Diseases Of External Auditory Canal

Question 1

How to differentiate inner ear conditions from external/middle ear?

Answer 1

Conditions of inner ear will never present with pain or discharge as there is no sensory nerves for pain sensation

Question 2

What is the causative organism of furuncle?

Answer 2

Staphylococcus aureus

Question 3

What is the C/F of furuncle?

Answer 3

• pain with or w/o discharge (purulent)
• pain in ear on jaw movement

Question 4

Examination of furuncle

Answer 4

• localized swelling in cartilaginous part
• tragal sign = +ve EAC movement

Question 5

What is tragal sign and its significance?

Answer 5

Press tragus -> increase pressure in EAC -> increase pain -> indicates +ve EAC involvement

• to differentiate btwn referred pain and pain due to EAC pathology

Question 6

What is the management for a furuncle?

Answer 6

• antibiotics + incision & drainage
• 10% icthmol glycerine pack = to relieve pain

Question 7

What is the pathogenesis for swimmer’s ear/tropical ear/diffuse OE?

Answer 7

Itching -> abrasion -> infection

Question 8

What is the causative organism for swimmer’s ear/tropical ear/diffuse OE?

Answer 8

Pseudomonas

Question 9

What is the C/F of swimmer’s ear/tropical ear/diffuse OE?

Answer 9

• pain with or w/o discharge (purulent)
• pain in ear on jaw movement

Question 10

What is the examination findings in swimmer’s ear/tropical ear/diffuse OE?

Answer 10

• diffuse edema of EAC
• tragal sign +ve

Question 11

What is the management for swimmer’s ear/tropical ear/diffuse OE?

Answer 11

Aural toileting -> ciprofloxacin (local + systemic)

Question 12

What is the pathogenesis of malignant OE/skull base osteomyelitis?

Answer 12

Immunocompromised individuals
Spreads to base of skull via fissures of Santorini -> skull base osteomyelitis (mimics malignancy)

Question 13

What is the m/c causative organism in malignant OE/skull base osteomyelitis?

Answer 13

Pseudomonas

Question 14

What is the C/F of malignant OE/skull base osteomyelitis?

Answer 14

Severe, excruciating pain with discharge

Question 15

What is the examination findings in malignant OE/skull base osteomyelitis?

Answer 15

Necrosis & granulations

Question 16

What is the investigations done for malignant OE/skull base osteomyelitis?

Answer 16

1. Tc99 bone scan = increased uptake
2. Biopsy = -ve for malignancy
3. Gallium/Indium scan = to pick up inflammatory activity

Question 17

What is the oral treatment for malignant OE/skull base osteomyelitis?

Answer 17

Ciprfloxacin for 6 weeks

Question 18

What are the parental antibiotics for malignant OE/skull base osteomyelitis?

Answer 18

• ceftazidime
• cefoperazone
• newer penicillin (piperacillin/ticarcillin)

Question 19

What is the complication seen in malignant OE/skull base osteomyelitis?

Answer 19

Spreads to base of skull -> involves CNS 7, 9, 10, 11

Question 20

What is the m/c causative organism in otomycosis?

Answer 20

1st = aspergillus niger
2nd = candida

Question 21

What is the clinical feature of otomycosis?

Answer 21

Pain with discharge

Question 22

What is the examination findings in aspergillus niger caused otomycosis?

Answer 22

Wet newspaper appearance

Question 23

What is the examination findings in candida caused otomycosis?

Answer 23

Cotton ball appearance

Question 24

What is the management of otomycosis?

Answer 24

Aural toileting -> local antifungal (ear drops)

Question 25

What is the causative organism for herpes zoster oticus?

Answer 25

Varicella zoster virus

Question 26

What is the C/F of herpes zoster oticus?

Answer 26

Pain

Question 27

What is the examination findings of herpes zoster oticus?

Answer 27

Vesicles

Question 28

What is the management for herpes zoster oticus?

Answer 28

Antiviral + short course of steroids

Question 29

What is the Ramsay hunt syndrome?

Answer 29

herpes zoster oticus + facial palsy

Question 30

What is the cause of Ramsay hunt syndrome?

Answer 30

Reactivation of herpes zoster in geniculate ganglion of facial nerve

Question 31

Wax is a secretion from

Answer 31

Ceruminous gland

Question 32

What is the C/F of impacted wax?

Answer 32

- blocked ears - pain +/-

Question 33

What is the management of impacted wax?

Answer 33

Aural syringing

Question 34

What is the direction of aural syringing?

Answer 34

Posterosuperior

Question 35

What are the complications of aural syringing?

Answer 35

- perforation - vertigo - infection

Question 36

How does aural syringing cause vertigo?

Answer 36

When hot/cold water is used, it stimulates the internal ear by convection currents leading to vertigo - advised to us body temp water

Question 37

What are the contraindications for aural syringing?

Answer 37

- Existing perforation - presence of battery (can cause necrosis/leakage)

Question 38

What is the pathogenesis of keratosis obturans?

Answer 38

1. Abnormal epithelial migration 2. Collection of desquamated epithelium in onion skin pattern 3. Impaction 4. Dilatation of EAC 5. Ulceration 6. Severe pain

Question 39

What is the C/F of keratosis obturans?

Answer 39

Blocked ear with severe pain

Question 40

What is the examination findings for keratosis obturans?

Answer 40

- wax seen covering mass - widened canal

Question 41

What are the association with keratosis obturans?

Answer 41

Sinusitis & Bronchiectasis - due to abnormal cilia

Question 42

What is the management of keratosis obturans?

Answer 42

Removal by instrumentation

Question 43

What is the complication of keratosis obturans?

Answer 43

7th CN palsy