of the external ear

Prof. Dr. Mohamed Talaat ELGhonemy

 CONGENITAL ANOMALIES OF THE
EXTERNAL EAR
Auricle:
1. Anotia : Absent auricle.
2. Microtia : Small deformed auricle.
3. Bat ear (protruding auricle): commonest.
4. Pre-auricular fistula: A tiny opening in front of
auricle.
5. Accessory auricles.
External auditory meatus:
Congenital atresia of external auditory canal
Congenital anomalies of the auricle

Anotia (absence of auricle).

Congenital anomalies of the auricle ;
Microtia . Small deformed auricle.

Macrotia . Abnormal large auricle

Bat Ear . (protruding auricle): commonest.
Accessory Auricle .
Pre-auricular sinus ( Fistula ) A tiny opening
in front of auricle.
.
Congenital Atresia Of The EAC
Unilateral or Bilateral .
• Atresia of the external auditory

meatus due to failure of canalization

during the first trimester of
pregnancy .
leads to conductive deafness. It is
commonly associated with
congenital anomalies of the auricle
and the middle ear.
 Investigations ;
1- Audiological assessment , e.g., evoked response audiometery .
2- Radiological assessment , e.g., C.T.

Treatment ;
1- Unilateral cases ; no treatment or for
cosmetic reasons .
2- Bilateral cases ;
* Hearing Aid at the age of 1 year .
* Operation at the age of 2 years
(Meatoplasty)
(Auriculoplasty)
Trauma to the Auricle
Haematoma of the auricle :
Collection of blood between the cartilage and the perichondrium.
Due to closed blunt trauma.
If infected, it leads to perichondritis of the auricle.
Clinical picture: painful, swollen and bluish auricle.
Treatment: antibiotics and aspiration of the collected blood
Haematoma of the auricle
 PERICHONDRITIS OF THE AURICLE
Infection, suppuration and necrosis of the auricular
cartilage leading to cauliflower auricle. (‫)ا لقرنبيط‬
 Causes:

Infected hematoma, septic incisions or furunculosis.

 Symptoms and signs:

The auricle is swollen, red, hot and tender.

 Treatment:

-Antibiotics.
-Multiple incisions to drain the pus and remove the
necrosed cartilages.
Perichondritis
Cauliflower auricle
 Trauma of external canal
 FOREIGN BODY (F.B)Common in children
 Types of F.B

-Animate: flies, mosquitoes and larvae (myiasis).

-Inanimate: seeds, beans, beads and buttons.
Complications:
 -Acute otitis externa and otitis media.

 -Injury of the external canal, the drum and the

ossicles during unskilled attempts of removal.

 Treatment: Ear wash or hocks remove most

foreign bodies which could be done under general

anesthesia in children.
Foreign body
Foreign body
Foreign body
External otitis / Otitis externa
BACTERIAL
 A). Localized otitis externa (Furunculosis)

 B). Diffuse external otitis

 C). Malignant otitis externa.

FUNGAL INFECTIONS (Otomycosis)

VIRAL INFECTIONS
ALLERGIC OTITIS EXTERNA
SEBORRHOEIC OTITIS EXTERNA
Localized otitis externa (Furunculosis)
A staphylococcal infection of a hair follicle in the skin
of the cartilagenous external canal.
 Symptoms:

-Pain: severe on mastication because the skin is

adherent to the cartilage.
-Deafness follows if the canal is occluded by the
swelling.
-Scanty, purulent discharge if the furuncle bursts.
 Signs:

-Tenderness on moving the auricle or pressing the

tragus.
-Localized lymphadenitis (pre and postauricular).
-The drum is normal if seen beyond the furuncle.
 Treatment:
-Systemic and local antibiotics and analgesics.
-Local: glycerin icthtiol aural pack.
-Test for diabetes in recurrent cases.
Furunculosis
Diffuse Otitis Externa :A diffuse inflammation of the external canal
skin due of Staphylococcus infection.
 Causes:
-Scratching the ear with dirty fingers or unsterile pins.
- Sepsis from ear wash.
-Pus from chronic suppurative otitis media.
-Humidity in summer (excess sweating). (swimmer's ear).
 Symptoms:
-Pain on mastication.
-Scanty discharge.
-Slight deafness.
 Signs:
-The canal shows diffuse red swollen skin with narrow lumen.
-Tenderness on moving the auricle or pressing the tragus.
- Localized lymphadenitis (pre and postauricular).
 Treatment:
-Antibiotics and analgesics.
-Local antibiotic ear drops.
Diffuse Otitis Externa
Malignant otitis externa : (necrotizing otitis externa)
* Organism ; Pseudomonas .
•Patient ; Elderly diabetic or immunosupressed .

Clinical picture:
-Pain is severe and resistant to analgesics.
-Serosanguinous discharge (serous &blood).
-Infection and granulations may involve:
*Stylomastoid foramen leading to facial paralysis.
*Jugular foramen leading to paralysis of the last four cranial
nerves.
*Sigmoid sinus and meninges leading to fatal outcome.
Malignant otitis externa
Investigations
- 90% diabetic.
- C.T. + M.R.I.
- Radionuclide scanning(Gallium).
Treatment
- Control of diabetes &improve immunity.
- Antibiotic injections & topical gentamycin .
Fungal otitis externa :(Otomycosis)
* Organism ; - Aspergillus niger .
 - Candida albicans .
 * Symptoms ;
 - Itching may be the only symptom.
 - Ear discharge.
 - C.D. from a fungus mass .
 - Pain from secondary infection.
 * Signs ;
 - Whitish mass with black spots
 ( wet newspaper ) .
 * Treatment ;
 - Ear wash for fungus mass .
 - Antifungal ear drops .
 Wax accumulation ( Cerumen )

Abnormal accumulation
of ear wax (cerumen:
a mixture of secretions
of both ceruminous
and sebaceous
glands) which are
present in the outer
cartilagenous part of
the external canal.
 Wax normally leaves the meatus due to
1- Epithelial migration & Gravity .
2- Jaw movements .
3- Self cleaning .
Symptoms:
Deafness & tinnitus , usually after swimming & bathing .
* Treatment ;
1- Ear wash (glycerine bicarbonate).
2- Removal by hook or suction if there is T.M.
perforation .
Wax
Ear Wash

Indications
wax causing deafness .
Fungus mass (Otomycosis) .
F.B ( not impacted).
Aural toilet for discharge of chronic
suppurative otitis media
Contraindications
Dry or traumatic perforation.
Impacted foreign body.
Otitis externa.
Fistula from the middle ear to the inner
ear.
 Technique of ear wash
 The fluid used is sterile,
isotonic saline or water at
body temperature. The ear
canal is straightened by
pulling it upwards and
backwards. The sterile nozzle
of the syringe is put on the
posterior wall and the flow of
water is directed posteriorly to
avoid rupture of the drum.
Complications ;

-Trauma to the drum or injury of the external canal.

-Infection: Acute otitis externa or acute otitis media.
-Reflex cough or syncope due to vagal stimulation.
-Vertigo: Caloric reaction from hot or cold fluid used.
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