External Ear Flashcards
What congenital diseases can occur in the external ear?
- Anotia/microtia
- Macrotia
- Meatal atresia/stenosis
- Bat ears
What are infective/inflammatory causes of external ear disease?
- Otitis externa
- Furuncle
- Perichondritis
- Keratosis obturans
What are traumatic causes of diseases of the external ear?
- Blunt - haematoma auris
- Sharp
- Chemical/thermal
- UV
- Foreign Bodies
What is first line treatment for treating problematic ear wax?
Wax softening agents
- Use olive oil
- Water
What would you do to manage problematic ear wax if wax softeners didn’t work?
- Syringe the ears
- Referral to ENT - microsuction
When would you avoid syringing someone ear to get rid of wax?
- Tympanic membrane perforation
- Grommet in situ
- Previous ear surgery
- Otitis externa
What is otitis externa?
Common, generalised inflammation of the kin of the external auditory meatus. It can occur as an acute episode or as a chronic problem
What are causes of otitis externa?
- Skin conditions - eczema, psoriasis
- Skin infections - impetigo
- Neurodermatitis
- Trauma - cotton bud
- Local infection
- Middle ear discharge
What are symptoms of otitis externa?
- Itch
- Pain
What are signs of otitis externa?
- Tender pinna/tragus
- Tender nodes - behind ear
- Swollen EAM - obscures tympanic membrane
- Debris in EAM
- Meatal stenosis
- Watery discharge
What is the chief bacterial organism implicated in Otitis externa?
Pseudomonas aeruginosa
What are potential sequelae of otitis externa?
- Hearing loss
- Canal stenosis
What investigations might you do in someone with otitis externa?
Ear swab
How would you manage otitis externa?
- Aural toilet
- Local medication - Abx/steroids
- Systemic Abx - for gross cellulitis
What is an aural toilet?
All possible debris is removed from the EAM, either with suctioning and the aid of a microscope, or with dry mopping
What must you do once inflammation of the EAM caused by otitis media settles?
Tympanic membrane must be inspected - exclude middle ear infection
What is necrotizing otitis externa?
More aggressive form of otitis externa, ususally seen in the elderly and those with diabetes. It can lead to temporal bone destruction and base of skull osteomyelitis. This is a potentially lethal disease
Who are msot at risk of developing necrotising otitis externa?
Diabetics
What is the following?
Haematoma auris - cauliflower ear caused by tracking of blood between the perichondrium and the cartilage follwoing blunt force trauma
How would you treat a cauliflower ear?
- Aspiration/incision with drainage
- Pressure following drainage
- Antibiiotic cover
What type of disccharge can be produced in otitis externa?
Watery discharge - no mucinous glands in EAM
What is the comonest cause of conductive hearing loss?
Ear wax
