Diseases of external ear

Question 1

Congenital auricular appendages and aural fistula location and aetiology

Answer 1

found anterior to the auricle

They are due to incomplete closure of the first branchial groove or an incomplete fusion of auricular hillocks

Question 2

The different types of apppendages

Answer 2

simple skin tags to complex structures containing cartilage

Question 3

Dangers of excision of aural fistulae

Answer 3

danger of damage to the facial nerve or parotid gland.

Question 4

Congenital atresia of the external auditory canal: definition

Answer 4

This is complete closure of the external auditory canal, which is caused by a failure of canalisation of the epithelial plug portion of the first branchial cleft

Question 5

The type of atresia in Congenital atresia of the external auditory canal

Answer 5

The atresia is bony in most cases, and less often membranous

Question 6

Clinical features of congenital atresia of the external auditory canal

Answer 6

malformation of the middle and/or inner ear

Ossicular malformations

atresia or aplasia of the external auditory canal may occur as an isolated malformation

conductive hearing loss

sensorineural hearing loss

Question 7

Diagnosis of Congenital atresia of the external auditory canal

Answer 7

At birth, when a malformed auricle or atretic canal is noticed in a newborn.

An audiological assessment is carried out to rule out hearing impairment in the infant.

Imaging of the temporal bone is necessary for accurate diagnosis and in decision making in therapy.

CT scanning

Question 8

(BAHA)

Answer 8

First line of treatment Congenital atresia of the external auditory canal

In patients with bilateral abnormalities

Question 9

Acute otitis externa

Answer 9

It is an infection of the hair follicles, most often caused by Staphylococcus aureus, which may progress to form an abscess or furuncle.

Question 10

Acute otitis externa Clinical features

Answer 10

Severe pain in the ear elicited by moving or putting pressure on the auricle is characteristic

Question 11

Treatemnt of Acute otitis externa

Answer 11

Topical antibiotics or local antiinflammatory drugs can be used. A localised abscess should be treated by incision and drainage and oral or local antibiotics.

Question 12

Acute otitis externa – diffuse

Answer 12

Otitis externa or “Swimmer’s ear” is a bacterial infection of the external ear canal, with an incidence of 4/1000 children and adults per year; 80% of cases occur in summer

Question 13

Acute otitis externa – diffuse

aetiology

Answer 13

It is caused by an abrogation of the protective lipid film of the external canal, which exposes the epithelium to water and other contaminants

Question 14

Predusposing factors to Acute otitis externa – diffuse

Answer 14

heat, humidity, frequent swimming, anatomic obstruction of the ear canal (stenosis, exostosis, impacted cerumen), hearing aids, ear plugs, foreign bodies, and middle ear discharge

Question 15

Most common;y isolated dorganisms in Acute otitis externa – diffuse

Answer 15

Pseudomonas aeruginosa,

Proteus mirabilis and

S. aureus

Question 16

Clinical featuress of Acute otitis externa – diffuse

Answer 16

pain, itching, aural fullness, decreased hearing, and otorrhoea.

A typical sign is pain elicited by tragal pressure or by pulling on the auricle.

The lumen of the external auditory canal is narrowed by oedema and debris from the thickened and irritated skin

Question 17

Treatment of Acute otitis externa – diffuse

Answer 17

e careful atraumatic cleaning of the external ear canal using a microscope,

drying of the ear canal,

frequent inspection,

and control of pain

Question 18

Necrotising (malignant) otitis externa

Answer 18

Malignant otitis externa is a very aggressive form of otitis externa, typically seen in elderly people and people with diabetes. It is a potentially lethal infection of the auditory canal, surrounding tissue and skull base.

Question 19

Most common pathogen in Necrotising (malignant) otitis externa

Answer 19

Pseudomonas aeruginosa.

Question 20

Necrotising (malignant) otitis externa clinical features

Answer 20

severe otalgia, granulation tissue in the meatus, and facial nerve paralysis.

Question 21

Treatment of Necrotising (malignant) otitis externa

Answer 21

hospitalisation, treatment of diabetes, use of high-dose intravenous antibiotics specific for Pseudomonas, and sometimes surgery

Question 22

Cellulitis of ear

Answer 22

Cellulitis of the auricle is a bacterial infection; it often follows an ear piercing or laceration.

Question 23

Clinical features of cellulitis

Answer 23

Symptoms are pain with a red and swollen auricle.

Question 24

Treatment of cellulitis

Answer 24

consists of oral or intravenous antibiotic and wound care

Question 25

Perichondritis def

Answer 25

Perichondritis or chondritis is an infection of the perichondrium or cartilage of the auricle

Question 26

Aetiology of Perichondritis an causative pathogen

Answer 26

It usually arises from improper treatment of cellulitis or otitis externa. The most common pathogen is Pseudomonas sp

Question 27

Clinical features of Perichondritis

Answer 27

The affected ear is oedematous,

and painful, with

serous or purulent exudates

Question 28

treatment of Perichondritis

Answer 28

aural cleaning, local and oral antibiotics (fluoroquinolones) and, in severe cases, hospitalisation and intravenous antibiotics

Question 29

Complictions of Haematoma of the auricle

Answer 29

disruption of a perichondrial blood vessel,

accumulation of blood in the subperichondrial space,

and separation of the perichondrium from the cartilage

Question 30

Treatment of Haematoma of the auricle

Answer 30

evacuation of the haematoma; the method of choice is adequate incision and drainage, followed by compression dressing and antibiotics

Question 31

Frost bite of auricle

Answer 31

severe and prolonged vasoconstriction of the capillary walls, resulting in damage to these walls

red, swollen and tender

Question 32

Treatment of auricle frostbite

Answer 32

antibiotics and analgesics should be used. Rewarming with sterile dressings is usually successful; debridement of gangrenous tissue may be required

Question 33

What leads to perichondritis if untreated

Answer 33

Burns

Question 34

Where is cerumen produced?

Answer 34

produced in the outer third of the cartilaginous portion of the ear canal.

Question 35

The primary components of cerumen are

Answer 35

desquamated layers of skin, with 60% of the cerumen consisting of keratin, 12–20% saturated and unsaturated long-chain fatty acids, alcohols, and squalene, and 6–9% cholesterol

Question 36

Functions of cerumen

Answer 36

Cerumen protects the skin, assists in lubrication, and also provides some protection from bacteria, fungi, insects and water

Question 37

Usuaul Foreign bodies in the external auditory canal

Answer 37

Food (nuts, beans), stones, little toys and other small objects, and cotton from cotton swabs in adults are common