External EAR! Flashcards by Demetré Harris

How do you use the otoscope for adults and kids

Gentle traction on pinna

Up for adults
Back for kids

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A pt presents a non healing lump of the outer ear

What is the 1st DDX

Basal Cell Carcinoma

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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)

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What surgery has a 99% cure rate for Basal Cell Carcinoma

MOHS surgery

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A pt presents with a non healing ULCER/PLAQUE on the outer ear

What is High on the DDx

Squamous cell Carcinoma

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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

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A pt presents with a PIGMNENTED lesion on the outer ear

What is high on the DDx

Malignant Melanoma

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What is the prognosis of thick vs thin melanoma

Thin (epidermis) <10% risk of mets

Thick (dermis) >90% risk of mets

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A pt presents with a swollen, fluctuant and red ear
With loss of land marks of the external ear

Post trauma

Think

Auricular Hemotoma

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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

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If a pt presents with an auricular hematoma and they were in the water or have diabetes

What is the ABX of choice

CIPRO!

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If a pt has a auricular hematoma older than 7 days

What should you do

STAT REFERAL!

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When doing an I&D on an áuricular hematoma

What is the technique

Incise parallel to the skin folds

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What is the onset of cauliflower ear

Auricular hematoma not treated within 48-72 hours

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What is the difference of an easy vs extensive ear laceration

Simple- skin only

Extensive- Involves cartilage

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What should you do before evaluation an ear laceration

Infiltrate with anesthetic

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What are the S/s of a basi

Retroauricular hematoma (Battle sign)

Ecchymosis around eyes (Raccoon eyes)

CSF in ears or nosE

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When should you do primary vs secondary closure for an ear laceration

Primary if less than 24 hours old

Sec. If older.

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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!