The External Ear Flashcards
What is ear trauma commonly related to?
Sports injuries
Violence
How severe is ear trauma normally?
Normally uncomplicated and treatable under local anaesthetic
Why is the sensory supply to the pinna important?
Allow you to perform regional nerve blocks
How are most lacerations of the external ear managed?
Clean wound
Simple primary closure of skin with suture
How should a laceration with exposed cartilage be managed?
Cover any exposed cartilage with skin
What may be done if there is skin loss or a skin laceration can’t be closed by primary closure?
Plastic reconstructive surgery
What is the main risks with bites to the ear?
Infection from skin commensal or oral commensal of offending creature/person
How would you manage a patient with an ear bite?
Take a good history - work out likely organism
Leave wound open
Irrigate wound thoroughly
Antibiotics
Why are pinna haematoma’s dangerous?
Disrupt blood supply to cartilage as it normally obtains nutrients via diffusion from vessels in the perichondrium.
Can lead to avascular necrosis
What is cauliflower ear?
Cartilage undergoes avascular necrosis which stimulates the formation of new cartilage but it grows asymmetrically
What can cause a tympanic membrane perforation?
Blunt force - trauma to side of head
Penetrating trauma - e.g. cotton bud
Otitis media
Barotrauma - explosion/scuba diving
How does a tympanic membrane perforation present?
Pain
Conductive hearing loss (possibly)
Can get tinnitus and serosanguineous discharge
How can tympanic membrane perforation be managed?
Most heal within 8 weeks- monitoring
Antibiotics if contamination
Keep clean and cry
Not healing after 6 months or hearing loss/recurrent infection - myringoplasty
What is haemotympanum?
Blood in the middle ear
What can cause haemotympanum?
Basal skull fracture - most common
Nasal packing
Bleeding disorders/anticoagulants
Recurrent ear infections
How does haemotympanum present?
Seen through tympanic membrane
Associated with conductive hearing loss
Sense of fullness in ear
Pain
How is haemotympanum managed?
Treat conservatively but follow up to ensure no residual hearing loss
However commonly associated with other issues - head trauma
What is swimmer’s ear?
Otitis Externa - inflammation of the external ear canal lining
What can cause Otitis Externa?
Bacteria - pseudomonas aeruginosa, staph aureus
Fungi - aspergillus and candida
Furuncle - deep folliculitis
Allergic
How does otitis externa present?
Painful discharge from ear History of itchy ear ?History of swimming on holiday Muffled hearing side of discharge Fever Peri-auricular lymphadenopathy
Who commonly gets Malignant Otitis Externa?
Elderly, Diabetics or Immunocompromised
How can Otitis Externa spread?
Through into bone causing several complications
What are the possible complications of Otitis externa?
Perforated Tympanic Membrane Abscess Sepsis Become Chronic Cellulitis Malignant otitis externa - high mortality rate (10%) even with aggressive management
How does malignant otitis externa present?
Chronic ear discharge despite topical treatment
Deep seated ear pain - out of proportion pain
Oedema
Exudate
Cranial Nerve palsies - usually CNVII
How is otitis externa managed?
Topical drops for at least a week
- Mild - acetic acid
- Everything else - neomycin
Oral fluclox if systemically unwell/lymphadenopathy
Insert ear wick coated in steroid/antibiotics
Ear health advice - keep dry, dont use cotton buds, olive oil to stop wax build up
How is malignant otitis externa treated?
Urgent ENT referral
Aggressive IV antibioic therapy alongside topical treatment - gentamicin
What advice is given for swimming and flying for patients with otitis externa?
Ear plugs for swimming
Avoid getting water/shampoo in ears
Don’t fly with ear infections ideally - increase pain, risk of perforation and time to settle
How can discharge be indicative of aetiology of otitis externa?
White-yellow - bacterial
Thick, grey with visible spores - fungal
Clear grey - likely otitis media
What risk factors predispose otitis externa?
Humid environment Swim Old age Immunocompromised Presence of foreign bodies or polyps Eczema Psoriasis Seborrheic Dermatitis
How long is the external auditory meatus and how is it made up?
2.5cm
Outer 2/3 - cartilaginous + hairs
Inner 1/3 - petrous part of temporal bone
What are the key parts of the tympanic membrane that can be seen?
Pars flaccida (top) Pars Tensa (vibrates) Cone of light
How does a pinna haematoma occur?
Shearing forces separate the perichondrium from the tightly adhered cartilage
Perichondrial blood vessels tear leading to haematoma formation
What are the complications associated with pinna haematoma?
Superimposed infection
Cauliflower ear
How is a pinna haematoma managed?
Drainage within 24 hours of injury
Tight head bandage
What problems may be associated with tympanic membrane perforation?
Basal skull fracture
Facial nerve palsy
Temporal bone fracture
How does otitis external appear on examination?
Ear canal with erythema, oedema and exudate
What happens in furuncle otitis external?
Small localised infection causing lots of pain and swelling
If lesion burst, there is a sudden relief of pain
What happens in allergic otitis external?
Contact dermatitis
Fast onset with itching as main symptom
How is otitis external investigated?
Only need to swab of MC&S if treatment failure or atypical
What is malignant (necrotising) otitis externa?
Life threatening spread of otitis external into the mastoid or temporal bone
When is otitis external classified as chronic?
> 3 Months
What must you consider with patients that have chronic otitis externa?
Poor compliance
Abx drop can lead to fungal infection
Contact sensitivity to Abx drop
How is chronic otitis external investigated and managed?
Swab
7 days acetic acid + corticosteroid drop
