External Ear Disorders Flashcards
What is the most common malignant tumor of the skin?
Basal Cell Carcinoma
Sun exposure/exposed sites
Presents as a painless ulcer/nodule
Rolled, pearly border
Basal Cell Carcinoma
What is the most common neoplasm of the ear canal?
Squamous Cell Carcinoma
Presents as a hard, non-tender, red, indurated papule, nodule, or
plaque
Prolonged UV light exposure/exposed sites
Often arises from actinic keratosis
Incidence increases with age
Squamous Cell Carcinoma
In cases of squamous cell carcinoma, the cure rate is what percentage with lesions of the auricle?
90%
Usually asymptomatic
Common around the ear
Well defined, non-tender, soft, mobile
Cystic mass that is slow growing
Spontaneous drainage is not uncommon
Epidermal Inclusion Cyst
Inflammation of auricular cartilage
Tender, red, tense auricle
Spares the lobe
Secondary to cellulitis, frostbite, trauma
+/- discharge or crusting
Perichondritis
What are some complications of perichondritis?
Relapsing polychondritis
Cartilage destruction
deformity
What are some differential diagnoses to consider when evaluating for a possible epidermal inclusion cyst of the ear?
Furuncle
Lipoma
Pyogenic granuloma
Painful swelling following blunt trauma
Common in boxers and wrestlers
Present as a tender, tense, fluctuant collection of
blood - The overlying skin can be erythematous or ecchymotic
Auricular Hematoma
What is the treatment for an auricular hematoma?
I&D ASAP after injury
Splint
Prophylactic antibiotics
Prevent reaccumulation of blood
What are some complications of an auricular hematoma?
Infection
Recurrence of hematoma
Cauliflower ear (Due to fibrocartilage overgrowth)
Septic or aseptic necrosis
In the cases of an auricular hematoma, what is the time frame to treat to avoid a cauliflower deformity?
48-72 hours
What is the function of cerumen?
Cerumen cleans, protects, and lubricates the EAC
Ear wax produced in what part of the EAC? distal 1/3
distal 1/3
What must you rule out before performing otomicroscopic debridement?
MUST rule out perforation first!!
What are some differential diagnoses to consider when evaluating for cerumen impaction?
Foreign body
Tumor
Furuncle
Blood clot from TM perforation
What are some causes of a cerumen impaction?
cerumen over-production
tortuous canal
Q-tip cleaning
In an external ear canal foreign body, what are some common presenting symptoms?
pain, discharge, aural fullness, hearing loss, itching, tinnitus
AKA Swimmers Ear
Infection of the EAC caused by a bacterial, viral, or fungal etiology
Seen most often in the summer months secondary to retained moisture in EAC
Otitis Externa
In otitis externa, what are some common presenting symptoms?
Otalgia out of proportion to PE findings
Pain with traction to tragus or helix
Pruritis
Purulent or watery discharge
Erythematous/edematous EAC
+/- conductive loss
Rarely fever
What are the two most common organisms in otitis externa?
Staph and Pseudomonas
In a case of otitis externa, if you see a discharge colored green, you should suspect which organism?
Pseudomonas
In a case of otitis externa, if you see a discharge colored yellow, you should suspect which organism?
S. Aureus
In a case of otitis externa, if you see a discharge that is “cheesy”, you should suspect which organism?
Candida
In a case of otitis externa, if you see a discharge that is “fluffy”, you should suspect which organism?
Aspergillus
What are some complications of otitis externa?
Myringitis
Conductive hearing loss
Cellulitis
Osteomyelitis of skull base
What is the drug of choice for otitis externa?
Ciprodex
Persistent foul otorrhea, canal granulation, deep otalgia and
progressive palsies (VI, VII, IX, X, XI, or XII)
Begins in the floor of ear canal, may extend into middle fossa floor,
clivus and contralateral skull base
Typical agent: P. aeruginosa
Diabetic and the immunocompromised
Malignant Otitis Media
What location does malignant otitis media occur?
Occurs in the cartilaginous-boney junction
What is the most common organism in malignant otitis media?
P. aeruginosa
List some possible pathogens responsible for viral otitis externa
varicella
measles
herpes virus
Otologic complication of varicella zoster virus reactivation
Clinical presentation typically includes ipsilateral facial paralysis, ear pain, and vesicles in the auditory canal and auricle
Herpes zoster oticus (Ramsay Hunt syndrome)
What is another name for Ramsay Hunt syndrome?
Herpes zoster oticus
What is the most common external ear canal neoplasia?
Squamous Cell Carcinoma
Congenital anomaly (Narrow or closed EAC)
Often malformation of pinna and middle ear structures as well
Atresia
Present as fistulas, cysts, and sinuses
Prone to infection
First Branchial Cleft Anomalies
