1. Diseases of the external Ear
By: Botoul alharz *Rana ahmad *Rana Hawsawi *Narjis bakkar

3. A-Diseases of the pinna
( congenital disorder )
Anotia : is the total absence of the auricle , most often with narrowing or absence of external auditory canal .
Microtia : there is some degree of malformation of the external ear ( peanut ear ) , as seen in down’s syndrome .
Macrotia : it is excessively large pinna .
Cup ear or lop ear : it is hypoplasia of upper third of the auricle .
Coloboma : there is a transverse cleft in the pinna in the middle.

4. Anotia
Microtia (peanut ear )
Coloboma

5. Preauricular tag or appendages (accessory amicle)
Anterior to the tragus
Range from simple skin tags or complex structures
Containing cartilage .
Preauricular pit or sinus :
Depression in front of the crus of helix or above the tragus.
An epithelial track due to incomplete fusion of tubercles
Repeatedly infected causing purulent discharge, may also form abscess.
Treatment:
Surgical excision of the track if the sinus gets repeatedly infected. 

6. Preauricular sinus
Preauricular tag

7. B. Trauma to the auricle :
 Haematoma of the auricle
 Lacerations
 Avulsion of pinna.
 Frostbite
 Keloid of auricle

8. 1. Hematoma of the auricle.
It is collection of blood between the auricular cartilage and its perichondrium.
Extravasated blood may clot and resulting in a  deformity called Cauliflower ear .
If gets infected severe perichondritis may set in.

9. Cauliflower ear

10. treatment
Aspiration of the haematoma under aseptic precautions and a pressure dressing.
Packing all concavities of the auricle to prevent reaccumulation.
When aspiration fails, incision and drainage should be done and pressure applied.
Prophylactic antibiotics.

11. 4. Frostbite. Injury due to frostbite varies between ((Stages))
erythema
 oedema
bullae formation
 necrosis of skin & subcutaneous tissue
or complete necrosis with loss of the affected part.

12. Treatment of a frostbitten ear consists of:
rewarming with moist cotton pledgets
application of 0.5% silver nitrate soaks for superficial infection
analgesics for pain,
protection of bullae from rupture,
systemic antibiotics for deep infection.
surgical debridement .

13. 5. Keloid of auricle. It is follow trauma or piercing of the ear
Surgical excision of the keloid ..
Recurrence of keloid can be avoided by pre and postoperative  radiation.

14. C. Iinflammation of the auricle :
Perichondritis
 Relapsing polychondritis
Chondrodermatitis nodularis chronica helicis.

15. 1. Perichondritis
It is infection secondary to lacerations, haematoma or surgical incisions.
common pathogens:Pseudomonas and mixed flora
symptoms: red, hot and painful .
Treatment in early stages : systemic antibiotics
When abscess has formed >must be drained

16. 2. Relapsing polychondritis.
It is a rare autoimmune disorder.
Affect cartilage of the ear and other cartilages,laryngeal, tracheal.
Treatment consists of high doses of systemic steroids.

17. DISEASES OF EXTERNAL AUDITORY CANAL

18. A. CONGENITAL DISORDERS
1. Atresia of external canal
It’s a rare congenital, due to failure of canalization of the ectodermal core
If it’s with microtia It may be associated with abnormalities of the middle ear, internal ear
2. Collaural fistula.
This is an abnormality of the first branchial cleft
The track of the fistula traverses through the parotid in close relation to
the facial nerve

19. B. TRAUMA TO EAR CANAL
Minor lacerations : result from q-tip injury or unskilled instrumentation by the physician sequelae
. They usually heal without
Major lacerations : result from gunshot wounds, automobile accidents or fights.
These cases require careful treatment..
common complication: stenosis of the ear canal.

20. INFLAMMATIONS OF EAR CANAL
REACTIVE GROUP
INFECTIVE GROUP
viral
fungal
Eczematous otitis externa
Seborrhoeic otitis externa
Neurodermatitis
Bacterial

21. C. INFLAMMATIONS OF EAR CANAL
Fungal: Otomycosis
is a fungal infection of the ear canal that often occurs due to
Aspergillus Niger, A. fumigatus or Candida albicans.

22. clinical features:
1-Mild edema
2-intense itching
3-discomfort
4-watery discharge with a musty odor and ear blockage
Examination with otoscope
1-candida :it will appears as white or creamy deposit
2-A.niger :it will appears as black-headed filamentous growth
3-A.fumigatus: it will appears as pale blue or green
: Treatment
Ear Cleaning
(to remove all discharge and epithelial debris )it can be done by syringing or suction
Specific antifungal agents can be applied
treatment should be continued for a week even after apparent cure to avoid recurrences
. Ear must be kept dry

23. Viral 2.Herpes zoster oticus:
It is characterized by formation of vesicles on the tympanic membrane
, meatal skin, concha and post auricular groove
Clinical feature: burning pain in one ear ,headache, fever dizziness
. The facial nerve and vestibulocochlear nerve may be involved
Treatment :
Oral steroid
Antiviral (acyclovir)

24. Bacterial infection:
1)Localized otitis externa (Furuncle)
It is a staphylococcus aureus infection of the hair follicle.
Clinical features:
•severe pain
•tenderness (out of proportion to the size of the furuncle)
•movements of the pinna are painful.
•Jaw movements, also cause pain.

25. Treatment:
In early cases, without abscess formation: • Systemic antibiotics. • Analgesics. • Local heat. • An ear pack of 10% ichthammol glycerin If abscess has formed: incision and drainage. In case of recurrent furunculosis: • Diabetes should be excluded. Attention: paid to the patient’s nasal vestibules • may harbor staphylococci • the infection may be transferred by patient’s fingers.

26. 2)Diffuse otitis externa
It is diffuse inflammation of meatal skin..
•may spread to involve : the pinna.
epidermal layer of tympanic membrane.
Etiology: •commonly seen in:
•hot and humid climate •in swimmers.
Two factors commonly responsible for this condition are:
(I) trauma to the meatal skin (ii) invasion by pathogenic organisms
Common organisms responsible for otitis externa: Staphylococcus aureus  Pseudomonas aregnosa

27. Clinical features:
•Diffuse otitis externa may be acute or chronic •varying degrees of severity. Acute phase: is characterized by:1. hot burning sensation in the ear 2. followed by pain (aggravated by movements of jaw). •Ear starts oozing thin serous discharge (later becomes thick and purulent). •Meatal lining becomes inflamed and swollen. •Collection of debris and discharge accompanied with meatal swelling gives rise to conductive hearing loss. In severe cases, regional lymph nodes become enlarged and tender with cellulitis of the surrounding tissues.

28. Treatment: Ear cleaning ii) Medicated wicks. (iii) Antibiotics.
(iv) Analgesics.

29. Clinical features:
Chronic phase: is characterized by: 1. irritation 2. strong desire to itch (responsible for acute exacerbations and reinfection). Discharge is scanty and may dry up to form crusts. Meatal skin which is thick and swollen may also show scaling and fissuring. Treatment: •Treatment aims at :1. reduction of meatal swelling 2. alleviation of itching. 1. A gauze wick soaked in 10% ichthammol glycerin ,helps to reduce swelling. 2. followed by ear toilet (particular attention to anteroinferior meatal recess). 3. Itching can be controlled by topical antibiotic steroid cream.

30. 3)Malignant (necrotizing) otitis externa.
It is an inflammatory condition •caused by: pseudomonas infection •usually in the: 1. Elderly 2. Diabetics 3. on immunosuppressive drugs Its early manifestations: •resemble diffuse otitis externa •BUT there is:•excruciating pain •granulations in the ear canal. Facial paralysis is common Infection may spread to the skull base and jugular foramen causing multiple cranial nerve palsies.

31. Diagnosis:
CT: scan may show bony destruction but is often not helpful. Gallium-67: is more useful in diagnosis and follow-up of the patient. is indicative of soft tissue infection. Technetium 99: bone scan reveals bone infection but test remains positive for a year or so and cannot be used to monitor the disease. ESR Treatment: (I) Control of diabetes. (ii) cleaning of ear canal. (iii) Antibiotic If patient is not responsive: •culture and sensitivity of ear discharge.

32. Neurodermatitis:
It is caused by compulsive scratching due to psychological factors. Patient’s main complaint is intense itching. Treatment: is sympathetic psychotherapy and that meant for any secondary infection. Ear pack and bandage to the ear are helpful to prevent compulsive scratching.

33. Tympanic Membrane Diseases
1. Retracted tympanic membrane: Is the result of negative intratympainc pressure when the Eustachian tube is blocked.
Foreshortened
handle of malleus
Normal tympanic membrane
Retracted tympanic membrane

34. 2. Myringitis bullosa: it is a painful condition characterized by formation of hemorrhagic blebs on the tympanic membrane. It is probably caused by a virus or Mycoplasma pneumoniae.

35. 3.Herpes zoster oticus: it is a viral infection involving geniculate ganglia of facial nerve. 4. Myringitis granulosa: Nonspecific granulations form on the outer surface of tympanic membrane. It may be associated with long- standing foreign body or external ear infection.

36. (a) Trauma due to hair pin, matchstick.
5. Traumatic rupture. Tympanic membrane may be ruptured by;
(a) Trauma due to hair pin, matchstick.
(b) sudden change in air pressure. e.g. sudden blast.
(c) pressure by fluid column. e.g. diving.
(d) Fracture of temporal bone

37. 5. Traumatic rupture . Treatment:
- In a majority of cases, edges of perforation
get inverted towards the middle ear.
- In such cases, the ear should be examined under operating microscope and the edges of perforation repositioned and
splinted.
- injuries of tympanic membrane may be associated with facial paralysis or subluxation of stapes (vertigo and nystagmus) and sensorineural hearing loss. In such cases, urgent exploration may be required.

38. Questions?

39. Thank you