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m4 ENT > External Ear Conditions > Flashcards

External Ear Conditions Flashcards

1
Q

Perichondritis

A

Infection of perichondrial lining of cartilage of pinna

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2
Q

Common causative agents of perichondritis

A

Pseudomonas aeruginosa (commonest)
Staphylococcus aureus

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3
Q

Causes of perichondritis

A

Injury, insect bites, pierced ears, burns

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4
Q

What patient profile predisposes to perichondritis?

A

DM or immunocompromised patients

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5
Q

Clinical feature of perichondritis

A

Inflammation of perichondrium -> pain, warmth, erythema, non-fluctuant swelling limited to cartilaginous part of pinna
***LOBULE UNTOUCHED as no cartilage

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6
Q

Complications of perichondritis

A

Pus collects between cartilage and overlying infected perichondrium
-> subperichondrial abscess
-> separates cartilage from perichondrium
-> devascularise cartilage
-> ischemia and avascular necrosis
-> cauliflower ear + swollen cartilage

If infected -> pinna abscess

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7
Q

Management of perichondritis

A

Admit
Analgesia
Abx: Oral ciprofloxacin
More severe: IV ceftazidime
Subpericondrial abscess: Incision & Drainage

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8
Q

Pinna hematoma

A

Collection of blood between perichondrium and cartilage

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9
Q

Causes of pinna hematoma

A

Direct trauma to external ear

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10
Q

Clinical features of pinna hematoma

A

Fluctuant purple swelling of ventral part of pinna (usually superior area)

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11
Q

Complications of pinna hematoma

A

Blood clot between cartilage and overlying perichondrium
-> separates cartilage from perichondrium
-> devascularise cartilage
-> ischemia and avascular necrosis
-> cauliflower ear

If infected -> abscess

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12
Q

Management of pinna hematoma

A
  • Remove blood collection via incision & drainage, use firm dressing to keep perichondrium in contact with cartilage to prevent reaccumulation of blood
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13
Q

Keloid

A

Overgrowth of fibrous or scar tissue from trauma, excessive activity of fibroblasts after injury

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14
Q

Clinical features of keloid

A
  • Painless raised nodules over injury site (usually pierced ear hole)
  • Itchy, bleed, pigmented
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15
Q

Management of keloid

A

Excise with cold knife
Inject wound with steroids every few weeks for up to 6 months

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16
Q

Wax/cerumen

A

Wax is produced only in outer 1/2 of meatus
- ear has own self-cleaning mechanism as wax migrates out of ear together with desquamating cells of migrating canal skin

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17
Q

Wax in the EAC can lead to what type of hearing loss?

A

Conductive hearing loss

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18
Q

Management of wax/cerumen

A
  • Remove wax via syringing: use water at body temperature, direct flow along posterior canal wall
  • Manual removal if syringing unsuccessful or pre-existing TM perforation
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19
Q

Contraindication of syringing wax out

A

Tympanic membrane perforation

20
Q

Furunculosis

A

Infection of hair follicles by S. aureus in cartilaginous hair-bearing area (outer 1/3, inner 2/3 bony) of external auditory canal

21
Q

Clinical features of furunculosis

A

Otalgia, pain on tugging pinna and tragal compression

22
Q

Management of furunculosis

A

Drainage
Warm compress
Antistaphylococcal oral abx
Topical abx ointment

23
Q

Causes of otitis externa

A

Trauma from:
- chronic ear digging
- scratching
- swimming
- overuse of topical abx ear drops
- eczema
- frequent visits to hair salon

24
Q

Clinical feature of otitis externa

A

Otalgia
- severe
Otorrhoea
- green: p. aeruginosa
- creamy: fungal
Erythema
Pruritis
- deep-seated itching
Hearing loss (due to debris, edema)
Swollen EAC, filled with debris and discharge

NIL CN involvement
*hypae suggests otomycosis

25
Q

Causative agents of otitis externa

A

Bacterial: P. aeruginosa (esp for immunocompromised, DM), staph aureus
Fungal: Aspergillus niger, Candida albicans

26
Q

How to differentiate aspergillus vs candida otomycosis?

A

Otoscopy
- Aspergillus: Mushy white with black spots (Spores) - “Wet newspaper appearance”
- Candida: Soft, white, sebaceous-like material that fill the ear canal

*aspergillus is a more aggressive infection and can cause TM perforation

27
Q

Risk factors of otitis externa

A

Congenitally narrow canal
Bony exostosis
Skin conditions
- eczema
- seborrhoea
- psoriasis

Trauma from:
- ear plugs
- hearing aids
- chronic ear digging
- scratching
- swimming
- overuse of topical abx ear drops
- frequent visits to hair salon

Medical comorbidities
- Immunocompromised
- Previous RT

28
Q

Treatment of otitis externa

A
  • Aural toilet
  • Topical sodrafex
  • Canesten (Clotrimazole) ear drops TDS for 10 day
  • Only give PO Ciprofloxacin if facial swelling and cellulitis
  • Analgesia
  • Patient education: Don’t swim and avoid water entering EAC (can use some cotton wool mixed with hand lotion as ear plug) for bath during Tx, don’t dig ears!!!
29
Q

Malignant otitis externa

A

Rapidly spreading infection by P. aeruginosa or S. aureus to temporal bone, middle ear and inner ear
- Osteomyelitis of bony external ear

30
Q

Risk factors of malignant/necrotising otitis external

A

DM, elderly, immunocompromised

31
Q

Clinical features of malignant/necrotising otitis externa

A
  • Excessive otalgia out of proportion! to ear signs, interferes with sleep and function
  • Purulent otorrhea
  • Does not improve with abx or ear drops
  • Affects CN 7 first –> CN 8 –> CN 9, 10 as it spreads along skull base –> Ipsilateral CN signs/ facial palsy
  • Otoscopy: Granulation tissue at bony cartilaginous junction of EAC, intact ear drum

*can DIE if untreated

32
Q

Investigations for malignant/necrotising otitis externa

A
  • FBC ESR CRP RP LFT
  • Biopsy TRO SqCC
  • CT Temporal bone
  • MRI scan to determine extent of soft tissue involvement and differentiate b/w inflammation and tumour (NPC)
  • Bone scan (Gallium): Taken up by polymorphonuclear leukocytes so areas with active infection i.e. osteomyelitis will be hyperintense (Lights up)
33
Q

Management of malignancy/necrotising otitis externa

A
  • Admit
  • Analgesia
  • Intensive pharmacotherapy: IV ceftazidime or piptazobactam for at least 6 weeks
  • Control predisposing conditions e.g. DM
  • Aural toilet (microsuction)
  • Surgical debridement of necrotic tissue or bone
34
Q

Bony exostoses

A

aka Surfer’s ear
- Bony protuberances, arise from periosteum of tympanic part of EAC

35
Q

Pathophysio & clinical features of bony exostoses

A
  • Repeated exposure to cold water and wind (eg. wind surfers, swimmers)
  • Slowly occlude EAC, failure of wax extrusion and cerumen impaction, otitis externa due to retained skin and cerumen, conductive hearing loss
36
Q

In approach to otalgia, consider pain from

A

Primary otalgia (ear problem)
Secondary otalgia
- Pharyngeal
- Oral/Dental
- Neurological

TMJ
Neck and lymph nodes
- Occipital, preauricular
Parotid gland
Referred pain
- Pharynx (CN 9,10)
- Cervical plexus
- Bell’s palsy, IAM tumour (CN 7)
- Toothache/Myalgia (V3)

37
Q

External ear canal defence mechanisms

A
  1. Acidic pH 6-6.5
    - Wax is composed of glandular secretions and sloughy epithelium
  2. Migratory nature of keratin debris
    - From the drum centrifugally out
  3. Normal flora
    - Most commonly S aureus, S epidermidis
38
Q

Contact dermatitis

A

May affect auricle, or just conchal bowl
- Erythema, itching
- Seen in patient on prolonged topical abx
- Stop offending agent
- Start topical steroids and moisturiser

39
Q

Ramsay hunt syndrome

A
  • Varicella zoster infection
  • Prodrome of severe otalgia
  • Vesicular eruption
    +/- vertigo, hearing loss
    +/- present as Bell’s palsy initially and rash can occur before, during or after facial paralysis
40
Q

Management of Ramsay hunt syndrome

A

Local ear care
Valcyclovir
High dose steroids
Eye care

41
Q

Complication of Ramsay hunt syndrome

A

Post herpetic neuralgia (tx: gabapentin)
Facial paralysis persists

42
Q

DDX for pinna hematoma (if no history of trauma)

A

Pseudocyst

43
Q

What is the grading system for microtia

A

Marx or nagata

44
Q

Mangement for pseudocyst

A

Aspiration of contents (I&D)
- straw coloured fluid seen (instead of blood)
- problem of recurrence

Definitive tx: Excise one leaflet of cartilage to prevent recurrence

45
Q

Complications of malignant otitis externa

A

Intracranial:
sigmoid sinus thrombosis
meningitis
temporal lobe abscess
CN9-12 palsy

Intratemporal:
facial palsy
suppurative labyrinthitis

Extratemporal: abscess

46
Q

DDX for pinna perichondritis

A

Erysipelas
Cellulitis
Insect bite reaction
Relapsing polychondritis

47
Q

Etiologies of cauliflower ear

A

Trauma with pinna haematoma
Abscess
Surgery
Relapsing polychondritis

m4 ENT (25 decks)

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