1. بسم الله الرحمن الرحيم

2. ANATOMY OF THE EAR

3. EXTERNAL EAR Auricle External Canal

4. THE AURICLE

5. Normal Absence of antihelix (protruding ear)

6. PerichondritisErysipelas

7. Endaural incision for external and middle ear surgery

8. Postauricular incision for external and middle ear surgery

9. Blood Supply Richly supplied by branches from the external carotid

10. Hematoma Auris Cauliflower ear

12. The External Auditory Canal

13. Cartilagenous Present at birth Hair follicles Sebacous glands Ceruminous glands Medial Two Thirds: Lateral Third: Bony Develops after birth

14. Furunclosis Skin of outer third of the external canal Wax

15. ANATOMY OF THE EAR External Ear Middle Ear Cleft Inner Ear

16. MIDDLE EAR CLEFT Eustachian Tube Tympanum (Middle Ear Cavity) Mastoid Antrum and Air Cells

17. MIDDLE EAR CLEFT The Eustachian Tube

19. MIDDLE EAR CLEFT Eustachian tube Tympanic cavity (Middle ear cavity)

20. WALLS OF TYMPANIC CAVITY Roof Floor Anterior wall Posterior wall Lateral wall Medial wall

21. WALLS OF TYMPANIC CAVITY Roof Floor Tegmen

22. WALLS OF TYMPANIC CAVITY Roof Floor Anterior wall Posterior wall

23. WALLS OF TYMPANIC CAVITY Roof Floor Anterior wall Posterior wall Lateral wall

24. Membrana flaccida Membrana Tensa Epitympanum(attic) Mesotympanum Hypotympanum

25. WALLS OF TYMPANIC CAVITY Roof Floor Anterior wall Posterior wall Lateral wall Medial wall

27. MIDDLE EAR CLEFT Eustachian (Pharyngo-tympanic) Tube Tympanic (Middle Ear) Cavity Mastoid antrum and air cells

28. Mastoid Antrum & Air cells

31. CONTENTS OF MIDDLE EAR CAVITY Air Ossicles Malleus, Incus, & Stapes Muscles Tensor Tympani & Stapedius Nerves Tympanic Plexus & Chorda Tympani

33. LINING OF MIDDLE EAR Mucous membrane : ciliated columnar anteriorly and cuboidal or flat elsewhere

34. SENSARY SUPPLY OF MIDDLE AND EXTERNAL EAR Cervical II & III ( great auricular and lessor occipital) V cranial nerve ( auriculotemporal) IX cranial nerve (tympanic or Jacobson’s) X cranial nerve ( auricular or Arnold’s) VII cranial nerve

35. Referred Earache Pain in the ear due to a disease in an area supplied by a nerve that also supply the ear.

36. Referred Earache Cervical II & III –Cervical spondylosis, neck injury etc. V cranial nerve –Dental infections, sinonasal diseases etc. IX cranial nerve –Tonsillitis, post-tonsillectomy, carcinoma etc. X cranial nerve –Tumors of hpopharynx, larynx & esophagus

37. ANATOMY OF INNER EAR Osseous Labyrinth Perilymph Membranous labyrinth

39. The Bony Labyrinth Bony Cochlea Vestibule Bony semicircular canals

40. CONTENTS OF THE BONY LABYRINTH Perilymph Membranous labyrinth –Cochlear duct –Saccule and utricle –Membranous semicircular ducts

41. CONTENTS OF MEMBRANOUS LABYRINTH Endolymph Sensory epithelium –Cochlea: organ of Corti –Utricle & saccule: maculae –Semicircular canals: cristae

42. INNER EAR SENSORY EPITHELIUM Cochlea: organ of Corti Utricle & saccule: maculae Semicircular canals: cristae

43. THE VESTIBULO-COCHLEAR NERVE

45. CENTRAL CONNECTIONS OF COCHLEAR NERVE

46. CENTRAL CONNECTIONS OF VESTIBULAR NERVE

48. PHYSIOLOGY OF THE EAR

49. FUNCIONS OF THE EXTERNAL EAR Auditory functions: –Sound conduction –Increase sound pressure by the resonance function Protection of the middle ear –Curvature –Cerumen

50. FUNCTIONS OF THE EUSTACHIAN TUBE Ventilation Protection Drainage

51. Role of ET Dysfunction Main route of infection in AOM (from the nasopharynx) Obstruction –Negative middle ear pressure –Formation of non purulent fluid in the middle ear (Otitis Media with Effusion)

52. FUNCIONS OF THE MIDDLE EAR Conduction of sound Transformer mechanism –Hydraulic action –Ossicular leverage

53. FUNCIONS OF THE MIDDLE EAR Conduction of sound Transformer mechanism –Hydraulic action –Ossicular leverage Protection to the inner ear –stapedial reflex

54. FUNCIONS OF THE INNER EAR Hearing Function: –Transduction of sound to action potentials

56. FUNCIONS OF THE INNER EAR Hearing Function: –Transduction of sound to action potentials Vestibular Function : – Participate in maintaining body balance

57. THE BALANCE SYSTEM

58. BRAIN-STEM Cerebellum C. Cortex THE BALANCE SYSTEM

59. VisualProprioceptiveVestibular BRAIN-STEM Cerebellum C. Cortex INPUT THE BALANCE SYSTEM

60. VisualProprioceptiveVestibular BRAIN-STEM Postural musclesOcular muscles Cerebellum C. Cortex INPUT OUTPUT THE BALANCE SYSTEM

62. DEVELOPMENT OF THE EAR External ear: 1 st pharyngeal cleft & arch Middle ear: 1 st pharyngeal pouch & 1 st and 2 nd arches

64. DEVELOPMENT OF THE EAR External ear: 1 st pharyngeal cleft & arch Middle ear: 1 st pharyngeal pouch & 1 st and 2 nd arches Inner ear: Ectoderm of hindbrain

66. DISEASES OF THE EXTERNAL EAR

67. CONGENITAL MALFORMATIONS Anotia & microtia Accessory auricle Preauricular sinus Protruding ear

69. TRAUMA TO THE AURICLE Lacerations Hematoma auris

70. Complication Cauliflower ear

71. PERICHONDRITIS OF THE PINNA Usually follow trauma (hematoma auris, surgical, frostbite, burn) or otitis externa Commonly caused by Pseudomonas Fever, pain, redness and swelling Treatment is by antibiotics

72. OTITIS EXTERNA

73. DEFINITION An acute or chronic infection of the whole or a part of the skin of the external ear canal

74. CAUSES OF OTITIS EXTERNA

75. INFECTIVEREACTIVE

76. CAUSES OF OTITIS EXTERNA INFECTIVE BacterialFungalViral REACTIVE

77. CAUSES OF OTITIS EXTERNA INFECTIVE BacterialFungalViral REACTIVE EczematousSeborrheic

78. CAUSES OF OTITIS EXTERNA INFECTIVE Bacterial Staph. arues Pseudomonos Others FungalViral REACTIVE EczematousSeborrheic

79. CAUSES OF OTITIS EXTERNA INFECTIVE Bacterial Staph. arues Pseudomonos Others Fungal Aspirigillus Niger Candida Albicans Viral REACTIVE EczematousSeborrheic

80. CAUSES OF OTITIS EXTERNA INFECTIVE Bacterial Staph. arues Pseudomonos Others Fungal Aspirigillus Niger Candida Albicans Viral Herpes zoster Others REACTIVE EczematousSeborrheic

81. CLINICAL FEATURES OF OTITIS EXTERNA Itching Pain Tenderness and swelling Otorrhea Deafness Changes in the lumen and skin of EAM

82. CLINICAL TYPES OF OTITIS EXTERNA Localize O.E ( furuncle)

83. CLINICAL TYPES OF OTITIS EXTERNA Localize O.E ( furuncle) Diffuse infective O.E.

84. CLINICAL TYPES OF OTITIS EXTERNA Localize O.E ( furuncle) Diffuse infective O.E. Otomycosis

85. CLINICAL TYPES OF OTITIS EXTERNA Localize O.E ( furuncle) Diffuse infective O.E. Otomycosis Bullous myringitis

86. CLINICAL TYPES OF OTITIS EXTERNA Localize O.E ( furuncle) Diffuse infective O.E. Otomycosis Bullous myringitis Herpetic O.E.

87. CLINICAL TYPES OF OTITIS EXTERNA Localize O.E ( furuncle) Diffuse infective O.E. Otomycosis Bullous myringitis Herpetic O.E Eczematous and seborrheic O.E.

88. CLINICAL TYPES OF OTITIS EXTERNA Localize O.E ( furuncle) Diffuse infective O.E. Otomycosis Bullous myringitis Herpetic O.E Eczematous and seborrheic O.E. “Malignant” otitis externa

89. MANAGEMENT OF OTITIS EXTERNA Swab for culture and sensitivity Ear toilet Keep the ear dry Local medications Systemic medications Surgery may be required in chronic cases

90. NECROTIZING (MALIGNANT) OTITIS EXTERNA An acute Pseudomonas infection of the skin of the external ear canal which has spread to the adjacent bone. It occurs mostly in elderly diabetic patients.

91. Complications

92. DIAGNOSIS Diabetes Advanced age Severe otalgia Granulation tissue Cranial nerve involvement Radiology

94. TREATMENT Anti Pseudomonas antibiotics Local treatment and debridement Control of diabetes The role of surgery remains controversial

95. MISCELLANEOUS CONDITIONS OF THE EXTERNAL EAR

96. WAX Mixture of ceruminous and sebaceous glands secretion Normally is expelled from the canal aided by movements of the jaw When accumulated it may cause deafness, earache or tinnitus

98. WAX Treatment is by removal using syringing, suction or instrumentation

100. KERATOSIS OBTURANS Accumulation of desquamated epithelium in the bony canal It may be associated with sinusitis, bronchiectasis or primary ciliary dyskinesia Usually cause deafness and pain Treatment is periodic removal

101. ACUTE OTITIS MEDIA

102. DEFINITION Acute infection of the mucous membrane lining of the middle ear cleft

103. PREDISPOSING FACTORS Age Maleness Bottle feeding Climate Crowded living conditions Heredity Associated conditions: cleft palate, immunodeficiency, ciliary dyskinesia, Down syndrome, and cystic fibrosis

104. ROUTE OF INFECTION Eustachian tube External auditory canal Blood borne

105. BACTERIOLOGY Streptococcus pneumonia Haemophilus influenzae Branhamella catarrhalis Streptococcus pyogens Staphylococcus aureus

106. PATHOLOGY Tubal occlusion Exudative inflammation Suppurative inflammation Tympanic membrane rupture Resolution

107. PATHOLOGY

108. CLINICAL PICTURE Tubal occlusion –Discomfort, autophony, retracted drum Exudative inflammation –Fever, earache, deafness, congested drum Suppurative inflammation –Fever, sever earache, deafness, bulging drum Tympanic membrane rupture – Otorrhea... temp. & earache subside Resolution

110. TREATMENT Symptomatic Antimicrobials –Amoxycillin/clavulanic acid –Tri-methoprim- sulphamethoxazole –Cefaclor, cefixime –Erythromycin-sulfisoxazole Decongestant Myringotomy Ear toilet and local antibiotics

111. RECURRENT ACUTE OTITIS MEDIA

112. DEFINITION Three or more attacks over a 6-months period

113. TREATMENT Long-term low dose antimicrobials Ventilation tube insertion

115. THANK YOU