3. Bat ear (Lop ear)
- Poorly developed antihelix
- Concha is large
Preauricular appendages
- Skin covered tags
Preauricular sinus or pit
- Commonly seen at root of helix
- Due to incomplete fusion of tubercles
- Surgical excision is required
4. Anotia
- Complete absence of pinna
- Seen in first arch syndrome
Microtia
Macrotia
5. Hematoma of Pinna
- Collection of blood between cartilage &
perichondrium
- Cauliflower ear (Boxers, wrestlers & rugby)
- Aspiration with tight bandage
- Incision and drainage
Lacerations
Avulsion of pinna
Frostbite
Keloid
8. Perichondritis
- Pseudomonas is common pathogen
- Symptoms are red, hot & painful pinna and
abscess formation later
- Systemic antibiotics
- I & D for abscess
10. Relapsing polychondritis
- Autoimmune disorder
- High doses of systemic steroids
Chondrodermatitis nodularis chronica helicis
- Small painful nodules near free border of
helix
- Seen in males of 50 years
- Excision required
12. Benign tumors of pinna
- Sebaceous cyst: Commonly seen in
postauricular sulcus
- Dermoid cyst
- Keloids: Black races affected more
Post operative radiation required
- Hemangioma
Capillary (Port wine stain): Doesn’t regress
Cavernous (Strawberry): Regresses after 1
year
13. - Pappiloma (Wart): Viral in origin
- Cutaneous horn: Heaping up of keratin like a
horn. Seen at rim of helix in elderly.
- Keratoacanthoma: Raised nodule with a
central crater
- Neurofibroma: Non-tender, firm swelling.
May be associated with von Recklinghausen’s
disease
16. Malignant Tumors
- SCC: Common at helix. More common in
males in fifties. Due to excessive sunlight
exposure.
- BCC: Common at helix & tragus
- Melanoma: Common in men of light
complexion
18. Atresia of canal
- Due to failure of canalization of the
ectodermal core that fills the dorsal part of
the first branchial cleft
Collaural fistula
- Abnormality of first branchial cleft
- Connection between EAC and neck (below &
behind the angle of mandible)
- Tract of fistula traverses through the parotid
20. Furuncle (localised acute otitis externa)
- Staphylococcal infection of hair follicle
- Seen only in cartilaginous meatus
- Symptoms: Severe pain, jaw movements are
painful during chewing
- Signs: Obliteration of retroauricular groove
Preauricular LNs may be enlarged
- Treatment: Antibiotics, analgesics, heat
appliacation. Ear packed with 10%
ichthammol glycerine (hygroscopic)
- DM should be excluded in recurrent furuncles
21. Diffuse Otitis Externa
- Seen in hot & humid climates in swimmers
- Excessive sweating pH changes from acid to
alkaline favors growth of pathogens
- Two factors: Trauma & pathogens
- Organisms: Staph aureus, Pseudomonas
pyocyaneus, B. proteus, E. coli
- Symptoms: Hot burning sensation in ear
Serous discharge (later purulent)
Conductive hearing loss
Regional LNs enlarged
23. Otomycosis
- A. niger (black), A. fumigatus, C. albicans
- Seen in hot & humid climate
- Can be secondary to topical antibiotic use
- Symptoms: Intense itching, pain, watery
discharge with musty odor & ear blockage
- Signs: Wet piece of filter paper
- Treatment: Ear toilet, antifungal agents
(nystatin, clotrimazole, povidone iodine)
24. Otitis externa haemorrhagica
- Formation of haemorrhagic bulla on TM
- Caused by influenza virus
- Pain and blood stained discharge
- Antibiotics & analgesics
Herpes zoster oticus
- Formation of vesicles over TM, meatal skin
- CN VII and VIII may be involved
25. Malignant (necrotising) otitis externa
- Caused by pseudomonas in elderly diabetics
or immunocompromised individuals
- Facial palsy is common
- Infection may spread to skull base & jugular
foramen causing multiple CN palsies
- CT scan is useful
- High dose of antibiotics (tobramycin,
ticarcillin, 3rd gen cephalosporins)
- DM should be controlled
- Surgical debridement
26. Eczematous otitis externa
- Due to hypersensitivity to infective organisms or ear
drops
- Intense itching, vesicle, oozing and crusting
- Treatment: Application of steroid ointment
Seborrhoeic otitis externa
- Salicylic acid and sulphur containing cream
Neurodermatitis
- Compulsive scratching due to psychological factors
- Treatment: Sympathetic psychotherapy
Primary cholesteatoma of EAC
- Squamous epithelium of canal invades its bone
27. Benign
- Ceruminoma: Tumor of modified sweat
glands
- Sebaceous adenoma
- Papilloma
Osteoma Exostosis
Cancellous bone Compact bone
Single Multiple
Pedunculated Sessile
Outer end of bony wall Inner end (cold water exposure)
29. Secretion of sebaceous glands, ceruminous
glands, hair, desquamated epithelial debris,
keratin and dirt
Lubricates the canal & traps foreign bodies
Normally expelled by movements of jaw
Predisposing factors: tortuous canal, stiff
hair, exostosis
Symptoms: Blocked ear, hearing loss,
tinnitus, giddiness, cough
Treatment: Syringing or instrumentation
30. - Syringing should be in posterosuperior
direction
- Too cold or too hot water can cause vertigo
- Wax softening agents: H2O2, liquid paraffin,
olive oil, paradichlorobenzene (2%)
31. Non living FB
- Methods of removing FB
Forceps (piece of paper)
Syringing (seed grains, smooth objects)
Suction
Microscopic removal
Postaural approach
- Impacted FBs are removed under GA with
microscope
32. Living FB
- Mosquitoes, beatles, ant, cockroaches
- First insect is killed (oil, spirit or chloroform)
Maggots in ear
- Larvae of flies
- August to October
- Chloroform water is used to kill maggots and
then they are removed using forceps
34. Collection of pearly white mass of
desquamated epithelial cells in deep meatus
Causes widening of canal due to pressure
Commonly seen between 5-20 years
May be associated with bronchiectasis &
chronic sinusitis
Failure of migration of epithelium from TM to
posterior meatal wall may lead to
accumulation of epithelial plug in deep
meatus
Removed by syringing or instrumentation
35. Retracted TM: TM is dull, COL absent, HOM
foreshortened, malleal folds become sickle
shaped
Myringitis bullosa: Caused by virus or
mycoplasma
Herpes zoster oticus: Involves geniculate
ganlion of FN
Myringitis granulosa
Traumatic rupture
36. Atrophic TM: Absent fibrous layer
Tympanosclerosis: Hyalinisation and
calcification of fibrous layer. It appears as
chalky white plaque
Retraction pockets
Perforarions