1. THE EAR

2. External Ear
Pinna
Tympanic membrane
External Auditory Canal

3. Pinna/Auricle
Location: oval-shaped appendage on the lateral surface of the head.
Auricleelastic cartilage+skin
Ear lobuleno cartilage (fat and subbutaneous tissue)
Function: sound localization and amplification.
Composition:
-thin skin with hair follicles
- sweat glands and sebaceous glands covers supporting structure of elastic cartilage
Auricle is relatively a common site of injury due to its exposed location. These kinjuries are visible due the absence of deepwe SQ structures

4. Diseases of the Pinna

5. Perichiondritis Definition:
An acute inflammation of the skin and the perichondrium that involves the articular cartilage
Most commonly due to bacterial infection stemming from a small injury in the conchal cavity or the auricle. (close attachment of the skin to the perichondrium)
Causative organisms: staphylococci, pseudomas

6. Symptoms Treatment - Severe pain (rapid onset) - Feeling of tension
- Auricular contours are effaced
- Swelling of the concha with marked tenderness
- Earlobes are spared
- Regional lymph nodes maybe painful and enlarged
- Fever may occur
Treatment
Systemic antibiotics
Cleaning of the auricle and ear canal
Antiseptic/antibiotic containing ointments
Oral analgesics for pain

7. Trauma
EAR TRAUMA

8. Ear Trauma
Auricle- skin-covered cartilage, with only a thin padding of connective tissue.
The entire cartilage framework is fed by a thin covering membrane called the perichondrium (meaning literally: around the cartilage)
Accumulation of fluid (swelling) or blood (injury) between the perichondrium and the underlying cartilage puts the cartilage in danger of being separated from its supply of nutrients  Ear deformity (lumpy, distorted)

9. Wrestler's Ear (cauliflower ear)- repeated trauma causing thickened auricle that resembles a vegetable.
wrestling is one of the most common ways such an injury occurs.
Ear lobe- devoid of cartilage, covered with adipose tissue.Instead, it is a wedge of adipose tissue covered by skin.
Tears of the earlobe can be generally repaired with good results. Since there is no cartilage, there is not the risk of deformity from a blood clot or pressure injury to the ear lobe.
Other injuries causing major deformity.
Lacerations, bite injuries, avulsion injuries, cancer, frostbite, and burns

10. External Auditory canal
S-shaped, approx 2.5 cm long
Outer 1/3  cartilage , hair, cilia, mucus, sebaceous glands, ceruminous gland (secretes a brown-like substance, wax-like cerumen “ear wax”)
Inner 2/3  bone (tympanic and squamous portion of temporal bone) , anteroposteriorly , only epithelial lining on the periostium
Skin is very thin, directly overlying the periosteum  temperature and pain sensitivity.

11. The ear's self-cleaning mechanism moves old skin cells and cerumen to the outer part of the ear.
Epithelial migration of the lining of the EAC is a well-known phenomenon and is essential for the self-cleansing mechanism of this structure.
In most cases, the epicenter of this migratory process appears to reside in the vicinity of the umbo of the tympanic membrane.
The epithelial migration takes place at a rate of approximately 0.07mm/day and serves to cleanse the canal of debris, foreign bodies, and bacteria.

12. Cerumen and Cerumen impaction
- forms a protective film in which the fatty acids, lysozymes and the creation of an acid milieu bacteriostatic and bactericidal) effectively protects the skin of the ear canal.
- Consists of a combination of desquamated epithelium, thick sebaceous gland secretions, and thinner apocrine gland secretions
- Water resistant, traps debris
produced by the ceruminous glands and sebaceous glands in the skin of the ear canal.

13. Cerumen impaction - Disturbance of the normal self cleaning mechanism or excessive cerumen secretion. Cerumen plug - Sebum, exfoliative debris, contaminants Symptoms: - pressure sensation in the ear, concomitant hearing loss, occasional vertigo and tinnitus

14. Cerumenolytics Ceruminolytics – “cerumen softeners” Hydrogen peroxide
Mineral oil, baby oil
Commercially prepared otic drops (Otosol, Auralgan)
Water

15. Foreign Body Classification Animate (living) Inanimate (non-living)
Bugs
Mosquito
Cockroach
Lice/mites
Inanimate (non-living)
Cotton
Pebbles
Small marbles

16. Foreign Body

17. Foreign Body: treatment
Methods of removal of foreign body from the ear:
Hooking out
- care is taken not to push the foreign body deeper into the ear canal or through the tympanic membrane.
Syringing
Removal under the microscope

18. Otitis externa Predisposing factors: Exogenous factors
Definition:
Inflammation of the external auditory canal caused by factors that interfere with the normal defenses against infection.
Barriers to infection:
Normal cerumen film (acidic pH, fatty acid content- antibacterial)
Lateral migration of the epithelium
Predisposing factors:
Exogenous factors
- Water (maceration), shampoos (alteration in pH), manipulations with cotton-tipped (overcleaning/daily) swabs, earphones/plugs
Endogenous factors
- eczema, allergies, metabolic disorders
Local changes
- exostoses, stenoses
Common causes:
Cotton buds
Use of ear spoon
Overcleaning/daily cleaning

20. S/Sx: Treatment: Tragal tenderness Pain and itching of the ear canal
Erythema
Edema
Canal debris, discharge
Treatment:
Instructions for prevention
Appropriate canal cleaning
Antibiotics
Pain control (analgesics)

21. Tympanic Membrane
Separates the outer ear from the middle ear.
Consists of 2 portions: pars tensa, pars flaccida
3 layers of the pars tensa:
Outer- cutaneous layer; smooth muscle, stratified squamous epithelium that reflects the light
Middle- lamina propria; with 2 layers of connective tissue fibers. Outer (radiate layer), inner (circular layer)
Inner- mucosal layer; single layer of squamous epithelium
The eardrum separates the outer ear from the middle ear
Creates a barrier that protects the middle and inner areas from foreign objects
Cone-shaped in appearance
about 17.5 mm in diameter
The eardrum vibrates in response to sound pressure waves.
The membrane movement is incredibly small
as little as one-billionth of a centimeter

22. Pars Flaccida (Sharpnell membrane)
Superior to the malleolar folds
It lacks the reinforcing fibrous layer present in the pars tensa ---retracts first in response to negative pressure in the middle ear  epithelial pocket

23. Myringitis Inflammation of the tympanic membrane Characterized by:
Hemorrhage
Effusion of fluid into the tissue at the end of the external car canal and the tympanic membrane.
This self-limiting disorder (resolving spontaneously within 3 days to 2 weeks) often follows acute otitis media or upper respiratory tract infection and frequently occurs epidemically in children.
Bullous myringitis

24. organism that may cause acute otitis media.
Causes:
Viral infection
Bacteria (pneumococci, Haemophilus influenzae, betahemolytic streptococci, staphylococci)
organism that may cause acute otitis media.
Symptoms:
- severe ear pain
- tenderness over the mastoid process
- Small, reddened, inflamed blebs form in the canal, on the tympanic membrane
- Fever and hearing loss are rare unless fluid accumulates in the middle ear or a large bleb totally obstructs the external auditory meatus.
-Bloody discharge- with ruptured blebs
- No hearing impairment

25. Treatment: Self-limiting Analgesics
Topical antibiotics- prevent secondary infection

26. Granular Myringitis
Localized chronic inflammation of pars tensa with granulation tissue
Sequalae of primary acute myringitis, previous otitis externa, perforated TM
Common organisms: Pseudomonas
Proteus
s/sx:
Foul smelling discharge
Often asymptomatic
No hearing loss/significant pain
No TM perforations
“peeping granulations”
TM obscured by pus

27. Treatment: Careful and frequent debridement
Topical anti-pseudomonal antibiotics
Steroids
2 weeks of therapy

29. Bulging Tympanic membrane
Bulging tympanic membrane: bulging tympanic membrane occurs due to fluid collection in the middle ear cavity.
Causes:
- Acute otitis media
- Serous effusion
- Glue ear
- Tumors
Total bulging
- a convex-appearing tympanic membrane with loss of visualization of the lateral process and/or the manubrium of the malleus bone.
- diagonal cleft in the bulging tympanic membrane where its fibers are tightly adherent to the handle of the malleus.
Partial bulging
- fullness of an opacified, convex tympanic membrane with preservation of the outline of either the manubrium or the lateral process of the malleus bone.
- Mobility is impaired during negative and positive pressure.