ENT - The ear

Question 1

A 17yo boy presents to ED. He was punched in the right ear during a rugby match. O/E the pinna of the right ear is swollen, boggy + bruised.

What is the diagnosis and how should he be managed?

Answer 1

Pinna haematoma: risk of cartilage avascular necrosis due to separation from perichondrium

Urgent drainage + pressure dressing to prevent re-accumulation.

Question 2

A 26yo woman presents with ear pain + white-yellow purulent smelly ear discharge. O/E the tragus is tender and the EAM is red + swollen.

What is the likely diagnosis and how would you manage?

Answer 2

Otitis media externa

1. advise to avoid water
2. analgesia e.g. paracetamol
3. ACETIC ACID 2% spray TDS for 7/7 or CIPROFLOXACIN/DEXAMETHASONE drops BD for 7-10/7

Question 3

A 72yo man presents with severe R ear pain, hearing loss + vertigo. O/E: temp 39, granulation tissue in EAM + facial n. palsy. He has a PMH of DM.

What is the likely Dx, how would you Ix and Mx?

Answer 3

Malignant otitis externa

Ix
- urgent CT

Mx

1. urgent ENT referral + admission
2. CIPROFLOXACIN/DEX ear drops
3. TAZOCIN IV then r/v when micro results available, continue IV ABx for 4-6/52
4. surgical debridement of granulation tissue