External Ear

DISEASES OF THE EXTERNAL EAR

AURICALE
Congenital : Artesia ,microtia , secondary auricle, & preauricular sinus / fistula 2. Trauma : * haematoma *laceration

Hillocks (or accessory lobules).

Microtia.
Preauricular sinus
Prominent ears.
Hematomas
Trauma


Perichondritis - haematoma -extension of infection from EAM - iatrogenic
> Pseudomonas pyocyanea

C/F: - severe pain - swollen , hot & dusky color - necrosis &deformity Treatment : 1- ticarcillin 2- 3rd generation cephalosporin 3- incision



Is an inflammation of the skin of the external ear arising from local or general causes or from both. Predisposing factors: a- heat, humidity, bathing &swimming b- trauma via cotton buds, dirty finger& hair grips c- hereditary / narrow canal.

classification

Infective : 1-bacterial : - diffuse otitis ext. - localized (furunculosis) - malignant otitis ext. - erysipelas - perichondritis - impetigo


B- fungal : 1- Aspergillosis 2- candidiasis
C-viral : 1- herpes simplex 2- herpes zoster

B- Reactive

Eczematus Seborrhoeic Neurodermatitis Keratitis obturans psoriasis

furunculosis

Staphylococcal infection of the hair follicle affects the cartilaginous part of the EAM. c/f ; * itching * pain * hearing difficulty /large * regional lymphadenitis

DIFFRENTIAL DIAGNOSIS

ACUTE MASTOIDITIS / OM. HERPETIC LESIONS/ vesicles EXOSTOSIS / hard swelling

treatment

Antistaph/antibiotics Local soothing agent (oint.) Analgesia +/- sedation Incision

treatment

Systemic AB. Broad spectrum Local treatment * aural toilet * wick soacked with 8% alminium acetate * AB / steroid wick

Diffuse otitis externa

Infective dermatitis Mixed inf. / strept. , staph , & G-ve c/f: - itching - pain - redness - swelling - serous oozing - crust - LN. - scaling, fissuring& stenosis /chronic

Erysipelas

Acute superficial cellulitis Group A, beta hemolytic streptococci Skin: bright red; well demarcated,Advancing margin• Rapid treatment with oralor IV antibiotics

otomycosis

Aspergilla spp. ,candida Hot& moist climates c/f : * thick discharge * mass like wet newspaper * granules containing hyphae, & spores * pain is unusual X pyogenic infection

Dx: - direct ex. - culture

R/ : removal of mass Keratolytic agent Fungicides / nystatin , clotrimazole, amphotericin B


Herpetic lesion
H. simplex H. zoster oticus Otitis externa haemorrhagica

Herpes zoster oticus

c/f : pain may present several days before rash Vesicular rash /concha /disappear early cranial n. palsies ( VII.) vertigo SNHL R/ : antiviral ( acyclovair) analgesia

Pseudomonal inf. Not infrequently fatal/ involvement of the sigmoid sinus or meninges Elderly diabetic & immune compromised pt. Osteitis +/_ osteomyelitis Cr. N n (V, VI, VII, --- IX,X, XI, XII)

Clinical features

Pain Discharge , may be seropurulent Granulation tissue / floor Cr. N. palsies

treatment

Medical: Control of DM 3rd generation cephalosporin Gentamycin Topical application of the gentamycin.

2-Surgical R/ : removal of the gr. T. /mastoidectomy Prognosis: -worse with cr , n . Involvement - may be fatal

Bullous Myringitis

• Viral infection• Confined to tympanic membrane• Primarily involves younger children

Bullous Myringitis: Symptoms

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

Bullous Myringitis: Signs

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

Bullous Myringitis: Treatment

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


Eczematous ot, ext. Aetiology: *- extrensic factors : - general/ food, inhalation allergy - local / contact dermatitis//nickle ( spectacle frame). * - intrensic factors : psychosomatic (neurodermatitis)

c/f: * Iritation ,redness , +/_ oedema * Weeping & crust formation * Scaling & fissuring in chronic state R/ : * local & systemic steroid * antihistamine