Otology 3

Question 1

What is a cauliflower ear?

Answer 1

classically caused through a boxing or rugby injury or during other contact sports it results from bleeding which strips the vascularizing perichondrium from the underlying cartilage of the external ear
If not drained can become infected or the cartilage can become ischaemic this can result in perichondritis, necrosis and later atrophy, distortion of the pinna and a cosmetic deformity which is extremely difficult to reverse

Question 2

How is a perichondrial haematoma drained?

Answer 2

Under local anaesthetic
After an incision, a wick or corrugated drain should be inserted and pressure dressing applied to the ear as the haematoma has a tendency to reform
Prophylactic antibiotics should be given

Question 3

What is chondrodermatitis nodularis?

Answer 3

Inflammation of the skin and cartilage of the ear causing a nodule, common and harmless
Pressure on the skin of the ear- usually sleeping mainly on one side
Other factors include damage from cold and the sun
Poor blood supply to the ear
M>W, middle-old age

Question 4

What are the features of chondrodermatitis nodularis?

Answer 4

Pain is intense and short lived
Usually a single lump (5-10mm) typically on the outer side of the upper part of the rim of the ear, it may look red and its surface can be scaly or crusty, a small raw area or core is often seen in the centre when the crust is removed

Question 5

What is the management for chondrodermatitis nodularis?

Answer 5

Avoid direct and prolonged pressure on the lesion
o Self-adhesive ‘blister’ style dressings can be used at night to relieve the pressure over the affected
site
o Avoid too much exposure to the cold and the sun.
o A corticosteroid may be applied as a cream, or injected into the nodule to try and reduce pain and redness
o The lesion can be frozen off with liquid nitrogen
o Surgery: the chondrodermatitis may be removed by cutting it out, having first numbed the skin with a local anaesthetic injection, occasionally, it can come back after surgery and so it is important to avoid pressure on the ear afterwards

Question 6

What are the peripheral causes of vertigo?

Answer 6

o	Labyrinthitis
o	BPPV
o	Ménière’s disease
o	Endolymphatic hydrops from other causes
o	Middle-ear diseases
o	Post-ear surgery
o	Post-trauma
o	Vascular insufficiency
o	Drugs
o	Dead labyrinth from any cause

Question 7

What are the central causes of vertigo?

Answer 7

Vestibular neuritis 
o	Tumours, e.g. acoustic neuroma Multiple sclerosis
o	Head injury
o	Vascular occlusion
o	Drug-induced

Question 8

What are other causes of balance disturbance?

Answer 8

o	Cardiac insufficiency
o	Cervical spine disease
o	Neurological disorders
o	Metabolic disorders  e.g. diabetes
o	Anaemia
o	Epilepsy
o	Migraine