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Boies > Chapter 5: Diseases of the External Ear > Flashcards

Chapter 5: Diseases of the External Ear Flashcards

1
Q

Auricle/Pinna (Portion)

A 
Cartilaginous portion (outer 1/3) MOBILE
Bony portion (inner 2/3)
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2
Q

External ear (Function)

A
  1. Collect and funnel sound waves to the middle ear structures
  2. Protects the TM from injury
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3
Q

External auditory canal (length)

A
  1. 2.5 cm long

2. Extending from the anterior lip of the concha to the TM

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4
Q

Narrowest area of the canal

A

Bone-cartilage junction

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5
Q

Upon inserting otoscope, the auricle should pull…

A

Posterolateral

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6
Q

Susceptible to infection

A

Epithelium-line pouch (can trap moisture)

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7
Q

Skin lining of cartilaginous portion

A
  1. Thicker than the bony portion

2. Contains hair follicle

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8
Q
  1. The only place in the body where there is skin directly overlying bone with no subcutaneous tissue
  2. Extremely sensitive and any swelling is very painful (no room for expansion)
A

Bony external auditory canal

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9
Q

Provides protection through formation of cerumen or ear wax

A

External ear

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10
Q

Location of glandular structures, sebaceous and apocrine glands that produce cerumen

A

Cartilaginous portion

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11
Q

Provides a protective, water-repellent coating to the canal

A

Cerumen + exfoliated cells of the stratum corneum

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12
Q

pH of cerumen

A

6 (acidic)

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13
Q

Provides a cleansing mechanism form the TM outward

A

Migration of desquamated epithelial cells

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14
Q

Ear canal infections are more common in a…

A

Warm, humid environment

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15
Q

More common presenting symptoms of conditions involving the auricle and external auditory canal

A
  1. Pain (otalgia)
  2. Itching
  3. Swelling
  4. Bleeding
  5. Blocked sensation
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16
Q

Product of both sebaceous and apocrine glands which are located in the cartilaginous portion of EAC

A

Cerumen

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17
Q

Types of cerumen

A
  1. Wet (dominant)

2. Dry

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18
Q

Has bactericidal properties

A

Cerumen

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19
Q

Acts as a vehicle for the removal of epithelial debris and contaminants away from the TM

A

Cerumen

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20
Q

Provides lubrication and prevents desiccation of the epidermis with its associated fissuring

A

Cerumen

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21
Q

Components of cerumen that are believed to be inhibitory or bactericidal

A
  1. Fatty acids
  2. Lysozyme
  3. Immunoglobulin
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22
Q

Drier in older individuals because of…

A
  1. Atrophy of the apocrine gland

2. Lessening of the sweat component of the cerumen

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23
Q

May present as a keratin plug occluding the EAC

A
  1. Keratosis obturans

2. Cholesteatoma

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24
Q

Bilateral and may present with bronchiectasis and chronic sinusitis

A

Keratosis obturans

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25
Q

Patients presents with pain and hearing loss

A

Keratosis obturans

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26
Q
  1. Widening of external canal
  2. Hyperplasia
  3. Inflammation of the epithelium and subthelium
  4. No bony erosion
A

Keratosis obturans

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27
Q

Postulated theory of keratosis obturans

A
  1. Overproduction of squamous epithelium and squamous plugs

2. Faulty migration of the epithelium

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28
Q

Management of keratosis obturans

A
  1. Plug removal

2. Treatment of inflammatory process

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29
Q

Usually unilateral and patients present with dull pain and intermittent otorrhea due to bony erosion and secondary infection

A

Cholesteatoma

30
Q

Postulated theory of cholesteatoma

A
  1. Circumscribed periostitis

2. Faulty epithelial migration

31
Q

Management of cholesteatoma

A
  1. Debridement of the bone or canalplasty

2. Tympanomastoidectomy

32
Q

External Otitis: Predisposing factors

A
  1. Change from the normally acid pH of canal skin
  2. Increased temperature and humidity
  3. Trauma (excessive swimming or cleaning of the ear)
33
Q

Management of external otitis

A
  1. Careful cleaning of the canal
  2. Evaluation of discharge, canal wall edema and TM
  3. Selection of local medication
34
Q

AKA Furunculosis

A

Otitis External Circumscripta

35
Q

Furunculosis begins in a…

A

Pilosebaceous follicle

36
Q

Furunculosis is confined to the…

A

Fibrocartilaginous portion of the external auditory meatus

37
Q

Furunculosis is usually caused by…

A

Staphylococcus aureus or Staphylococcus albus

38
Q

AKA swimmer’s ear

A

Diffuse otitis externa

39
Q

Swimmer’s ear is caused predominantly by…

A

Pseudomonas group

Less:
Staphylococcus albus
Escherichia coli
Enterobacter aerogenes

40
Q

Diagnostic features of Diffuse otitis externa

A
  1. Tragal tenderness
  2. Severe pain
  3. Canal wall swelling
  4. Scanty discharge
  5. Normal or slightly diminished hearing
  6. Absence of obvious fungal particles
  7. Possible presence of tender regional adenopathy
41
Q

Most common caused of Otomycosis

A
  1. Pityrosporum

2. Aspergillus

42
Q

AKA Herpes zoster oticus

A

Ramsay hunt disease

43
Q

Facial paralysis accompanied by otalgia and a herpetic eruption involving portions of the external ear

A

Herpes zoster oticus

44
Q

Develops when trauma or inflammation cause an effusion of serum or pus between the layer of perichondrium and the cartilage of external ear

A

Perichondritis

45
Q

Diagnostic features of Perichondritis

A
  1. Red
  2. Warm
  3. Tender
46
Q

Lesion that involves the external canal and adjacent portions of the meatus and concha
Characterized by redness, itching, swelling and stage of water exudation followed by crusting

A

Eczematous dermatitis

47
Q

Management of eczematous dermatitis

A

Wet dressing using a solution (Burow’s) for 24-48 hours + fluorinated steroid ointment and solution

48
Q

Severe infection involving the temporal bone and soft tissue of the ear

A

Necrotizing external otitis

49
Q

Necrotizing external otitis is caused by…

A

Paeudomonas aeroginosa

50
Q

Necrotizing external otitis is generally found in…

A

Elderly diabetics

51
Q

Necrotizing external otitis is considered more common in…

A

Warm climates

52
Q

Should evaluated carefully for other symptoms indicating necrotizing external otitis

A

Patients with recalcitrant external otitis of more than 2 weeks duration

53
Q

Favored mode of treatment of Necrotizing external otitis

A

Extended mastoidectomy

54
Q

First line of therapy in Necrotizing external otitis

A

Systemic antibiotic intervention

55
Q

Surgery of Necrotizing external otitis be limited to the..

A
  1. Removal of sequestra
  2. Drainage of abscesses
  3. Local debridement of granulation tissue
56
Q

Recommended drug therapy in Necrotizing external otitis

A

Aminoglycoside + anti-Pseudomonas beta-lactam antibiotic

Prolonged therapy of at least 6 weeks is recommended

57
Q

Disease of unknown etiology leads to inflammation and destruction of cartilage
Generalized disorder of cartilage, involvement of the nose and ears (80-90%)

A

Relapsing polychondritis

58
Q

Relapsing polychondritis may also involved

A

Larynx
Trachea
Bronchi

May present as hoarseness even death due to collapse of laryngotracheal and bronchial walls

59
Q

Most common cause of lacerations

A

Digging in an ear with a finger or using an instrument

60
Q

Management of ear lacerations

A

Keep the ear dry

61
Q

Management of frostbite

A

Rapid rewarming in water between 100 and 108F

62
Q

Injury due to frostbite is due to…

A
  1. Direct cellular damage
  2. Microvascular insult
    Leading to local ischemia
63
Q

Untreated hematoma of the ear may result in the so-called…

A

Cauliflower ear

64
Q

Management of ear hematoma

A

I and D of collected blood under sterile conditions followed by the application of a pressure dressing

65
Q

Most common auricular deformity

A

Lop-ear deformity

66
Q

Types of 1st branchial cleft abnormalities

A

Type I: ectodermal tissue only, free of cartilage, 1st cleft origin only
Type II: epithelium of 1st cleft origin and cartilage from 1stand 2nd arches

67
Q

Benign tumor of the external canal wall which presents as a single, firm, rounded growth attached by a small bony pedicle to the inner third of the canal wall

68
Q

More common and which consists of a rounded protuberance of hypertrophic canal bone (multiple and bilateral)

69
Q

Management of osteoma

A

Chiseled from the canal wall with the aid of the operating microscope

70
Q

Most common malignancy of the EAC

A

Squamous cell carcinoma

71
Q

Nodules involving the helix may represent localized areas of chondritis

A

Chondrodermatitis nodularis chronicis helicis (painful nodule)

Boies (27 decks)

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