DISEASE OF EXTERNAL CANAL

I) CONGENITAL
CONGENITAL ATRESIA Failure of canalization of ext ear unilateral/bilateral usually congenital in ext ear associated with congenital in auricle and mid ear. INVESTIGATION CT scan : evaluate degree of atresia Audiologcal : TTT Unilateral cases Bilateral cases plastic surgery after puberty hearing aid after few month To help speech development Reconstruction surgery 6 yrs 1 ear,other After puberty Bilateral dead ear lip reading,cosmetic Surgery. B)LONGITUDINAL FRACTURE TEMPORAL BONE

II) TRAUMA
A) LACERATION Causes Sign self inflicted, unskilled ear wash mild bloody otorrhea,laceration otitis externa

Complication ttt

Antibiotic+steroid ear drop

C)FOREIGN BODY Common in child

Animate

mosquito,fleas discomfort, Should be kill by oil then ear Wash

Inanimate

vegetable(seed,beans) Use hook to remove it,dont Wash coz it will swell non-vege(paper) use ear Wash, asymptomatic May coz conductive deafness

Impacted dd

postauricular incision under Anesth. (ttt)

Complication

Skin&tympanic memb. Injury Impaction Otitis interna

D) Traumatic rupture Drum Tortuous direction protect the tympanic memb. Etiology Indirect : hand slap,otitic barotrauma Explosion

Direct : F.B , self inflicted, Unskill ear wash,

Sign

Blood in ext meatus

Perforation characterized by - central in pars tensa - small size - irregular hyperaemic sharp edge. In self inflicted perforation - perforation small - in post sup part tymp. Memb.

Conductive hearing loss

III) INFLAMMATION OF EXTERNAL EAR

(OTITIS EXTERNA) A) INFECTIVE
Diffuse otitis externa Localized otitis externa(Furuncle) Malignant otitis externa

Bacterial

Otomycosis

Fungal
Bullous myringitis Herpes zoster oticus

Viral

B) NON INFECTIVE (REACTIVE)

Eczematous otitis externa

Seborrhaeic otitis Externa

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FURUNCLE

DIFFUSE OTITIS EXTERNA

Def.

Localized supp. Infection oh hair follicle in skin lining of ext canal.

Diffuse inflamm. Of skin lining of ext canal.

Causative organism

Staph. aureus

Staph. Aureus, pseudomonas

Predispose scratch canal skin by contaminated bud Factor Debiliating disease(D.M)

self inflicted scratch canal skin by contaminated ear bud unskilled ear wash Local Earache : severe, On mastication

Symptoms

General absent coz area supp. is small. Local Earache : severe throbbing(coz skin Tightly attach to perichondrium) and On moving jaw( mastication)

Hearing Loss( when edema Occlude ext canal Hearing Loss( when furuncle is large And occludes ext canal Sign localized red tender swelling(outer cartilaginous 1/3 ext canal) Otorrhea(scanty,purulent when it rupture) tenderness pre&post auricular lymphadenitis diffuse redness, edema, tenderness skin of ext canal otorrhea tenderness pre & post auricular lymphadenitis

Treatment

Systemic

Antibiotics

Systemic

Antibiotics

Analgesic Local Aural toilet: repeat remove ear Discharge by suction Packing canal with gauze strip Soaked with antibiotic/steroid ear drop Local ear

Analgesic Aural toilet: repeat remove Discharge by suction Packing canal with gauze strip Soaked with antibiotic/steroid ear drop

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MALIGNANT OTITIS EXTERNA

Causative org : pseudomonas aeruginosa occur in immunocompromised patient & usually effect old diabetics angiopathy diabetics role in aggressive spread to skull(osteomyelitis)

Pathology

Facial n. Paralysis& jugular Foramen syndrome(9,10,11 n)

To big vessel of neck

Intracranial spread Start as otitis externa(severe pain) & doesnt respone to ttt

Clinical Picture

Granulation tissues at junction of bony,cartilaginous part

Scanty ,sanguineous, purulent discharge

Facial & other cranial nerve palsies

INVESTIGATION

CT scan of temporal bone, skull base & MRI Biopsy Culture& sensitivity for discharge Blood & urine test for sugar

TREATMENT

1) 2) 3) 4) 5)

CONTROL DIABETES MASSIVE ANTIBIOTIC THERAPHY ( QUINOLONES,CEPHALOSPORINE) ANALGESIC AURAL TOILET&ANTIBIOTIC EAR DROP SURGICAL