Outer Ear Pathology Flashcards
how long is the avg adult ear
2.5 cm (1 inch) and .7 cm (.3 in) in diameter
what two branches of external carotid with an extensive network of anastomoses bw the branches are
superficial temporal artery & postauricular artery
waht makes reconstruction of an auricle difficult
intricate & delicate topography & blood supply
venous drainage of pinna ends in
external & internal jugular veins
sensory innervation of auricle is supplied by
lesser occipital nerve (cervical spinal nerves), auriculotemporal (trigeminal nerve) , & auricular branch (vagus nerve)
transmission of auricular deformities
ad or ar
Some auricular deformities may be an indication of
middle & inner ear abnormalities
why is it good practice to inspect outer ear during otoscopy
because some auricle deformities can be an indication of middle or inner ear issues
Children with auricular anomalies show a slightly increased risk of concurrent
renal abnormalities that can require medical/surgical intervention
what is microtia
underdevelopment of outer ear
range from complete agensis (absence of pinna) to small ears with atretic canals
peanut ear
twice as many ____ affacted as ____ in microtia
males, females
which ear is most often involved in microtia
right, rarely bilateral
what is anastomoses
connections
what is the auricle supplied by
arterial, venous, & nerve supply
stenosis
narrowing of ec
atresia
no opening of the ear canal
where is bilateral microtia frequently seen
treacher collins (first arch) syndrome
what is constricted ear
encircling helix is tight
what does constricted ear include
loop & cup ear
an inferior bending of the superior helix
loop ear
increase in the bowl size
cup ear
do people have the same ears?
no, every ear is different even between family members
what are auricular appendages
often a result of accessory auricular hillocks from which the auricle develops
usualy unilateral
can be skin or skin and cartilage (skin tag)
can present with HL
what are auricular sinuses/pits
Usually harmless, pit-like depression anterior to the auricle
May be a result of failed closure of part of the first branchial groove
can get blocked with debris or become infected
auricular trauma can result from
thermal injury
penetrating injury
blunt injury
why is auricle susceptibel to trauma
Because of its prominent and unprotected position
the ear has no protective reflex
Auricular trauma often requires
antibiotics and tetanus prophylaxis but may also require surgical reconstruction
Can occur as a result of blunt force trauma and contact sport
auricular hematoma
what is an auricular hematoma
Blood vessels in the perichondrium (membrane covering the cartilage of the outer ear) get separated from the underlying cartilage
Because the cartilage receives oxygen and nutrients from the perichondrium, the separation can result in devitalization of the avascular cartilage and subsequent fibrosis (scarring)
what happens if you leave the hematoma left untreated
new and asymmetric cartilage forms from the perichondrium resulting in a distorted/thickened external ear or cauliflower ear
who commonly gets auricular hematomas
wrestlers, boxers, & football players
chondrium
cartilage
per
over it
what can occur with swelling (edema) seen in hematomas
swelling - when the ear does this it can close off the ear canal and can induce a CHL
if you already have a hl now you have a mixed hl and you wont be able to wear a ha
how can they fix hematomas
drain it
what are penetrating injuries to pinna
Seen with knife wounds, human and animal bites, and motor vehicle accidents
Can result in complete or partial avulsion (separation) of the auricle
what should you do if the ear is completely off
it should be transported in a cold, sterile container for re-attachment
can you reattach a pinna
Re-attachment is possible and often successful if done relatively early, preferably within five hours of the injury
what can thermal injuries be due to
due to temperature changes, both hot and cold
frostbite
burn of pinna with secondary infection
what is the treatment for bites (humans and animals)
prophylactic tetanus & antibiotics
why do dr worry the most with burn victims and keep in sterile environments are infections? why are they such a big concern?
there is not a skin barrier anymore
largest barrier and very important for protection against infections
biggest issue to burn victims
secondary infections
higher % and severe the burn, the
higher the infection worry
what is perichondritis
inflammation of the cartilage covering the ear
biggest problem is due to piercings that were not done sterily
what are the categories of perichondritis
infectious (suppurative perichondritis)
noninfectious (relapsing perichondritis)
what can perichondritis be caused by
Injury, burns, insect bites, ear piercing, boils, etc.
what is perichondritis insidious onset
Initially presenting with a dull ache, warmth, and redness
If untreated, it can progress to cartilaginous necrosis and deformity (death of the cartilage)
what is insidious
it will happen slowly, may not notice it right away
dull ache, warmth, redness, etc.
Infections of the auricle can be
bacterial or viral
most severe and common viral infection of the auricle
herpes zoster oticus
The most common viral infection with accompanying VII N paralysis
herpes zoster oticus
what is herpes zoster oticus
shingles
ramsay hunt syndrome
what is shingles caused by
Caused by reactivation of latent varicella zoster (chicken pox) virus in geniculate, spiral, and vestibular ganglion, and VII nerve sheath
The 2nd most common cause of facial nerve palsy (3 to 20%)
herpes zoster oticus
earliest symptom of shingles
pain and painful rash in the ear canal, concha, or below/behind the auricle
can shingles affect the 8th nerve
yes, but not very common
more externally
what is allergic contact dermatitis
Caused by exposure to medicinal and cosmetic products (particularly jewelry containing nickel)
The auricle becomes red, inflamed, and there may be pain
he auricle is prone to allergies resulting most commonly in
contact dermatitis
treatment for shingles
antiviral drugs and steroids
sometimes med to calm the nerves
treatment for contact dermititis
topical antibiotics and steroids
what is seborrheic dermatitis
etiology unknown
believed to be due to infection by yeast like organism Malassezia furfur
result of seborrheic dermatitis
scaly superficial eczematous dermatitis (not contagious)
often causes otitis externa
seborrheic dermatitis
treatment for seborrheic dermatitis
Decrease yeast colonization and inflammation by antimycotic drugs, topical steroid cream, and drops
neoplasm menaing
new tissue
can be benign or malignant
Benign neoplasms include
cysts and keloids
what is a keloid
scar tissue
Benign outward overgrowth of scar tissue
what are cysts
fluid filled cavities anywhere in the body
what are sebaceous cysts
Fluid filled cysts that are generally seen following trauma such as ear piercing
can become secondarily infected
treatment for sebaceous cysts
antibiotics followed by surgical excision
Commonly seen following ear trauma, ear piercing, and viral infections like herpes varicella zoster
keloid
can spread to adjacent tissue
this is why they are considered in tumor categories
keloid
treatment for keloids
surgical excision
steroid injection
these are rare
malingnant neoplasms of the auricle
most common malingnant neoplasms of the auricle
represents ½ to 2/3 of all skin cancers involving the auricle
squamous cell carcinoma
most common skin cancer but its occurrence in the auricle is fairly uncommon
basal cell carcinoma
the 6th most common cancer in the U. S.
cutaneous malignant melanoma
represent 7 to 20% of all head/neck cutaneous melanomas
auricular melanomas
ancer of connective tissue
rhabdomyosarcoma
most common soft tissue childhood tumor
rhabdomyosarcoma
melanoma =
moles
can be cancer of the muscles
sarcomas
signs and symtpoms of rhabdomyosarcoma
otalgia (pain), otorrhea (drainage), bleeding and bone destruction
