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Dr Ajeet Kumar Khilnani
 Congenital
 Traumatic
 Inflammatory
 Neoplastic
 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
 Anotia
- Complete absence of pinna
- Seen in first arch syndrome
 Microtia
 Macrotia
 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
Diseases of External Ear
Diseases of External Ear
 Perichondritis
- Pseudomonas is common pathogen
- Symptoms are red, hot & painful pinna and
abscess formation later
- Systemic antibiotics
- I & D for abscess
Diseases of External Ear
 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
Diseases of External Ear
 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
- 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
Diseases of External Ear
Diseases of External Ear
 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
 Congenital
 Trauma
 Inflammation
 Tumors
 Miscellaneous
 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
 Otitis externa is of two types
- Infective
Bacterial Furuncle
Diffuse otitis externa
Malignant otitis externa
Fungal Otomycosis
Viral Herpes zoster oticus
Otitis externa haemorrhagica
- Reactive Eczematous
Seborrhoeic
Neurodermatitis
 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
 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
- Treatment
- Ear toilet (most important)
- Medicated wicks (antibiotic steroid,
aluminium acetate, silver nitrate)
- Antibiotics
- Analgesics
 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)
 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
 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
 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
 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)
 Malignant tumors
- SCC (FN palsy common)
- BCC
- Malignant ceruminoma
- Malignant melanoma
 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
- 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%)
 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
 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
Diseases of External Ear
 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
 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
 Atrophic TM: Absent fibrous layer
 Tympanosclerosis: Hyalinisation and
calcification of fibrous layer. It appears as
chalky white plaque
 Retraction pockets
 Perforarions
Diseases of External Ear
Diseases of External Ear
Diseases of External Ear
Diseases of External Ear
Diseases of External Ear

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Diseases of External Ear

  • 1. Dr Ajeet Kumar Khilnani
  • 2.  Congenital  Traumatic  Inflammatory  Neoplastic
  • 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
  • 17.  Congenital  Trauma  Inflammation  Tumors  Miscellaneous
  • 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
  • 19.  Otitis externa is of two types - Infective Bacterial Furuncle Diffuse otitis externa Malignant otitis externa Fungal Otomycosis Viral Herpes zoster oticus Otitis externa haemorrhagica - Reactive Eczematous Seborrhoeic Neurodermatitis
  • 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
  • 22. - Treatment - Ear toilet (most important) - Medicated wicks (antibiotic steroid, aluminium acetate, silver nitrate) - Antibiotics - Analgesics
  • 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)
  • 28.  Malignant tumors - SCC (FN palsy common) - BCC - Malignant ceruminoma - Malignant melanoma
  • 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