Dse

Pathogenesis/ Causes
Deformities and Malformations of the EXTERNAL EAR
Prominent Ears
normal congenital variant

Diagnosis

Exostoses (true
osteomas)

near annulus on
superomedial canal wall
from ossification centers

pale, rounded bony prominences

on otoscopy

Cerumen impaction

disturbance of normal selfcleansing mechanism

excessive cerumen secretion

Sx:pressure sensitisation with

hearing loss, vertigo, tinnitus

Complications

recurrent OTITIS
EXTERNA
CONDUCTIVE
HEARING LOSS on
high-grade stenoses
may develop OTITIS
EXTERNA

DDx: cholesteatoma, tumors,

foreign bodies, crusted blood

Auricular appendages

Aural fistulas
Preauricular fistulas
Cysts

skin and cartilage

from aberrant embryonic cell
rests trapped in the area of
1st brachial cleft
from sites of epithelial
retention in 1st brachial cleft

Grade 1 dysplasia

Grade 2 dysplacia (mild

microtia)
Grade 3 dysplasia
(microtia and anotia)

preauricular

openings commonly found at

preauricular sites on the helical
rim
infra or retroauricular continuum
in high cervical fistulas
-prominent ears
-macrotia
-Darwinian tubercles
-auricular apex or helical
projections
-macacus ear with partial
absence of helix
small, severely misshapen
auricle, lack subunits
ext meatus anomaly
absent auricular structures, atretic
ear canal

Tx

Prognosis

Notes

surgical correction- ear

dressing worn 2 weeks after
op
surgery

no fxnal
consequences

NORMAL: 20-30
deg

removed with a hook,

currette
or by aural irrigation
-hydrogen peroxide/glycerincontaining/detergents
-posterosuperior
-followed by otoscopy and
tuning fork test
CI: positive otologic hx,
single earing ear affected,
restless, foreign body
excision

***avoid cottontipped swabs

cerumen plug= FA,

lysozymes, sebum,
exfoliative debris,
contaminants

partial reconstruction- local

cartilage, advancement flaps
or preliminary expansion
bone conducting hearing aid
for unilateral atresia in
children (1st months)
surgery at 10 yrs- autologous
carilage grafts from costal
cartilage
epithesis

Stenosis and atresia of

ear canal
Foreign bodies

children-beads, lego

history, otoscopy

middle and inner ear

small extraction hook

Dse

Pathogenesis/ Causes
adults-ear plugs, obj for
manipulation

Injuries and Physical Damage

Auricular hematoma
due to blunt trauma causing
Auricular Seroma
separation of skin and
attached perichondrium from
the auricular cartilage
Sharp auricular injury
Auricular avulsion
(partial or complete)

Diagnosis
DDx:
cerumen impaction, dried blood,
ear canal tumors, cholesteatoma,
otitis externa
Sx: trauma itself is painful, no
pain afterward
DDx: recurrent polychondritis->
spontaneous seroma
associated injuries of the
temporal bone, ear canal, middle
ear or TMJ should be excluded

Complications
damage
otitis externa with fetid
discharge

Tx
*do not use irrigation
general anesthesia for
children
Lidocaine 10% for insects

secondary infection by
needle aspiration->
perichondritis

surgery
-perichondrium reattached
-oil-impregnated cotton/
contoured dressing
*seromas may recur
cover wound with sterile
dressing
refer px
send severed parts with th px
cool the part using moist
gauze in plastic bag
immersed in ice water
-no more than 6 hr for
reanastomosis
local tx should not exert
pressure on auricle
superficial: cooled, antiinflamm
severe:debridement

cauliflower ear
soft-tissue infection
perichondritis
necrosis

Burns

Grade 1: localized erythema

Grade 2: blistering of skin
Grade 3: deep tissue necrosis

Frostbite

initially as white skin, demarcated

painful when area is rewarmed

External Auditory Canal

injury

foreign bodies
harmful manipulation
previous trauma
Inflammatory Dses of the Ext Ear
Eczema and Dermatitis
confined to the dermis
of the Auricle
-jewelries, soaps, cosmetics,
listening aids, thermal injury

tender
bleeding, hemorrhagic bulla or
crusted blood

infection
cyst
stenosis due to scarring

ITCHING, occasional burning with

little pain
erythematous skin, may be dry
and scaly or moist and weeping
DDx:
perichondritis
pyoderma, celluliis
preauricular crease- seborrheic
dermatitis, psoriasis

bacterial complications
in the p=form of
pyoderma,
perichondritis, cellulitis

Perichondritis of Auricle

SEVERE PAIN of rapid onset and

feeling of TENSION
effaced auricular contours
swelling, tenderness of concha

cartilage destruction with

permanent auricular
deformity

-acute inflammation of
skin and perichondrium

bacterial infection dt conchal

cavity or auricular injurylateral
Staphylococci

cartilage necrosis,
permanent deformity
chilblains on the helical
rim with ulcerations and
itching
perichondritis

gently warmed with heat

lamp
dextran or pentoxifylline for
circulatory stimulation
6 months healing then
surgery
reapproximate epithelium
Gelfoam or synthetic sponge
for bleeding

systemic antibac against

staph
NSAIDs

Prognosis

Notes

ear protection

poor prognosis for

complete avulsion

uncomplicated

Dse
plus articular cartilage,
localized

Pathogenesis/ Causes
Pseudomonas

Diagnosis
blisters
earlobe- spared
lymphadenopathy
fever

Complications

Tx

glomerulonephritis,
rheumatic fever,
rheumatic
endochondritis

PCN G 4x2 mega IU IV

NSAIDs

Prognosis

leukocytosis, high XRP and/or

CSR

Auricular cellulitis

access through concha or ext

meatus injuries

-acute strep infection of

subQ involving auricle
and surroundings

Herpes zoster oticus or

Ramsay Hunt syndrome

reactivation of dormant VZV

in ganglion cells
CN7 and/or CN 8,
occasionally 9, 10

Diffuse otitis externa

and eczema of external
ear canal

gram (-): Pseudomonas

aeruginosa, Proteus mirabilis
anaerobes
otomycosis
myringitis
otitis externa

Circumscribed otitis
externa

local mechanical trauma and

contamination lead to

DDx:
eczema, dermatitis, cellulitis,
zoster oticus
recurrent polychondritis
redness, swelling, warmth
involved earlobe and facial skin
malaise, fever, otalgia
DDx:
eczema, dermatitis perichondritis,
zoster oticus

ear pain or burning on one side

vesicles errupt
followed by hearing loss, vertigo,
dysequilibrium
facial nerve palsy
clustered, herpetiform vescicles
at meatus and concha , *pinna
direct electron microscopy
four-fold titer increase
DDx:
bullous otitis externa, otitis media,
mastoiditis, labyrinthitis,
cholesteatoma, tumors of ear and
lateral skull base
ITCHING
pain if with infection
crusting, purrulent aural
discharge
conductive hearing loss in
obstruction
diffuse swelling
fetid- anaerobes
DDx:
acute otitis media, chronic
suppurative otitis externa,
otomycosis, tumor, necrotizing
otitis externa if with otalgia
very PAINFUL, tender swelling,
mild hearing loss

necrotizing fascitisanaerobes
bacterial infection:
staphylococci,
pseudomonas

acyclovir
valaciclovir
famiciclovir

zoster
meningoencephalitis

corticosteroids if with facial

nerve palsy

post-zoster neuralgia in
older patients

antiseptic

perichondritis
cellulitis
abscess
necrotizing otitis externa

meticulous, repeated
cleansing and drying of ear
canal
antiseptic, antibiotic drops
no more than 2 weeks

severe course on px with

DM

cleaned with 70% alcohol

applied to a SELF-

permanent
functional deficits
poorer prognosis
than idiopathic
facial paralysis

Notes

Dse
or furuncle
-acute cartilaginous
infection of ear canal

Necrotizing otitis
externa
or Malignant otitis
externa

Pathogenesis/ Causes
obstruction of hair follicles or
glandular ducts followed by
staph infections of
pilosebaceous units

older px with DM
begin with simple otitis
externa that becomes
infected with Pseudomonas
auriginosa

Bullous otitis externa

Flu-related otitis,
hemorrhagic otitis
externa

influenza virus*
toxic capillary damage in the
thin eithelial layer of the
meatal skin and on the
tympanic membrane

Otomycosis

saprophytic fungi
Aspergillus, Candida
albicans, Mucor
dermatophytes

Recurrent polychondritis
relapsing polychondritis
systemic
chondromalacia
chronic atrophic
panchondritis
Chronic
chondrodermatitis

auricular perichondritis as
initial manifestation
auricle and nose deformities,
chronic bronchitis, dyspnea
dt larynx and trachea
involvement
cutaneous-perichondrial unit
older px

Diagnosis

Complications

Tx
EXPANDING FOAM or
GAUZE WICK for 1-2 days
antibiotic ointment strips for
crusts
antibiotic and steroid drops
after swelling subsides
NSAIDs
incision for clearly
demarcated abscess

Prognosis

infection may spread to

middle ear, skull base,
retromandibular fossa,
parotid compartment

locally debrided and cleanes

antibiotic against
Pseudomonas for 6 weeks
bone resection

50% survival in
cases that
develop facial
nerve palsy

I/P: tragal tenderness,

circumscribed swelling
Ot: swelling, debris, tympanic
membrane unseen
some degree of hearing loss
pus pocket
DDx: foreign bodies, otitis externa
with chronic suppurative otitis
media, infected retroauricular
atheroma, tumors`
osteitis and ulceration on canal
flooor with exposed, brownish
bone and a fetid discharge
moderate pain at first
DDx:
simple otitis externa,
cholesteatoma, tumor, chronic
otitis media

severe otalgia of sudden onse

followed by a bloddy discharge
may develop conductive and
sensorineural hearing loss
DDx:
trauma (barotrauma)
herpes zoster oticus
tumors
severe itching and feeling of
fullness
white, yellow or black membrane
lining swollen erythematous skin
bony portion of the canal
exclusively affected
mycelia
may develop from suppurative
otitis media
DDx:
diffuse otitis externa
systemic inflammatory disease
Ab against cartilage tissue

very PAINFUL epithelial nodule

with an umbilicaterd center on the

mastoiditis, petrostitis,
otitis media, soft tissue
abscess, CN 7-11
deficits, sepsis, venous
sinus thrombosis,
meningitis
middle ear or inner ear
(labyrinthitis)

tympanic membrane
infection can lead to
perforation and otitis
media

local anesthetic ear drops

NSAIDs
no specific antiviral therapy

clean, dry
local antimycotics
soften with salicylate
containing solution

oral corticosteroids
azathioprine
cyclosporin

complete excision

refractory course
tendency to recur

Notes

Dse
nodularis helicis
Winkler disease
Gouty tophi

Lymphadenosis cutis
benigna (Bafvertedt
disease)
Granulating otits
externa

Specific otitis externa

Pathogenesis/ Causes
DDx:
tumors
gouty tophi
near the joints and auricular
cartilage
Borrelia burgdoferi, tick bite
hx
spontaneous or sequel to
otitis externa or surgery

Syphillis stage 1
Mycobacterium TB
atypical mycobacteria

Diagnosis
free border helix or antihelix

Complications

Tx

small, pale, freely movable

subcutaneous nodules on the
helical rim
firm reddish nodule on earlobe

no need

circumscribed or diffuse
granulations on the skin of the
bony ear canal and tympanic
membrane

removal of granulations
topical antibiotics and
corticosteroids

DDx:
necrotizing otitis externa
tumor
`

Prognosis

>>>

refractory

Notes