DOC-20250317-WA0050..pptx external ear dise

Got it 👍 — here’s a structured overview of disorders of the external ear (useful for ENT study notes or exams):


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Disorders of the External Ear

1. Congenital Disorders

Microtia – small or malformed pinna.

Anotia – complete absence of pinna.

Preauricular sinus / tags – embryological remnant near pinna.

Atresia of external auditory canal – absent or narrowed ear canal → conductive hearing loss.



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2. Trauma

Auricular hematoma – collection of blood between cartilage and skin → if untreated → “cauliflower ear.”

Lacerations / burns / frostbite – may lead to deformity.



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3. Inflammatory Disorders

Otitis externa (swimmer’s ear) – infection of ear canal.

Causes: bacterial (Pseudomonas), fungal (Aspergillus, Candida).

Symptoms: ear pain, itching, discharge, swelling.


Furunculosis – staphylococcal abscess of hair follicle in outer canal.

Perichondritis – infection of auricular cartilage (often after trauma/piercing).

Eczema / psoriasis / allergic dermatitis – itching, scaling, redness.



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4. Foreign Bodies

Common in children: beads, seeds, insects.

Symptoms: pain, discharge, hearing loss.



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5. Tumors

Benign: exostosis, osteoma, papilloma, hemangioma.

Malignant: squamous cell carcinoma (most common), basal cell carcinoma, melanoma.



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6. Miscellaneous

Cerumen impaction – wax accumulation → hearing loss, tinnitus.

Keloid – after ear piercing.

Actinic keratosis – precancerous lesion on pinna from sun exposure.



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Key Points

Disorders may involve pinna, external auditory canal, or skin/cartilage.

Symptoms commonly include ear pain, discharge, itching, swelling, or hearing loss.

Treatment depends on cause: antibiotics/antifungals, removal of foreign body, drainage, surgery for tumors or congenital anomalies.



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👉 Do you want me to make this into a short tabular format (disease → features → management) for quick revision?
You’re asking again about Cholesteatoma 🙂
Here’s a clear, exam-ready short note for you:


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Cholesteatoma

Definition

An abnormal, non-cancerous collection of keratinizing squamous epithelium in the middle ear and mastoid that enlarges and destroys bone.


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Types

1. Congenital – epithelial remnants behind intact tympanic membrane, usually in children.


2. Acquired – more common, due to:

Retraction pocket (from Eustachian tube dysfunction)

Migration of epithelium through a perforation

Metaplasia (rare theory)





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Clinical Features

Persistent, foul-smelling scanty discharge (otorrhea)

Conductive hearing loss

Retraction pocket or pearly white mass on otoscopy

Complications:

Ossicular erosion → severe hearing loss

Facial nerve palsy

Labyrinthine fistula → vertigo

Intracranial: meningitis, brain abscess, lateral sinus thrombosis




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Diagnosis

Otoscopy: pearly white debris / retraction pocket

Audiometry: conductive hearing loss

HRCT temporal bone: extent, ossicle status, complications



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Treatment

Surgical (definitive):

Modified radical mas

1. Department of ent Mgm medical college, aurangabad Diseases of the external ear

2. Congenital diseases of pinna Anotia - complete absence of pinna and lobule Microtia - small pinna Macrotia - excessively large pinna Bat ear - abnormally protruding ear due to large concha with poorly developed antihelix and scapha Lop ear - hypoplasia of upper third of pinna Cryptotia - upper third of pinna embedded under scalp skin Coloboma - transverse cleft in middle of pinna

3. Darwin’s tubercle - pointed tubercle on upper part of helix Stahl’s ear - helix is flat and upper crus of antihelix is duplicated and reaches rim of helix Lobule deformities- large, bifid, pixed Pre-auricular tags- skin covered tags that appear on a line drawn from tragus to angle of mouth Pre-auricular sinus- epithelial track in front of crus of helix or above tragus due to incomplete fusion of tubercles

4. Traumatic diseases of pinna HEMATOMA Cauliflower ear/ boxer’s ear Collection of blood between auricular cartilage and its perichondrium Treatment- aspiration under aseptic precautions and pressure dressing, if fails then I&D with through and through sutures, prophylactic antibiotics

5. Lacerations & avulsions of pinna

6. Frost bite Erythema , oedema, bullae formation, necrosis of skin and subcutaneous tissue, complete necrosis with loss of affected part Treatment- Rewarming with moist cotton pledgets at temperature 38-42 deg C Application of 0.5% silver nitrate soaks Analgesics Protection of bullae from rupture Systemic antibiotics

7. Keloid May follow trauma or piercing of the ear Surgical removal may lead to recurrence Recurrence can be avoided by pre- and post-operative radiation with a total dose of 600-800 rad delivered in 4 divided doses

8. Perichondritis Infections sec to lacerations, hematoma or surgical incisions Common pathogens- pseudomonas and mixed flora Symptoms- red, hot and painful stiff pinna , abscess formation between cartilage and perichondrium with necrosis of cartilage Treatment- systemic antibiotics, 4% aluminium acetate compresses, abscess drainage, removal of devitalised cartilage

9. Furuncle Staphylococcal infection of hair follicle Symptoms- severe pain and tenderness, movements of pinna or jaw cause pain Treatment- systemic antibiotics, analgesics, local heat, ear pack of 10%ichthammol glycerine, I &D of abscess

10. Diffuse otitis externa Diffuse inflammation of meatal skin which may spread to involve the pinna and epidermal layer of tympanic membrane Hot and humid climate, swimmers Trauma to meatal skin and invasion by pathogenic organisms Staph. Aureus , Pseudomonas, Bacillus, E.Coli Acute phase: hot burning sensation followed by pain during jaw movements, thin serous discharge which later becomes thick and purulent, meatal lining is inflamed and swollen, severe cases- lymphnodes are enlarged and tender with cellulitis of surrounding tissues

11. Chronic phase: irritation and strong desire to itch, scanty discharge which dries up to form crusts, meatal skin is thick and swollen and shows scaling and fissuring Treatment: ear toilet, insertion of medicated wicks (antibiotic steroid preparation), local steroid drops, aluminium acetate or silver nitrate (mild astringents) wicks, broad spectrum systemic antibiotics, analgesics, 10% ichthammol glycerine wick to reduce swelling in chronic phase

12. Otomycosis Fungal infection of ear canal due to Aspergillus niger , A. fumigatus , Candida Albicans Hot and humid climate Secondary fungal growth in patients using topical antibiotics Intense itching, discomfort, pain, watery discharge with musty odour Treatment: ear toilet, Nystatin for candida , clotrimazole , povidone iodine, 2% salicylic acid in alcohol EAR KEPT DRY

13. Malignant otitis externa An inflammatory condition caused by pseudomonas infection usually in elderly diabetics, or in those on immunosuppressive drugs Excrutiating pain, appearance of granulations in the ear canal Facial paralysis Infection may spread to skull base and jugular foramen causing multiple cranial nerve palsies, anteriorly spreads to temporomandibular fossa , posteriorly to mastoid, medially to middle ear and petrous bone

14. Treatment: Control of diabetes Toilet of ear canal Antibiotic treatment for 6-8 weeks- Gentamycin + ticarcillin , third generation cephalosporins + aminoglycosides , quinolones

15. Impacted wax Wax is composed of secretion of sebaceous glands, ceruminous glands, hair, desqaumated epithelial debris, keratin and dirt Factors causing impacted wax- secretion of more sweat or cerumen , narrow and tortuous ear canal, stiff hair or obstructive lesion e.g. exostosis Symptoms- impaired hearing or sense of blocked ear, tinnitus, giddiness, reflex cough Treatment- removal by syringing or instrumental manipulation, prior sofening with wax solvents

16. Keratosis obturans Collection of pearly white mass of desquamated epithelial cells in the deep meatus By its pressure effect, causes bone absorption leading to widening of meatus , facial nerve may be exposed and paralysed Treatment- syringing or instrumentation

17. Diseases of tympanic membrane Retracted tympanic membrane Myringitis bullosa Herpes Zoster oticus Myringitis granulosa Traumatic rupture Atrophic tympanic membrane Retraction pockets & atelectasis Tympanosclerosis Perforations