External Ear Disease Flashcards
Overview of Pinna haematoma
-Perichondrium stripped off cartilage
-Cartilage revascularized
-Risks of necrosis/ infection»_space; Deformity (cauliflower ear)
=Needs aspiration/ drainage (incision and drainage superior to needle aspiration)
=Same day ENT assessment
Describe microtia due to embryological defect
-Develop from 6 Hillocks of His
-Spectrum of malformation
=Normal to absence of EAM and Pinna
Describe the pre-auricular sinus
-Pit at root of helix
-Can get infected
-Treat acute infection
-Surgical excision if recurrent infection
Describe pinna cellulitis
-Needs IV antibiotics
-Complication of other infection
-Perichondritis spares lobes
Describe skin neoplasis
-Sun exposed area
-Occult disease behind pinna
-Treat as per other skin lesions
Wax in the external auditory meatus treatment
-Soften with almond/ olive oil/ sodium bicarbonate 5%
-Syringe/ microsuction
-Rarely causes hearing loss
Causes, symptoms, and signs of otitis externa
-Infection (aureus, aeruginosa, fungal)
-Seborrheic dermatitis
-Contact dermatitis (allergic and irritant)
-Recent swimming
-Inflammation of skin
-Itch! and pain, bilateral
-Discharge
-Minimal hearing loss
-Post trauma (cotton buds)
-Red, swollen, eczematous canal
-Tympanic membrane erythema
Treatment of otitis externa
-Cleaning (syringe/ microsuction/ wick)
-Topical steroids/ antibiotics (no aminoglycosides in tympanic membrane)
-Swab C and S if not settling
-Aural hygiene
-if there is canal debris then consider removal
if the canal is extensively swollen then an ear wick is sometimes inserted
-consider contact dermatitis secondary to neomycin
oral antibiotics (flucloxacillin) if the infection is spreading
taking a swab inside the ear canal
empirical use of an antifungal agental ENT if not responding to abx
Describe malignant OE
-Diabetic patient with excessive pain/ immunocompromised
-Not neoplasia but osteomyelitis of temporal bone
-Pseudomonas infection can destroy cranial nerves
=Extension of infection into bony ear canal and soft tissues deep to bony canal
=Unremitting disproportionate ear pain, temporal headache, purulent otorrhoea, fever, malaise, potentially dysphagia, hoarseness, facial nerve dysfunction
=Vertigo
=Profound conductive hearing loss
=Systemically unwell, high fever
=Granulation tissue seen on floor of ear canal and at bone-cartilage junction/ exposed bone in canal
=Ipsilateral facial nerve palsy
-CT scan
-non-resolving otitis externa with worsening pain should be referred urgently to ENT
Intravenous antibiotics that cover pseudomonal infections
Describe Exostois/ exosclerosis
-Bony growth (benign)
-Triggered by cold water
-Excise if obstructive (traps water)
Describe Furuncluosis
-Lateral 1/3 EAM hairy
-Follicle infection/ abscess
-S. Aureus commonly
-Ab’s +/- I and D if needed
Describe Tympanosclerosis
-Calcification of fibrous layer (bleeding into middle fibrous layer of tympanic membrane)
-Previous ear disease
-Not clinically relevant
Describe granular myringitis
-Granulation on surface of TM
-Causes discharge
-Slow to settle
-MS and topical treatment
Symptoms and signs of chronic otitis externa
-Constant itch in ear
-Mild discomfort or pain
-Lack of ear wax in ear canal
-Dry scaly skin in canal/ red moist skin
-Fluffy, cotton-like debris if fungal
-Conductive hearing loss
Overview of mastoiditis
Mastoiditis typically develops when an infection spreads from the middle to the mastoid air spaces of the temporal bone.
Features
otalgia: severe, classically behind the ear
there may be a history of recurrent otitis media
fever
the patient is typically very unwell
swelling, erythema and tenderness over the mastoid process
the external ear may protrude forwards
ear discharge may be present if the eardrum has perforated
The diagnosis is typically clinical although a CT may be ordered complications are suspected.
Management
IV antibiotics
Complications
facial nerve palsy
hearing loss
meningitis
