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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
Causative agents of otitis externa
Bacterial: P. aeruginosa (esp for immunocompromised, DM), staph aureus Fungal: Aspergillus niger, Candida albicans
26
How to differentiate aspergillus vs candida otomycosis?
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
Risk factors of otitis externa
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
Treatment of otitis externa
- 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
Malignant otitis externa
Rapidly spreading infection by P. aeruginosa or S. aureus to temporal bone, middle ear and inner ear - Osteomyelitis of bony external ear
30
Risk factors of malignant/necrotising otitis external
DM, elderly, immunocompromised
31
Clinical features of malignant/necrotising otitis externa
- 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
Investigations for malignant/necrotising otitis externa
- 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
Management of malignancy/necrotising otitis externa
- 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
Bony exostoses
aka Surfer's ear - Bony protuberances, arise from periosteum of tympanic part of EAC
35
Pathophysio & clinical features of bony exostoses
- 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
In approach to otalgia, consider pain from
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
External ear canal defence mechanisms
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
Contact dermatitis
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
Ramsay hunt syndrome
- 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
Management of Ramsay hunt syndrome
Local ear care Valcyclovir High dose steroids Eye care
41
Complication of Ramsay hunt syndrome
Post herpetic neuralgia (tx: gabapentin) Facial paralysis persists
42
DDX for pinna hematoma (if no history of trauma)
Pseudocyst
43
What is the grading system for microtia
Marx or nagata
44
Mangement for pseudocyst
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
Complications of malignant otitis externa
Intracranial: sigmoid sinus thrombosis meningitis temporal lobe abscess CN9-12 palsy Intratemporal: facial palsy suppurative labyrinthitis Extratemporal: abscess
46
DDX for pinna perichondritis
Erysipelas Cellulitis Insect bite reaction Relapsing polychondritis
47
Etiologies of cauliflower ear
Trauma with pinna haematoma Abscess Surgery Relapsing polychondritis

m4 ENT (25 decks)

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