External EAR! Flashcards
How do you use the otoscope for adults and kids
Gentle traction on pinna
- Up for adults
- Back for kids
A pt presents a non healing lump of the outer ear
What is the 1st DDX
Basal Cell Carcinoma
In treating a non healing lump on the outer ear
What is the Tx approach
This is high index of suspicion for Basal Cell Carcinoma
Refer to ENT
Non surgical options include:
Topical 5-Flourouracil or Radiation
Surgical options: Local Excision
Or MOHS surgery (99% cure rate)
What surgery has a 99% cure rate for Basal Cell Carcinoma
MOHS surgery
A pt presents with a non healing ULCER/PLAQUE on the outer ear
What is High on the DDx
Squamous cell Carcinoma
What is the treatment approach to Advanced cases of Squamous cell carcinoma on the outer ear
Neck dissection and parotidecotmy
Squamous cell has a high metz rate
A pt presents with a PIGMNENTED lesion on the outer ear
What is high on the DDx
Malignant Melanoma
What is the prognosis of thick vs thin melanoma
Thin (epidermis) <10% risk of mets
Thick (dermis) >90% risk of mets
A pt presents with a swollen, fluctuant and red ear
With loss of land marks of the external ear
Post trauma
Think
Auricular Hemotoma
A pt with a auricular hematoma presents
What is the tx approach
I&D
Then a pressure dressing
ABX for prophylaxis
-Dicloxacillin or Cephalexin
(Cover staph)
STAT referal is more than 7 days old
If a pt presents with an auricular hematoma and they were in the water or have diabetes
What is the ABX of choice
CIPRO!
If a pt has a auricular hematoma older than 7 days
What should you do
STAT REFERAL!
When doing an I&D on an áuricular hematoma
What is the technique
Incise parallel to the skin folds
What is the onset of cauliflower ear
Auricular hematoma not treated within 48-72 hours
What is the difference of an easy vs extensive ear laceration
Simple- skin only
Extensive- Involves cartilage
What should you do before evaluation an ear laceration
Infiltrate with anesthetic
What are the S/s of a basi
Retroauricular hematoma (Battle sign)
Ecchymosis around eyes (Raccoon eyes)
CSF in ears or nosE
When should you do primary vs secondary closure for an ear laceration
Primary if less than 24 hours old
Sec. If older.
How do you prevent a hematoma in an ear laceration
Covers repairs with a pressure dressing
What ABX can penetrate the cartilage in an ear laceration
CIPRO!
How can you tell the difference with Cellulitus and perichondritis
Inflammation of the lobe means Cellulitus every time
Common causes of -itis to the ear
Piercings (esp. the cartilage)
Sports
Post surgery
What is the agent in 95% of ear -itis cases
Pseudomonas
What is the tx approach to -itis of the external ear
Mild- Treat and refer to ENT
— PO fluoroquinolone- F/U in 24 hrs max
Moderate/severe- Admit
- IV antibiotics- fluoroquinolone +/- aminoglycoside
- Potential surgical debridement
What are the S/s of a cerumen impaction
Usually none
Can present with decreased hearing
A feeling of fullness in the ear
+/- pain and itching
Can you clean out the ear with irrigation if the TM is rupured?
NO!
What is the Tx approach to a cerum impaction
Mechanical removal of cerumen
+/- suction
Irrigation only if TM is intact
When should you refer a pt with cerum impaction
Recurrent
Refractory to routine treatment
TM Perforation
Chronic Otitis Media
Child who is noncompliant
When are forieghn bodies to the ear very concerning
Middle or inner ear involvement
S/s dizzyness, or Senory HL
If a pt has a forieghn body obstruction with an organic material what should you NOT do!
DO NOT use aqueous irrigation
Organic objects can swell
What are the common agents of external otitis
Water exposure
- pseudomonas
- fungus
If a pt presents with Otitis Externa without infection
What is the Tx
Irritation from water in ear w/o infection
-Drying agent- 50/50 isopropyl alcohol and vinegar
What is the tx for otitis extrema with an infection
Infection present- topical ABX
-Neomycin/Polymixin B/Hydrocortisone
—DO NOT use if concerns for TM perf
Ciprofloxacin or Ofloxacin
In pts with refractory Externa otitis or Cellulitis
What is the ABX
Oral fluoroquinolones- ciprofloxacin 500 mg twice a day for 1 week
What are the S.s of malignant external otitis
Persistent, foul aural discharge
Deep otalgia
Temporal headaches
Late sign- CN palsies
How does malignant otitis externa develop
Pseudomonas penetrates the temporal bone
2/2 DM, AIDS or immunocomp pts
A pt presents with foul D/c, granulations in the external ear canal and CN palsies
Think
Necrotizing Otitis Externa
What is the gold standard to eval Necrotzing Otitis externa
CT!
What is the tx for Malignant/ Necrotizing external otitis
ABX for month!
Fluoroquinolones (CIPRO!)
IV!
Treat until gallium scanning shows resolution
A pt with refractory malignant external otitis should get what tx
Hyperbaric Oxygen
What is the common cause and treatment of pruritus for the ear
MC from over cleaning
TX: Allow cerumen to regenerate Avoid: -Soap and water -Cotton tipped applicator (CTA) -Scratching
Excessively dry skin- Mineral oil
Inflammation- Topical steroid (0.1% triamcinolone)
What is an exostoses/ oseomas
Bony overgrowth of the EAC
Bening and As/s
Can be from repeated cold water exposure
Generally no treatment required
If S/s then SRGICAL removal may be necessary
What is the most common neoplasia of the External ear canal
Squamous cell carninoma
If you find a visible ulcerated lesion in the external ear canal
Think
Neoplasia
Very likely SCC
What is the tx approach to Neoplasias of the ear
REFER!
