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Disease of the External Ear

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1 Disease of the External Ear
Shankai Yin Prof Dept of Otolaryngology, the sixth hospital affiliated to Shanghai jiaotong university Otolaryngology institute at Shanghai jiaotong university

2 Otitis Externa Bacterial infection of external auditory canal
Categorized by time course Acute Subacute Chronic

3 Acute Otitis Externa (AOE)
“swimmer’s ear” Preinflammatory stage Acute inflammatory stage Mild Moderate Severe

4 Preinflammatory Stage
Edema of stratum corneum and plugging of apopilosebaceous unit Symptoms: pruritus and sense of fullness Signs: mild edema Starts the itch/scratch cycle

5 Mild to Moderate Stage Progressive infection Symptoms Signs Pain
Increased pruritus Signs Erythema Increasing edema Canal debris, discharge

6 Severe Stage Severe pain, worse with ear movement Signs
Lumen obliteration Purulent otorrhea Involvement of periauricular soft tissue

7 Treatment Most common pathogens Four principles
P. aeruginosa and S. aureus Four principles Frequent canal cleaning Topical antibiotics Pain control Instructions for prevention

8 Chronic Otitis Externa (COE)
Chronic inflammatory process Persistent symptoms (> 2 months) Bacterial, fungal, dermatological etiologies

9 Symptoms Unrelenting pruritus Mild discomfort Dryness of canal skin

10 Signs Asteatosis Dry, flaky skin Hypertrophied skin
Mucopurulent otorrhea(occasional)

11 Treatment Similar to that of AOE
Topical antibiotics, frequent cleanings Topical Steroids Surgical intervention Failure of medical treatment Goal is to enlarge and resurface the EAC

12 Furunculosis Acute localized infection
Lateral 1/3 of posterosuperior canal Obstructed apopilosebaceous unit Pathogen: S. aureus

13 Symptoms Localized pain Pruritus
Hearing loss (if lesion occludes canal)

14 Signs Edema Erythema Tenderness Occasional fluctuance

15 Treatment Local heat Analgesics Oral anti-staphylococcal antibiotics
Incision and drainage reserved for localized abscess IV antibiotics for soft tissue extension

16 Granular Myringitis (GM)
Localized chronic inflammation of pars tensa with granulation tissue Toynbee described in 1860 Sequela of primary acute myringitis, previous OE, perforation of TM Common organisms: Pseudomonas, Proteus

17 Bullous Myringitis Viral infection Confined to tympanic membrane
Primarily involves younger children

18 Symptoms Sudden onset of severe pain No fever No hearing impairment
Bloody otorrhea (significant) if rupture

19 Signs Inflammation limited to TM & nearby canal
Multiple reddened, inflamed blebs Hemorrhagic vesicles

20 Treatment Self-limiting Analgesics
Topical antibiotics to prevent secondary infection Incision of blebs is unnecessary

21 Pseudocyst of the auricle
First reported by Hartmann in 1846 Fluctuant, tense, noninflammatory swelling of the upper ear Believed to be ass with trauma

22 Treatment Medical Care Surgical Care
No medical treatment is uniformly effective. Surgical Care surgical incision and pressure dressing aspiration followed by a pressure dressing intralesional steroids Surgical curettage and fibrin sealant

23 Injury of tympanic membrane
Otalgia Bleeding Fullness Hearing loss: conductive HL or mixed HL Tinnitus Shape of perforation is split

24 Treatment Antibiotic to prevent infection
Aseptic external auditory canal with alcohol Prevent super respiratory infection Prohibit nasal blow Prohibit ear drops It takes 3-4 w to heal the ear drum If 3 months later, perforation still exists, myringoplasty is indicated

25 Conclusions Careful History Thorough physical exam
Understanding of various disease processes common to this area Vigilant treatment and patience


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