EXTERNAL EAR

Question 1

• Inflammation of the perichondrium
• Etiology:
  *Ear Piercing
  *Trauma
  *Surgery
• Causative Organisms:
  1. Pseudomonas
  2.Staphylococcus
• Treatment
• Anti-Biotics
• I & D for Abscess formation

Answer 1

PERICHONDRITIS

Question 2

Blood supply of EXTERNAL EAR

Answer 2

• Anterior auricular artery
• Posterior auricular artery

Question 3

• Seen as a small pit along the anterior margin of ascending limb of helix
• The tract usually blends with the perichondrium of auricle
• Sinus tract is Usually superior and lateral to facial nerve and parotid gland
• Subcutaneous cyst formation in the area Is common

Answer 3

Preauricular sinus

Question 4

Preauricular sinus theories

Answer 4

• Embryological fusion: Incomplete fusion of Hillocks
• Ectodermal infolding: Isolated ectodermal infolding
• Incomplete closure of dorsal part of first pharyngeal
  groove: (accepted)

Question 5

• Begins during the 6th week of gestation
• Begins from 6 hillocks (Hillocks of His)

Answer 5

Pinna

Question 6

• Product of the sebaceous and ceruminous glands of the external ear
• Types: wet or dry

Answer 6

CERUMEN

Question 7

Functions of CERUMEN

Answer 7

1. lubrication
2. prevents aryness
3. antibacterial
4. protection

Question 8

Symptoms of CERUMEN

Answer 8

1. ear fullness
2. ear pain or otalgia
3. hearing loss

Question 9

OTITIS EXTERNA Predisposing factors:

Answer 9

1 change in pH of canal skin
2. environmental changes
3. mild trauma

Question 10

OTITIS EXTERNA Types:

Answer 10

1. acute circumscribed ofitis externa/ furunculosis
2. diffuse otitis externa
3. malignant otitis externa

Question 11

• Furunculosis
• Cause: infection of sebaceous follicle of EAC usually
  by Staph. aureus
• Signs/ symptoms:
  + pain
  + tenderness on manipulation
  + decreased hearing
  + purulent ear discharge
  + circumscribed swelling

Answer 11

ACUTE CIRCUMSCRIBED OTITIS EXTERNA

Question 12

Otitis media

• Pain:
• Tenderness on manipulation
• fever
• Hx of URTI
• Hx of ear manipulation
• Hearing
• Mastoid x-ray

Answer 12

• Pain: not as severe
• Tenderness on manipulation: (-)
• fever: usually (+)
• Hx of URTI: (+)
• Hx of ear manipulation: (-)
• Hearing: impaired
• Mastoid x-ray: mastoiditis

Question 13

Otitis externa

• Pain:
• Tenderness on manipulation
• fever
• Hx of URTI
• Hx of ear manipulation
• Hearing
• Mastoid x-ray

Answer 13

• Pain: very severe
• Tenderness on manipulation: present
• fever: usually absent
• Hx of URTI: (-)
• Hx of ear manipulation: (+)
• Hearing: not impaired
• Mastoid x-ray: normal

Question 14

• “swimmer’s ear’
• Secondary to acute or Chronic otitis media
• Ear manipulation
• Eflologic agents:
• Pseudomonas other gram-negative organisms

Answer 14

DIFFUSE OTITIS EXTERNA

Question 15

Signs/ symptoms of DIFFUSE OTITIS EXTERNA

Answer 15

1. pain
2. tenderness on manipulation
3. scanty ear discharge
4. diffuse swelling of whole ear canal *
5. decreased hearing — occasionally

Question 16

• An acute Pseudomonas infection of the skin of the external ear canal, which spread to the adjacent bone.
  (Deep seated pain for more than a month).
• Life-threatening; osteomyelitis of temporal bone
• can spread via fissures of Santorini or tympanomastoid fissure
• Triad: 1- ear discharge “Several weeks of purulent oforrhea with granulations”, 2- headache (esp at night), 3- Immunocompromised pt.

Answer 16

MALIGNANT OTITIS EXTERNA/Acute Necrotizing OE, Skull Base Osteomyelitis

Question 17

1. pain on manipulation
2. TMJ pain
3. deep tenderness on palpation beneath the ear
4. otoscopy: intact TM; bone & cartilage destruction; granulation tissues
5. cranial nerve problem especially VII —ominous sign
6. intracranial complications

Answer 17

MALIGNANT OTITIS EXTERNA

Question 18

Treatment of MALIGNANT OTITIS EXTERNA

Answer 18

1. local debridement
   2.IV gentamycin and carbenicillin
2. pesistence or extension of infection > local excision

Question 19

causes
1. ear cleaning with contaminated implements
2. diabetics
3. immunocompromised patients
4.normal flora affected
- Etiologic agents:
- Aspergillus
- Candida

Answer 19

Ostomycosis

Question 20

1. itchiness
2. diffuse swelling of EAC
3. mycelia or soorangia
4. discharge
5. decreased hearing — occasionally

Answer 20

Ostomycosis

Question 21

• etiologies:
  1. secondary to probing
  2. too forceful syringing of ear
  3. forceful change of oressure in the EAC
• Signs/ symptoms
  + sudden pain and bleeding

Answer 21

Traumatic rupture of TM

Question 22

Traumatic rupture of TM treatment:

Answer 22

1. most heals soontaneously
2. cauterize edges
3. cigarette paper as scaffold
4. myringoplasty

Question 23

Bony, fibrocartilagenous channel through which air passes between the pharynx and the tympanic cavity thus equalizing air pressure on the two surfaces of the air Crum.

Answer 23

Eustacnian Tube

Question 24

EUstacnian Tube supports

Answer 24

• outer 1/3 - Bony part
• inner 2/3 - Cartilagenous part
  > usually closed but opens during swallowing

Question 25

- near tympanic cavity > simple cuboidal to simple columnar ciliated - near pharynx > ciliated pseudostratified columnar > NUMeErous lymph nodes

Answer 25

Mucous membrane of Eustacnian Tube

Question 26

- Inflammatory condition involves the lateral surface of the TM and the medial portion of the canal wall. - lt typically occurs in association with upper respiratory infections - Clinical manifestations: > Severe otalgia; > Serosanguinous otorrhea; > hearing loss - Treatment includes analgesics, topical antibiotic/steroid drops to prevent bacterial superinfection.

Answer 26

Bullous Myringitis

Question 27

- An abnormal, OB noncancerous skin growth that can develop in the middle section of your ear, behind the eardrum. - May be a birth defect, but it's most commonly caused — by repeated middle ear infections. - Often develops as a cyst, or sac, that sheds layers of old skin.

Answer 27

Chronic Otitis Media With Cholesteatoma