Scribd
Upload
8 views

External Ear

Uploaded by

snpshubh444
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
8 views

External Ear

Uploaded by

snpshubh444
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 37

Davao Medical School Foundation

Chris Robinson D. Laganao, MD, DPBO-HNS


Review of the External Ear Anatomy

Noninfectious Disorders of the External Ear

Infectious Disorders of the External Ear


KEY POINTS IN EXTERNAL EAR ANATOMY
External ear = auricle and external auditory canal
Layers of the auricle
▪ keratinizing squamous epithelium
▪ subcutaneous layer and adipose tissue
▪ perichondrium
▪ elastic cartilage
External auditory canal
▪ lateral surface of TM to EAC meatus
▪ length of ~2.5 cm
▪ medial 2/3 bony wall
▪ covered by thin layer of nonkeratinizing squamous epithelium
▪ no subcutaneous layer, sebaceous glands, and hair follicles
▪ foramen of Huschke = defect in anterior bony canal → infection to deep parotid gland and
sternocleidomastoid
▪ lateral 1/3 fibrocartilage skeleton
▪ contains hair follicles and sebaceous glands, apocrine glands
▪ cerumen found in the cartilaginous portion, hydrophobic, slightly acidic pH 6.0 – 6.5
▪ fissures of Santorini = transverse slits in the cartilaginous canal → infection or neoplasm to
superficial parotid
KEY POINTS IN EXTERNAL EAR ANATOMY
Nerve supply of EAC and Auricle
KEY POINTS IN EXTERNAL EAR ANATOMY
Self cleansing mechanism of EAC
▪ centrifugal movement of epithelial debris of TM towards the annulus to
cartilaginous canal, combined with glandular secretions

Flora
▪ mostly Gram positive
▪ Staphylococcus auricularis
▪ Staphylococcus epidermidis
▪ Others: coryneform, streptococci, enterococci
EXTERNAL EAR

Laceration
▪ Types
▪ Simple
▪ Stellate
▪ Avulsion
▪ Treatment
▪ Deep cleaning
▪ Debridement
▪ Surgical repair (primary or staged
reconstruction)
▪ Wound dressing
▪ Systemic antibiotics
EXTERNAL EAR

Burns
▪ Types
▪ Thermal
▪ Electrical
▪ Chemical

▪ Treatment
▪ Dependent on degree of burn and
severity of tissue loss
▪ Debridement
▪ Wound dressing
▪ Topical and systemic antibiotics
EXTERNAL EAR

Keloid & Hypertrophic scar


▪ Associated with piercing of auricle
involving pinna or earlobe
▪ More common among blacks and
Hispanics
▪ Treatment
▪ Local steroid injection
▪ Surgical excision
▪ Pressure dressing
EXTERNAL EAR

Hematoma
▪ Collection of blood between the
auricular cartilage & perichondrium
▪ Blunt trauma seen in boxers,
wrestlers, and other contact sports
▪ Treatment
▪ Aseptic aspiration
▪ Incision and drainage
▪ Pressure dressing
▪ Systemic antibiotics
EXTERNAL EAR

▪ Microtia = Pinna or Auricle


▪ Atresia = External ear canal, middle
and inner ear contents
▪ May be associated with other
abnormalities such as preauricular
appendages, branchial arch remnants,
eye, facial, and cervical spine
anomalies
EXTERNAL EAR

Diagnosis
▪ Clinical examination
▪ Audiologic evaluation
▪ Speech and language assessment
▪ Imaging (HRCT scan)
Treatment
▪ Hearing amplification: hearing aids,
bone conduction implants
▪ Surgery: atresia repair, pinna
reconstruction
▪ Prosthetic management
EXTERNAL EAR

▪ Failure of fusion of the first and second


hillocks
▪ Commonly found at the root of helix
▪ Not considered a risk factor for hearing
loss
▪ Treatment
▪ Acute = antibiotics and surgical drainage
▪ Recurrent = excision of sinus tract
EXTERNAL EAR

▪ Commonly seen among children


▪ SSx: Purulent ear discharge and/or
otalgia
▪ Seeds = irrigation, extraction using
forceps
▪ Insects = immobilize with
vegetable/mineral oil, then do
irrigation or extraction with forceps
▪ Round objects e.g. beads = irrigation
or extraction with hook
EXTERNAL EAR

Accumulation of earwax in the EAC


Signs & Symptoms
▪ Ear fullness
▪ Hearing loss
▪ Otalgia
▪ Tinnitus
Treatment
▪ Extraction of cerumen
▪ Irrigation
▪ Ceruminolytics
▪ Docusate sodium, hydrogen peroxide, acetic acid
▪ Olive oil, mineral oil, or almond oil
EXTERNAL EAR

Exostosis
▪ Multiple, bilateral sessile
▪ Assoc. with cold water exposure
▪ Laminated growth pattern

Osteoma
▪ Benign neoplasm
▪ Usually unilateral
▪ Pedunculated
EXTERNAL EAR

Basal cell carcinoma


▪ Most common malignancy of the ear in
45% of cases
▪ SSx: erythematous lesion with raised
margins, occasionally with silvery scales in
pinna & EAC
Treatment
▪ Biopsy for histologic diagnosis
▪ Wide local excision
▪ Skin graft or local flap reconstruction
EXTERNAL EAR

Squamous cell carcinoma


▪ SSx: otalgia, bloody ear discharge,
polypoid lesion with granular appearance
Treatment
▪ Biopsy for histologic diagnosis
▪ Wide surgical excision
▪ May require parotidectomy, block
resection of ear canal, temporal bone
resection, with postop radiation therapy
EXTERNAL EAR INFECTIONS

▪ Preinflammatory
▪ Edema of EAC, Glandular obstruction induced by local trauma or moisture

▪ Acute inflammatory
▪ Mild = erythema + edema + odorless secretions
▪ Moderate = inc. edema + pain + mucopurulent discharge
▪ Severe = intense pain + periauricular edema + lymphadenopathy

▪ Chronic inflammatory
▪ Episode of more than 4 weeks, or
▪ More than 4 episodes in one ear
EXTERNAL EAR INFECTIONS

Bacterial Fungal Viral

• Localized AOE • Otomycosis • Herpes zoster


(Furunculosis) oticus
• Diffuse otitis
externa
• Malignant
otitis externa
EXTERNAL EAR

▪ Bacterial cellulitis of the EAC


▪ Localized otitis externa of the sweat
glands and hair follicles of EAC
▪ Staphylococcus aureus
Etiology
▪ Warm, wet ear canal
▪ Traumatic manipulation
▪ Chronic skin conditions (eczema,
psoriasis, seborrheic dermatitis)
EXTERNAL EAR

Signs & Symptoms


▪ Severe pain, aggravated by ear manipulation or mouth opening
▪ Erythema and edema
▪ Fever may be present

Treatment
▪ Pain control
▪ Warm compress
▪ Dry ear precautions
▪ Topical and oral antibiotics
▪ Surgical: debridement, incision and drainage
EXTERNAL EAR

▪ Superficial = Staphylococcus & Streptococcus

▪ Deep = Pseudomonas

Etiology:
▪ Trauma (blunt trauma, ear piercing)

▪ Extension of otitis externa


▪ Burn

▪ Postop complication of surgery


EXTERNAL EAR

Signs and Symptoms


▪ Tender, erythematous indurated pinna
▪ Fluctuant portions may indicate abscess
formation
Treatment
▪ Elimination of offending FB
▪ Debridement
▪ Incision and drainage
▪ Systemic antibiotics
EXTERNAL EAR

▪ Swimmer’s ear or tropical ear

▪ Rapid onset (<48 H) of EAC inflammation

▪ Generally unilateral
▪ Assoc. with exposure to water and local trauma

▪ Predisposing factors
▪ Narrow EAC
▪ Skin conditions (eczema, seborrhea,
psoriasis)
▪ Trauma from ear plugs, aids, wax removal
▪ Medical comorbidities
EXTERNAL EAR

▪ Signs and symptoms


▪ Erythema and edema
▪ Otorrhea
▪ Preauricular or cervical lymphadenopathy

▪ Diagnostics
▪ History and review of systems
▪ Culture and sensitivity studies
▪ Tissue biopsy for resistant cases and to exclude
malignancy
▪ Imaging may be required if infection has spread
beyond EAC
EXTERNAL EAR

▪ Microbiology
▪ Pseudomonas aeruginosa
▪ Staphylococcus epidermidis
▪ Staphylococcus aureus

▪ Preventive measures
▪ Occlusive earplugs for water exposure
▪ Proper fitting of hearing aids
▪ Avoid use of cotton tipped applicators
▪ Dry ear precautions
EXTERNAL EAR

▪ Treatment Ideal preparation


▪ Topical treatment ▪ Broad spectrum antibiotic
▪ Frequent aural toilet (fluoroquinolones or
aminoglycoside, or combination)
▪ Application of aural wick
▪ Contains steroid to reduce
▪ Acidification of EAC inflammation
▪ White vinegar or rubbing alcohol ▪ Acidic vehicle
▪ No allergic or ototoxic potential
▪ Low cost
EXTERNAL EAR

▪ Severe infection affecting the EAC and skull base


▪ Elderly and immunocompromised (poorly
controlled DM, HIV, transplant patients)
▪ Mortality rates 5 – 20%
Signs & Symptoms
▪ Ear pain and discharge
▪ Granulation tissue within EAC
▪ Neurologic deficits (CN palsy of VII to XII)
▪ Sigmoid sinus thrombosis
▪ Meningeal signs
EXTERNAL EAR

Diagnosis
▪ Tissue biopsy
▪ Imaging
▪ HRCT – cortical bone erosison
▪ MRI – soft tissue changes, dural involvement, more
useful in monitoring response to treatment
Treatment
▪ Multidisciplinary team approach
▪ Address primary comorbidity
▪ Culture directed IV antibiotic therapy (6 weeks)
▪ Surgical: drainage and/or debridement
EXTERNAL EAR

Etiology
▪ Warm wet ear canal
▪ Traumatic manipulation
▪ Postsurgical mastoid cavities
▪ Immunocompromised patients
Signs & Symptoms
▪ Itchiness and otalgia
▪ Visible fungal hyphal and spore elements
EXTERNAL EAR

Treatment
▪ Canal debridement
▪ Dry ear precaution
▪ Acidifying and drying agents (boric acid,
gentian violet)
▪ Topical antifungal agents (clotrimazole,
miconazole, tolnaftate)
▪ Oral antifungal agents
(immunocompromised patients, severe or
invasive fungal disease)
EXTERNAL EAR

▪ Varicella zoster virus infection


▪ Viral reactivation within ganglion nerve cells
▪ Signs and symptoms
▪ Otalgia
▪ Vesicular eruption and crust formation
▪ CN VII paralysis (Ramsay-Hunt syndrome)
▪ Treatment
▪ Local ear care
▪ Topical antibiotic and steroid drops
▪ Antiherpetic (Valacyclovir 1000mg TID x
7days)
▪ High dose steroids (Prednisone 1mkday)

You might also like