DISEASES OF THE EXTEhhhhhhhRNAL EAR-1.pptx

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1. DISEASES OF THE EXTERNAL EAR Dr. Alex Malambo Otorhinolaryngology Head and Neck Surgeon

2. DISEASES OF THE PINNA Includes congenital, traumatic, inflammatory or neoplastic disorders . congenital disorders Bat ear-abnormally protruding pinna Preauricular appandages –skin covered tags due to incomplete fusion during development Preauricular pits- incomplete fusion during development Microtia - small ear Anotia –no ear Macrotia - big ear Bat ear

3. DISEASES OF THE PINNA B . Ear trauma Haematoma of the auricle . collection of blood between the auricular cartilage and its perichondrium result of blunt trauma Unattended hematoma can lead to cartilage death and healing by fibrosis resulting in a cauliflower ear. Treatment is aspiration or incision and drainage

4. DISEASES OF THE PINNA 2. Lacerations, Avulsions Repair as soon as possible. Repair in layers i.e. perichondrium and skin Use absorbable for perichondrium an non absorbable for skin. Attempt reattachment of pinna with a stalk still attaching Complete avulsed pinna can be reattached consider viability and skill available 3. Burns and frost bite In burns treat like burns and debride as much a possible exposed cartilage Staged management In frost bite, warm dressing 38-42 degrees Analgesia and antibiotics and wait for demarcation the debride accordingly.

5. DISEASES OF THE PINNA 3. Keloids Due to trauma i.e. piercings High recurrence rate post excision Treatment is by excision And pre or post radiotherapy or steroids post excision

6. DISEASES OF THE PINNA C. Inflammatory conditions Perichondritis It results from infection secondary to lacerations , haematoma or surgical incisions Also extension of infection from diffuse otitis externa or a furuncle of the meatus Start with symptoms red , hot and painful pinna which feels stiff . Then abscess forms Treatment in early stage consists of systemic antibiotic 7-10 days. If abscess has formed, I$D and send pus for M/c/s. Leave a small drain

7. DISEASES OF THE PINNA 2. Tumours Benign and malignant From skin to cartilage

8. DISEASES OF THE EXTERNAL AUDITORY CANAL The diseases of external auditory canal are grouped as: A. Congenital disorders B. Trauma C. Inflammation D. Tumours E. Miscellaneous conditions . Congenital disorders Atresia of external canal may occur alone or in association with microtia If occurring is due to recanalization during development Maybe fibrous or bony TM is normal Atresia with microtia is more common Maybe associated with ME, inner ear abnormalities

9. DISEASES OF THE EXTERNAL AUDITORY CANAL 2. Branchial sinus type 1/ Collaural fistula 2 openings . In EAC and just around the angle of the mandible B. Trauma to Ear Canal From iatrogenic to accidents C. Inflammations of Ear Canal Otitis externa may be divided, on aetiological basis , into i . Infective cause

10. DISEASES OF THE EXTERNAL AUDITORY CANAL ii. Reactive cause Eczematous otitis externa Seborrheic otitis externa Neurodermatitis Eczematous OE Scalp seborrheic dermatitis

11. DISEASES OF THE EXTERNAL AUDITORY CANAL INFECTIVE CAUSES Furuncle (localized acute otitis external) is a staphylococcal infection of the hair follicle severe pain, pain on movement of pinna and the jaw Post auricular lymph node Treatmen t : systemic antibiotics. Analgesia and warm compressions Rule out immunosuppression in recurrent funiculitis 2. Diffuse otitis externa diffuse inflammation of meatal skin which may spread to involve the pinna and epidermal layer of tympanic membrane commonly seen in hot and humid climate and in swimmers Also called Swimmers ear Excessive sweating changes the pH of meatal skin from that of acid to alkaline which favors growth of pathogens . Common organisms responsible for otitis externa are: S. aureus , Pseudo, proteus and E . coli but more often the infection is mixed

12. DISEASES OF THE EXTERNAL AUDITORY CANAL Clinical features: hot burning sensation, pain, thin serous discharge which later becomes thick and purulent Meatal lining becomes inflamed and swollen . May become chronic characterized by irritation and strong desire scratch, crusts Treatment : Aural toilet, microsuctioning Antibiotics both topical (medicated wicks) and systemic Analgesia Topical steroids- usually combined in antibiotic ear drops

13. DISEASES OF THE EXTERNAL AUDITORY CANAL 3. Otomycosis fungal infection of the ear canal often occurs due to Aspergillus or candida . Seen in hot and humid climate of tropical and subtropical regions also s een in patients using topical aural antibiotics for a long duration Clinical features : intense itching , discomfort or pain in the ear, watery discharge and ear blockage The fungal mass may arrear white, brown or black and has been likened to a wet piece of filter paper . On microscopy hyphae is seen. Treatment: thorough Aural toilet, antifungal ear drops, analgesia and keep ear dry

14. DISEASES OF THE EXTERNAL AUDITORY CANAL 4. Herpes zoster oticus Also called Ramsay Hunt syndrome Reactivation of varicella zoster May involve other dermatomes characterized by formation of vesicles on the tympanic membrane , meatal skin, concha and postauricular groove Apart from CN 7 th , 8 th cranial nerve maybe involved Treatment: Antivirals, steroids and analgesia 5. Malignant ( necrotising ) otitis externa . inflammatory condition caused by pseudomonas infection usually in the elderly diabetics, or in those on immunosuppressive drugs Described as worse form of diffuse otitis externa Infection spreads to involve soft tissues around temporal bone and skull base and osteomyelitis Clinical feature: excruciating pain, ear discharge, granulation tissues in EAC. CN 7 palsy and other lower cranial Nerves

15. DISEASES OF THE EXTERNAL AUDITORY CANAL Treatment consists of high doses of i.v. antibiotics directed against pseudomonas atleast for 6weeks Aural toilet, analgesia Treat under lying DM and immunosuppression 6. Eczematous otitis externa It is the result of hyper sensitivity to infective organisms or topical ear drops Intense irritation , vesicle form ation , oozing and crusting in the canal. Treatment: withdraw drug and give steroid cream 7. Seborrhoeic otitis externa It is associated with seborrhoeic dermatitis of the scalp Itching is the main complaint Greasy yellow scales are seen in the external canal , over the lobule and postauricular sulcus Treatment: ear toilet, cream containing salicylic acid and Sulphur attend to scalp seborrhoea .

16. DISEASES OF THE EXTERNAL AUDITORY CANAL D. Tumours Chronic otitis externa with granulation tissue, foul smelling discharge consider biopsy Especially in adults

17. DISEASES OF THE EXTERNAL AUDITORY CANAL E. Miscellaneous Conditions Wax impaction/ cerumen Wax is composed of secretion of sebaceous glands, ceruminous glands. hair, desquamated epithelial debris. keratin and dirt . Wax has a protective function as it lubricates the ear canal and entraps any foreign material that happens to enter the canal excessive wax may be secreted and deposited as a plug in the meatus Presents with hearing loss, tinnitus, itchiness Treatment: Ear syringing. If hard instill wax softener for atleast 3 days 2. Foreign body Can be living or non living objects objects like seeds may swell if water instilled Removal can be by Forceps removal, Syringing, Suction, Microscopic removal with special instruments, Postaural approach For insects can instill oil as home remedy to kill it For corrosives objects like battery remove as soon as possible NOTE; syringing will removal most of the objects

18. DISEASES OF TYMPANIC MEMBRANE Diseases of tympanic membrane may be primary or secondary to conditions affecting external ear, middle ear or eustachian tube Retracted tympanic membrane A retracted tympanic membrane is the result of negative intratympanic pressure when the eustachian tube is blocked Prominent ME structures

19. DISEASES OF TYMPANIC MEMBRANE 2. Myringitis bullosa . It is a painful condition characterised by formation of haemorrhagic blebs on the tympanic membrane and deep meatus. It is probably caused by a virus or mycoplasma pneumoniae. 3. Herpes zoster oticus . 4. Perforations can be traumatic or due to infection Traumatic wait for 12 weeks for spontaneous healing. If non tympanoplasty 5. Tympanosclerosis It is hyalinisation and later calcification in the fibrous layer of tympanic membrane

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