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CMSD5260 Hearing Disorders > Disorders of the External Ear > Flashcards

Disorders of the External Ear Flashcards

1
Q

What does Congenital mean?

A

Present at birth

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2
Q

What does Acquired mean?

A

not present at birth

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3
Q

What is the relation between the branchial arches and the structures in embryology?

A

Each branchial arches develop into a specific structure (muscle, skeletal, nerve and artery). If there is a problem during development, it can cause congenital disorders like otosclerosis.

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4
Q

Which part of the outer ear develops at week 4-6-8 of gestation?

A

4: EAC
6: Hillocks of His distinct
8: Pinna structures identifiable

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5
Q

Which part of the outer ear develops at week 18-20-28 of gestation?

A

18: Auricle adult form
20: EAC plug disintegrates
28: EAC fully open

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6
Q

What are the sensory innervation of the External ear?

A

Sensory innervation: CN V, VII, IX, X, and great auricular nerve (C2, C3)

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7
Q

What are the arteries that supply blood to the OE? (2)

A

superficial temporal and posterior auricular arteries

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8
Q

What can we say about the OE and lymphatic system?

A

OE contains Lymphatic parotid and cervical nodes (immune system)
Infections and inflammatory conditions of the EAC (& ear) can present with enlarged lymph nodes

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9
Q

What is Darwin’s tubercule?

A

Unique congenital prominence that may be found on the posterior helix of the ear

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10
Q

What are prominent ears?

A

Ears that stick out more than 2 cm from the side of the head are considered to be prominent or protruding

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11
Q

What is Cryptotia?

A

Ear cartilage framework that is partially buried beneath the skin on the side of the head.

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12
Q

What is Cup/Lop ear?

A

Ear deformity where the rim of the ear can be folded forward slightly, giving the appearance of a cup, or more severely, with the entire outer ear appearing as a roll

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13
Q

What is Stahl Ear?

A

consists of an extra cartilage fold in the scapha portion of the ear.

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14
Q

What is Microtia?

A

Absent or underdeveloped external ear.

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15
Q

What are preauricular pits?

A

little dimple in front of the ear

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16
Q

What is a preauricular skin tag?

A

Bump of skin next to ear

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17
Q

What is auricular hematoma?

A

Mass of blood in the OE

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18
Q

What can Auricular hematoma cause?

A

Can have CHL

EAC swelling
Hemotympanum (blood in middle ear)
Ossicular injury/discontinuity

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19
Q

How do you treat auricular hematoma?

A

incision and drainage

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20
Q

What causes cauliflower ear?

A
  • Occurs secondary to hematoma
  • Auricular trauma - auricular hematoma - cauliflower ear (if hematoma left untreated)
  • Hematoma disrupts blood supply to auricular cartilage which leads to cartilage necrosis (death) and neocartilage formation
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21
Q

What is Cellulitis?

A

Cellulitis = inflammation/infection of skin

Pain (on touch)
Warmth
Erythema (redness)
Edema (swelling)
Pruritus (itching)
Weeping & crusting

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22
Q

What is Chondritis?

A

Chondritis = inflammation/infection of cartilage
(lobule is sparred)

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23
Q

What is perichondritis?

A

Inflammation of skin over the cartilage (perichondrium)

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24
Q

What can cause Cellulitis, Perichondritis, and Chondritis? (4)

A

Trauma (usually penetrating)
Piercings
Ear surgery (iatrogenic)
Underlying conditions (eg diabetes, immunosuppression)

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25
Q

How do we treat Cellulitis, Perichondritis, and Chondritis? (2)

A

Antibiotic treatment
Incision and drainage for abscess

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26
Q

Can Cellulitis, Perichondritis, and Chondritis cause hearing loss?

A

CHL possible but rare

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27
Q

What can cause weather-related injuries?

A

Frostbite
Sunburn

28
Q

What are the susceptible factors of weather-related injuries? (4)

A

Malnutrition
Dehydration
Prolonged exposure
Poor hygiene

29
Q

What can frostbite cause?

A

Superficial ->Deep
Erythema (light skin) or gray color (dark skin)
Tingling, stinging sensation
Numb, yellow, waxy/shiny, gray color
Feels cold, stiff, woody
Blisters
Black necrosis (tissue death)

30
Q

What can cause sunburn?

A

Winter -> Summer
Fair skin, light hair (red hair)
Exposed skin areas
Snow can reflect sunlight
UV light
Major risk factor for skin cancer

31
Q

What is 1st degree sunburn?

A

Superficial: red, tender, slightly swollen

32
Q

What is 2nd degree sunburn?

A

Superficial: very red, swollen

33
Q

What is 3rd degree sunburn?

A

Mid-level: severe blisters, peeling skin, nerve damage (no pain)

34
Q

What is 4th degree sunburn?

A

Deep: death of soft tissue, muscle, cartilage, bone

35
Q

How do you treat sunburn on ears?

A

1st degree burn-no referral needed (heals in 1 wk)
Other burns requires urgent treatment

36
Q

Do frostbite and sunburn cause hearing loss?

A

Very rare, it must swell or obstruct the canal to some degree

  • Ear canal swells
  • Secondary infection
  • Physical damage to pinna
  • Tympanic membrane involvement
37
Q

What are Dermatological Conditions?

A

Skin conditions that can affect the auricle and/or ear canal

38
Q

What Seborrheic Dermatitis?

A

Dermatological Conditions where there is an inflammatory skin

  • Eczema like condition
  • Scaly, flaky, itchy, and red skin
  • Affects sebaceous gland rich areas
  • May affect postauricular regions and EAC
39
Q

What is Actinic Keratosis?

A

Dermatological Conditions, Pre-malignant lesion caused by sun exposure

  • Thick, crusty patches of skin
  • Can progress to SCC
  • Early removal is recommended (surgery, laser, liquid nitrogen)
40
Q

What is Cutaneous Horn?

A

Dermatological Conditions, Conical projection above skin surface
Resembles a “horn”
Composed of compacted keratin
Base may be malignant
Requires surgical excision

41
Q

What is Staphylococcal Dermatitis?

A

Bacterial skin infection caused by staph aureus
Can be associated with hearing aid molds and poor hygiene

42
Q

What can cause skin cancer?

A

Sun exposure (UV light)
Skin type
Immunosuppression
Chronic inflammation
Genetic predisposition

43
Q

What is the most common human skin cancer?

A

Basal Cell Carcinoma
20% of all cancers in men
10-15% of all cancers in women

44
Q

85% of all BCC occur in _______ & _______

A

85% of all BCC occur in head & neck

44
Q

85% of all BCC occur in _______ & _______

A

85% of all BCC occur in head & neck

45
Q

What is squamous cell carcinoma?

A
  • More aggressive than BCC
  • Higher incidence of metastasis
  • Often a progression from sun-damaged areas (eg actinic keratosis
  • Erythematous, crusting, ulcerated lesion with friable base
46
Q

What is the most aggressive type of skin cancer?

A

Melanoma

  • 75% of deaths caused by skin cancers
  • Derived from melanocytes (produce melanin)
47
Q

What are the features of melanoma? (ABCDE)

A
  • Asymmetry
  • Borders (irregular)
  • Colour (variegated)
  • Diameter
  • Evolving over time
48
Q

What are features of the EAC?

A

Outer 40% is cartilaginous
Inner 60% is bony
Skin overlying bony canal
Skin, hair, and sebaceous glands overlying cartilaginous canal
Sebaceous glands produce wax for protection
Narrowest point at bony-cartilaginous junction (isthmus

49
Q

How do you remove excessive cerumen?

A
  • Small amount and not obscuring view-leave alone
  • Irrigation/flushing (TM must be intact)
  • Ear drops (oils, acetic acid, cerumenex; TM must be intact)
50
Q

What is Aural Atresia and stenosis?

A

Atresia-complete absence of EAC (no connection to middle ear)
Stenosis-narrowing of EAC
Congenital cause of CHL

51
Q

What is Otomycosis?

A
  • Fungal infection of the EAC
  • Fungal elements visible
  • Aspergillus fumigatus, Aspergillus niger, Candida albicans are most common forms
52
Q

What is Otitis Externa?

A

Inflammation/infection of the EAC
Bacteria induced
Most common condition that affect the EAC

Acute and chronic types

53
Q

What is Otitis Externa?

A

Inflammation/infection of the EAC
Bacteria induced
Most common condition that affect the EAC

Acute and chronic types

54
Q

What can cause Otitis Externa?

A
  • Ear canal skin is injured by trauma/humidity exposure
  • Normal protective wax layer is disrupted
  • Bacteria
55
Q

What is Acute otitis Externa?

A
  • Acute Infection of the EAC by Pseudomonas auriginosa (most commonly)
  • Causes
    Spontaneous/idiopathic
    Local trauma
    Frequent swimming
    Chronic OE
55
Q

What is Acute otitis Externa?

A
  • Acute Infection of the EAC by Pseudomonas auriginosa (most commonly)
  • Causes
    Spontaneous/idiopathic
    Local trauma
    Frequent swimming
    Chronic OE
56
Q

What can Otitis Externa cause? (3)

A

Otalgia (severe) with ear movement
Otorrhea
Pruritis
EAC swelling and collection of debris/discharge
CHL

57
Q

How can you treat Acute Otitis Externa?

A

Analgesics
Antibiotic/anti-inflammatory drops
Aural toilet (refer to ENT)
Counseling for prevention

58
Q

What is Necrotizing Externa Otitis?

A
  • Aka malignant external otitis
  • Infection of the temporal bone
    - Osteomyelitis
  • Mostly affects elderly with diabetes
    - Immunosuppressed
  • Often preceded by EAC trauma or OE
59
Q

What are features of Necrotizing Externa Otitis? (3)

A

Severe otalgia
Otorrhea
Graulation tissue
Cranial nerve weakness
- Facial palsy
Intracranial complications
May be lethal

60
Q

What foreign bodies are common with children in the External ear canal?

A

Toys and Bugs

61
Q

What is Exostosis?

A

Bony growths in the EAC (multiple)
Frequently bilateral
Arises near the annulus/TM
Associated with prolonged cold water exposure
May cause CHL

61
Q

What is Exostosis?

A

Bony growths in the EAC (multiple)
Location
Frequently bilateral
Arises near the annulus/TM
Radiographic appearance
Broad base
Solid
Associated with prolonged cold water exposure
May cause CHL

62
Q

What is Osteoma?

A

Bony growths in the EAC (solitary)
Unilateral
Lateral EAC
Radiographic appearance
Not solid
Pedunculated (on a stalk)
No association with cold water exposure
Typically no CHL

62
Q

What is Osteoma?

A

Bony growths in the EAC (solitary)
Location
Unilateral
Lateral EAC
Radiographic appearance
Not solid
Pedunculated (on a stalk)
No association with cold water exposure
Typically no CHL

CMSD5260 Hearing Disorders (12 decks)

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