Diseases of the external ear

By, Dr. Vanitha Palanisamy

ENT,HTAR
8th of April 2011.
External ear

Consists of the auricle and EAM

Skin-lined apparatus

Approximately 2.5 cm in length

Ends at tympanic membrane

AURICLE

Auricleelastic cartilage+skin

Cone shape

Ear lobuleno cartilage
External auditory canal

Outer 1/3  cartilage , ceruminous gland ,
seabaceous gland , hair

Inner 2/3  bone (tympanic and squamous portion
of temporal bone) , anteroposteriorly , only epithelial
lining on the periostium

Self-cleaning property

Tympanic membrane

Epithelial layer  squamous epithelium

Fibrous layer  circumferential and radial fiber

Mucosal layer
Tympanic membrane
Symptom

Otalgia

Otorrhea

Tinnitus aurium

Vertigo
Cause

Congenital

Trauma

Inflammation and infection

Tumor

Malignant

Miscellaneous condition
Congenital

Complete or partial absence of auricle

Preauricular sinus and/or cyst

Accessory auricle

Abnormalities in size or shape of auricle
Complete absence of auricle and
Abnormalities in size or shape of auricle

1.Anotia

2. Microtia

3.Bat ear

4.Lop-ear

5.Macrotia
Anotia : Total absence of the pinna
Microtia
Microtia,Anotia

.
Abnormalities in size or shape of auricle

Treatment

Minor defect : plastic surgery

Major defect : prothesis

Preauricular sinus and/or cyst

-seen at root of helix

-due to incomplete fusion of tubercles.

-repeated infections causes purulent discharge,
may lead to abscess formation.

TREATMENT-surgical excision of the track.

Preauricular sinus and/or cyst
Accessory auricle/Preauricular
appendages.
Trauma

Laceration

Blows

Foreign body
Laceration

Post trauma, assault, industrial injuries.

Must be repaired as early as possible.

Perichondrium is stitched with absorbable
sutures, skin closed with non-absorbable
sutures.

Cover with oral antibiotics for 1 week.
Laceration
Blows/ Hematoma of the auricle

Collection of blood between the

auricular cartilage and its
perichondrium.

Results from blunt trauma,ex: boxers.

Blood may clot and organise,results in
deformity- Cauliflower ear

if hematoma gets infected,
Perichondritis sets in.
Hematoma of pinna
Cauliflower ear
Treatment.

Aspiration of hematoma under aseptic

technique, and pressure dressing.

If aspiration fails, incision and drainage done,
then apply pressure by dental rolls tied with
through and through sutures.

Cover with prophylactic antibiotics.
Foreign body

1) Non-living: seeds, pencil tip, vegetables,

beads
-removed by forceps, suction syringing,
postaural approach.
2) Living: mosquito, beatles, cockroach
-kill first by instilling oil, then remove.
Maggots-instill chloroform to kill, then remove.
Foreign body in EAC
Inflammation and Infection
Infective group
BACTERIAL

Furuncle of external meatus

Diffuse infective otitis externa

Malignant otitis externa

FUNGAL

Otomycosis

Viral
-Herpes zoster oticus
-Myringitis bullosa hemorrhagica
Inflammation and Infection
Reactive group

Eczematous otitis externa

Seborrhoeic otitis externa

Neurodermatitis

Inflammatory disorders

Perichondritis

Relapsing polychondritis.
Furuncle
Staphylococcal infection.
Confined to the cartilaginous part of meatus.
 Furuncle

-severe pain and tenderness.

-movement of pinna painful.

-if furuncle at post meatal wall, causes oedema over

the mastoid with obliteration of retroauricular groove.

-palpable periauriculat lymph nodes.

TREATMENT
-exclude diabetes is recurrent furunculosis.
-systemic antibiotics, analgesics and heat.
 Diffuse infective otitis externa
Diffuse inflammation of meatal skin.
Causes:
-excessive sweating
-trauma: scratching using pins,removal of foreign body,
vigorous cleaning of ear after swimming
-Invasion by pathogens : Staph. aureus, Pseud. pyocyaneus, B.
protus and Esch. Coli.
Clinical pictures:
-pain,serous to purulent discharge, blocked ears, tenderness at
surroundings.
Treatment:
-Ear toilet,medicated wickswith ear drops, antibiotics and
analgesics.
Acute Diffuse Otitis Externa
[swimmer's ear]
Otomycosis
-fungal infection of ear canal due to Aspergillus
niger, A.fumigatus, or Candida albicans.
-also occurs as secondary fungal growth in patients
using topical antibiotics for OE or OM.
CLINICAL FEATURES
-Intense itching,pain and ear dyscomfort,watery
discharge,ear block.
Colour:
-A.niger:black headed filamentous growth.
-A.fumigatus:pale blue or green.
-Candida:white or creamy deposit.
Severe Aspergillus Niger Otitis Externa
Otomycosis
Eczematous otitis externa

-results of hypersensitivity to infective
organisms or topical ear drops
ex:chloromycetin or neomycin.

-intense irritation,vesicle formation,oozing

and crusting in the canal.

TREATMENT:
-stop topical antibiotics and apply steroid
cream.
 Seborrhoeic otitis externa

-associated with seborrhoeic dermatitis of the scalp.

-Greasy scaled seen at EAC,lobule and postauricular sulcus.

TREATMENT:
-ear toilet,apply cream contains salycylic acid
and sulphur,treat the dermatitis.
Myringitis bullosa haemorrhagica

-formation of haemorrhagic bullae on the TM and deep
meatus.

Usually viral in origin.

Clinical picture:severe pain and blood stained discharge

when bullae ruptures.
Treatment:analgesics and antibiotic.
Malignant otitis externa

Caused by pseudomonas infection.

Affects elderly,diabetics,those on immunosuppressive
drugs.

Clinical picture:

-excruciating pain, granulations in the meatus,facial

paralysis is common.
-Infection may spread to skull base and jugular
foramen,causing multiple cranial nerve palsies.
-Spreads anteriorly to temporomandibular fossa,posteriorly
to mastoid and medially into middle ear and petrous
bone.
Malignant otitis externa

Treatment: High doses of antibiotics,6-8weeks.

-Control diabetics.

-Surgical debridement of devitalized tissues and bone (To do CT-
Scan to know the extend)
Perichondritis

-results from lacerations,haematoma or surgical
incisions.

-also due to extension of infection from diffuse OE
or furuncle.

Commonly caused by Pseudomonas and mixed
flora.

Sx: red,hot,painful pinna,stiffness of pinna.

TREATMENT:systemic abx,local application of

aluminium acetate compresses.
-if abscess has formed,it must be drained.
-devitalised cartilage must be removed.
Perichrondritis
Tumor

Exostosis

Papilloma

Angioma

Fibroma

Adenoma

Osteoma
Exostoses

Is the most common benign tumor of the
EAC.
-they are multiple and bilateral,smooth bony
swellings near TM,arise from compact bone.
-Often found in swimmers who have
repeated exposure to cold water. .
-Treated by cleaning the ear using high
speed drill. Gross bone surgery.
-may damage facial nerve during surgery
when exostoses lies deeply.
Exostoses
Osteoma
A solitary benign bony growth.
Common position in the EAC tympanomastoid
suture line.
-Treatment: Surgical removal
Malignant

Found in elderly patients with exposure to

the sun.
TYPES

Squamous cell carcinoma

Basal cell carcinoma (Rodent ulcer)

Squamous cell carcinoma

Common than other cancers.

-Site of occurrence: Helix

Treatment
-Small lesions with no nodal mets: Excised 1cm
around it.
-Larger lesions:Total amputation of pinna with
removal of parotid gland and lymph nodes.
Squamous cell carcinoma
Basal cell carcinoma

Found in countries with more sunlight.

Common sites : helix and tragus.

-ulcer looks raised,often extends
circumferentially into skin.

Treatment:Surgical excision.
Basal cell carcinoma
(Rodent ulcer)
Miscellaneous condition
of the external ear
Miscellaneous condition

Wax

Sebaceous cyst

Keloid

Acquired atresia and stenosis of external
auditory canal
 Ear wax

Composed of secretion of sebaceous
glands,ceruminous glands,hair,desquamated
epithelial debris,keratin and dirt.

Impacted ear wax causes blocked
ears,tinnitus and giddiness resulting from
impaction of wax against TM,and cough due
to stimulation of auricular branch of vagus.

TREATMENT:Remowal of ear wax.

Impect Cerumen
Sebaceous cyst

The common area behind the ear and the

lobule.
Keloid

Often occur after ear piercing.
.
Steroid treatment of the lesion by injection
every 1-2 weeks or until the clot dissolved,
then excision and radiation.
Keloid of ear lobule
Acquired atresia and stenosis of external
auditory canal

May be caused as follows.

 Chronic otitis externa is usually found in their
eczematous type
 Operation
 Perichondritis
 Injury after corrosive burn
 Idiopathic
Treatment

Polyethylene tube

Surgical treatment
References

-Diseases of external ear ,www.vadlo.com.US

-Diseases of Ear,Nose and Throat, PL
DHINGRA

Thank You.