Ear disease presentation (manchester g ps)

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Management of external ear disease

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  • Solar keratosis – Sundamagedskin,painless, scaly, cream, ‘cutaneous horn’, not malignant, no treatment/cryotherapy/excisionSeborrhoeickeratosis – Round, dark, wart like, not malignant, ‘liver spots’, sun damage, no treatment/cryotherapy/excisionTophi – Painless, smooth, uric acid crystals subcutaneously, resolve slowly with treatment of gout
  • CDHNC – pressure induced, painful, round raised, central crust, helix or antihelix, cryotherapy/excisionKeloid – Follows piercing, dark skin, hypertrophy of fibrous tissue, excise/inject steroid/clasp ear ringDarwins tubercle – Inherited, thickening of cartilage of helix
  • Ear disease presentation (manchester g ps)

    1. 1. Ear Disease<br />Simon Lloyd<br />Consultant ENT Surgeon<br />Manchester Royal Infirmary<br />
    2. 2. Anatomy<br />
    3. 3. Tympanic Membrane<br />Left ear<br />Long process of incus<br />Pars flaccida<br />Handle of malleus<br />Pars tensa<br />Light reflex<br />
    4. 4. Middle Ear<br />
    5. 5. Inner Ear<br />Consists of:<br />Semi-circular canals<br />Vestibule<br />Cochlea<br />Function:<br />Balance<br />Hearing<br />
    6. 6. Clinical Assessment<br />
    7. 7. Symptoms<br />5 symptoms<br />Otalgia<br />Otorrohoea<br />Hearing impairment<br />Tinnitus<br />Vertigo<br />
    8. 8. Investigation<br />
    9. 9. Pure Tone Audiometry<br />
    10. 10. Familiar Sounds<br />
    11. 11. External Ear<br />
    12. 12. Otitis externa<br />Inflammation of ear canal skin<br />Aetiology:<br />Bacterial – Staph. aureus, Pseudomonas, Proteus<br />Fungal – Aspergillus niger, Candida albicans<br />Viral – Herpes simplex,Herpes zoster<br />Reactive – Eczema, Psoriasis<br />Predisposing factors:<br />Bathing, humidity<br />Trauma<br />Canal stenosis<br />Eczema<br />
    13. 13. Symptoms & Signs - Bacterial<br />Otalgia - severe<br />Purulent otorrhoea<br />Deafness<br />Inflammation of ear canal +/- pinna<br />
    14. 14. Treatment<br />Swab for sensitivities<br />Aural toilet<br />Splinting of ear canal (Pope wick)<br />Topical antibiotics eg. Sofradex, Gentasone<br />Keep dry<br />
    15. 15. Malignant OtitisExterna<br />Osteomylitis of temporal bone<br />Immunocompromised patients eg. Diabetes<br />Usually pseudomonas<br />Extremely painful<br />May be associated with cranial nerve palsy<br />Have a high index of suspicion<br />Treat aggressively with IV antibiotics for at least 6 weeks<br />
    16. 16. Symptoms & Signs - Fungal<br />Itching<br />Mild otalgia<br />Fullness<br />Greyish white debris +/- fungal spores<br />
    17. 17. Treatment<br />Aural toilet<br />Topical antifungal agents eg. Canestan<br />
    18. 18. Furunculosis<br />Staph. infection of hair follicle causing abscess formation<br />Severe otalgia<br />Requires I&D<br />
    19. 19. Ramsey Hunt Syndrome<br />Herpes zoster<br />Geniculate ganglion of facial nerve<br />Vesicular rash of pinna and ear canal (+/- mouth and tongue)<br />Facial nerve palsy<br />Painful<br />Vertigo<br />Treatment<br />Analgesia<br />Antiviralseg. Acyclovir<br />Protect the eye<br />
    20. 20. Perichondritis<br />Inflammation of perichondrium<br />Aetiology:<br />Ear piercing<br />Laceration<br />Surgery<br />CT disease<br />Treatment:<br />Antibiotics<br />I & D (if abscess)<br />Sequelae: <br />Cauliflower ear<br />
    21. 21. Foreign body in ear<br />
    22. 22. Hyperostosis<br />Exostosis<br />Multiple bony swellings in deep canal<br />Cold water<br />Asymptomatic<br />No treatmentunless large<br />Osteoma<br />Single benign bony tumour outer bony meatus<br />No treatment unless large<br />
    23. 23. Embryology<br />
    24. 24. First Branchial Cleft Anomalies<br />Pre-auricular sinus<br />
    25. 25. First Branchial Cleft AnomaliesAccessory Auricle<br />
    26. 26. Benign Skin Pathology<br />SeborrhoeicKeratosis<br />Gouty Tophi<br />Solar keratosis<br />
    27. 27. Benign Skin Pathology<br />Chondrodermatitishelicisnodularischronica<br />Keloid Scarring<br />Darwin’s tubercle<br />
    28. 28. Malignant Skin Pathology of The Pinna<br />Basal Cell Carcinoma<br />Squamous Cell Carcinoma<br />

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