A Practical Guide to Diseases
of the Ear
Simon Lloyd
Consultant ENT Surgeon
Manchester Royal Infirmary
Otitis externa Acute otitis media Chronic otitis media
without cholesteatoma
Chronic otitis media
with cholesteatoma
Otiti...
Acute Otalgia with normal TM
Otitis externa
• Inflammation of ear canal skin
• Aetiology:
– Bacterial – Staph. aureus, Pseudomonas, Proteus
– Fungal – ...
Symptoms & Signs - Bacterial
• Otalgia - severe
• Purulent otorrhoea
• Deafness
• Inflammation of ear
canal +/- pinna
Treatment
• Swab for sensitivities
• Aural toilet
• Splinting of ear canal
(Pope wick)
• Topical antibiotics eg.
Sofradex,...
Malignant Otitis Externa
• Osteomylitis of temporal bone
• Immunocompromised patients eg. Diabetes
• Usually pseudomonas
•...
Symptoms & Signs - Fungal
• Itching
• Mild otalgia
• Fullness
• Greyish white debris
+/- fungal spores
Treatment
• Aural toilet
• Topical antifungal agents eg. Canestan
Furunculosis
• Staph. infection of
hair follicle causing
abscess formation
• Severe otalgia
• Requires I&D
Ramsey Hunt Syndrome
• Herpes zoster
• Geniculate ganglion of
facial nerve
• Vesicular rash of pinna
and ear canal (+/- mo...
First Branchial Cleft Anomalies
Pre-auricular sinus
First Branchial Cleft Anomalies
Pre-auricular sinus
First Branchial Cleft Anomalies
Pre-auricular sinus
First Branchial Cleft Anomalies
Accessory Auricle
Benign Skin Pathology
Benign Skin Pathology
Gouty
Tophi
Benign Skin Pathology
Seborrhoeic Keratosis
Gouty
Tophi
Benign Skin Pathology
Seborrhoeic Keratosis
Gouty
Tophi
Solar keratosis
Benign Skin Pathology
Benign Skin Pathology
Chondrodermatitis
helicis nodularis
chronica
Benign Skin Pathology
Chondrodermatitis
helicis nodularis
chronica
Darwin’s tubercle
Benign Skin Pathology
Chondrodermatitis
helicis nodularis
chronica
Keloid ScarringDarwin’s tubercle
Malignant Skin Pathology of The
Pinna
Malignant Skin Pathology of The
Pinna
Basal Cell Carcinoma
Malignant Skin Pathology of The
Pinna
Basal Cell Carcinoma
Squamous Cell Carcinoma
Middle Ear
• Otitis media
– Acute
– Chronic otitis media +/- cholesteatoma
– Otitis media with effusion
– Complications
• ...
Acute Otitis Media
• Definition
– Inflammation of the middle ear cleft
• Demographics
– Mostly children (age 3-7)
• Aetiol...
Natural History
Infection via ET tube (Fever)
Mucosal oedema
Hyperaemia of tympanic membrane &
purulent middle effusion
Bu...
Acute Otitis Media
Acute Otitis Media
• Treatment
– Expectant
– Paracetamol/NSAIDS
– Oral amoxycillin
– +/- myringotomy
• Complications
– Acu...
Acute Mastoiditis
• History of acute otitis
media
• Infection spreads to
mastoid
• Post-auricular abscess
• Treatment
– Gr...
Mastoiditis Treatment
Intracerebral Abscess
Ring
enhancement
with contract
enhanced CT
Lateral Sinus Thrombosis
Filling defect
on MRA
Tympanic Membrane Perforation
• Causes
– Trauma
– Otitis media
– Iatrogenic eg. Grommets
• Symptoms
– None
– Recurrent oto...
Tympanic Membrane Perforation
• Treatment
– None
– Myringoplasty
– +/- ossiculoplasty
Graft is placed under
perforation to...
Chronic Otitis Media
• Without cholesteatoma
– Tympanic membrane perforation
– Chronic middle ear infection
– May resolve ...
Chronic Otitis Media
• With cholesteatoma
• Eustachian tube dysfunction results in tympanic membrane retraction
(attic)
• ...
Cholesteatoma
Chronic Otitis Media with
Cholesteatoma
Chronic Otitis Media with
Cholesteatoma
• Treatment is surgical
• Aims of surgery
− Remove all disease
− Dry ear
− +/- Res...
Chronic Otitis Media with
Cholesteatoma
Post-auricular incision Mastoid air cells
drilled away
Posterior ear canal
removed...
Inner Ear
Sudden Hearing Loss
• Normal TM with sudden hearing loss
• Aetiology unknown
• Viral
• Vascular
• Rarely acoustic neuroma,...
Cochlea Drug Delivery
Sudden Hearing Loss
Management
• Refer urgently
• Treatment options
• Oral steroid
• Antiviral
• No evidence for efficacy
...
Hyperostosis
• Exostosis
– Multiple bony swellings in
deep canal
– Cold water
– Asymptomatic
– No treatment unless large
•...
Perichondritis
• Inflammation of
perichondrium
• Aetiology:
– Ear piercing
– Laceration
– Surgery
– CT disease
• Treatment...
Upcoming SlideShare
Loading in...5
×

External and middle ear disease for g ps

2,528

Published on

Published in: Health & Medicine
0 Comments
3 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
2,528
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
204
Comments
0
Likes
3
Embeds 0
No embeds

No notes for slide
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • External and middle ear disease for g ps

    1. 1. A Practical Guide to Diseases of the Ear Simon Lloyd Consultant ENT Surgeon Manchester Royal Infirmary
    2. 2. Otitis externa Acute otitis media Chronic otitis media without cholesteatoma Chronic otitis media with cholesteatoma Otitis media with effusion Severe Otalgia Otalgia for a few days Otorrhoea intermittently or for more than 3 months Otorrhoea intermittently or for more than 3 months Hearing loss Mild otorrhoea Fever Possibly conductive hearing loss Probably conductive hearing loss Speech delay Occasionally conductive hearing loss Otorrhoea once otalgia resolves Usually a child History of swimming/holiday Conductive hearing loss May have adenoidal symptoms Often a child Differentiating Types of Otitis
    3. 3. Acute Otalgia with normal TM
    4. 4. Otitis externa • Inflammation of ear canal skin • Aetiology: – Bacterial – Staph. aureus, Pseudomonas, Proteus – Fungal – Aspergillus niger, Candida albicans – Viral – Herpes simplex,Herpes zoster – Reactive – Eczema, Psoriasis • Predisposing factors: – Bathing, humidity – Trauma – Canal stenosis – Eczema
    5. 5. Symptoms & Signs - Bacterial • Otalgia - severe • Purulent otorrhoea • Deafness • Inflammation of ear canal +/- pinna
    6. 6. Treatment • Swab for sensitivities • Aural toilet • Splinting of ear canal (Pope wick) • Topical antibiotics eg. Sofradex, Gentasone • Keep dry
    7. 7. Malignant Otitis Externa • Osteomylitis of temporal bone • Immunocompromised patients eg. Diabetes • Usually pseudomonas • Extremely painful • May be associated with cranial nerve palsy • Have a high index of suspicion • Treat aggressively with IV antibiotics for at least 6 weeks
    8. 8. Symptoms & Signs - Fungal • Itching • Mild otalgia • Fullness • Greyish white debris +/- fungal spores
    9. 9. Treatment • Aural toilet • Topical antifungal agents eg. Canestan
    10. 10. Furunculosis • Staph. infection of hair follicle causing abscess formation • Severe otalgia • Requires I&D
    11. 11. Ramsey Hunt Syndrome • Herpes zoster • Geniculate ganglion of facial nerve • Vesicular rash of pinna and ear canal (+/- mouth and tongue) • Facial nerve palsy • Painful • Vertigo • Treatment – Analgesia – Antivirals eg. Acyclovir – Protect the eye
    12. 12. First Branchial Cleft Anomalies Pre-auricular sinus
    13. 13. First Branchial Cleft Anomalies Pre-auricular sinus
    14. 14. First Branchial Cleft Anomalies Pre-auricular sinus
    15. 15. First Branchial Cleft Anomalies Accessory Auricle
    16. 16. Benign Skin Pathology
    17. 17. Benign Skin Pathology Gouty Tophi
    18. 18. Benign Skin Pathology Seborrhoeic Keratosis Gouty Tophi
    19. 19. Benign Skin Pathology Seborrhoeic Keratosis Gouty Tophi Solar keratosis
    20. 20. Benign Skin Pathology
    21. 21. Benign Skin Pathology Chondrodermatitis helicis nodularis chronica
    22. 22. Benign Skin Pathology Chondrodermatitis helicis nodularis chronica Darwin’s tubercle
    23. 23. Benign Skin Pathology Chondrodermatitis helicis nodularis chronica Keloid ScarringDarwin’s tubercle
    24. 24. Malignant Skin Pathology of The Pinna
    25. 25. Malignant Skin Pathology of The Pinna Basal Cell Carcinoma
    26. 26. Malignant Skin Pathology of The Pinna Basal Cell Carcinoma Squamous Cell Carcinoma
    27. 27. Middle Ear • Otitis media – Acute – Chronic otitis media +/- cholesteatoma – Otitis media with effusion – Complications • Tympanic membrane perforation • Hearing loss – Conductive
    28. 28. Acute Otitis Media • Definition – Inflammation of the middle ear cleft • Demographics – Mostly children (age 3-7) • Aetiology – Viral (majority) – Bacterial (1y or 2y) - Strep. Pneumoniae, H. influenzae, Bramhamella catarrhalis) • Risk Factors – Poor sanitation/ hygiene and parental smoking – Exposure to other children – Eustachian Tube Dysfunction – ? allergy
    29. 29. Natural History Infection via ET tube (Fever) Mucosal oedema Hyperaemia of tympanic membrane & purulent middle effusion Bulging tympanic membrane (Pain) Pressure necrosis of tympanic membrane resulting in perforation Mucopurulent discharge
    30. 30. Acute Otitis Media
    31. 31. Acute Otitis Media • Treatment – Expectant – Paracetamol/NSAIDS – Oral amoxycillin – +/- myringotomy • Complications – Acute • Mastoiditis • Facial palsy • Labyrinthitis • Meningitis • Intracranial abscess • Lateral sinus thrombosis - Long term • Tympanosclerosis • Tympanic membrane perforation • Ossicular damage
    32. 32. Acute Mastoiditis • History of acute otitis media • Infection spreads to mastoid • Post-auricular abscess • Treatment – Grommet – Cortical mastoidectomy
    33. 33. Mastoiditis Treatment
    34. 34. Intracerebral Abscess Ring enhancement with contract enhanced CT
    35. 35. Lateral Sinus Thrombosis Filling defect on MRA
    36. 36. Tympanic Membrane Perforation • Causes – Trauma – Otitis media – Iatrogenic eg. Grommets • Symptoms – None – Recurrent otorrhoea – Hearing loss
    37. 37. Tympanic Membrane Perforation • Treatment – None – Myringoplasty – +/- ossiculoplasty Graft is placed under perforation to allow epithelium to regrow Myringoplasty
    38. 38. Chronic Otitis Media • Without cholesteatoma – Tympanic membrane perforation – Chronic middle ear infection – May resolve with topical or oral antibiotics – If no resolution – myringoplasty +/- cortical mastoidectomy • Otorrohoea for more than 3 months • May occur with or without cholesteatoma
    39. 39. Chronic Otitis Media • With cholesteatoma • Eustachian tube dysfunction results in tympanic membrane retraction (attic) • Accumulation of keratin in retraction pocket • Gradual enlargement and adjacent bony destruction • Complications as for AOM above
    40. 40. Cholesteatoma
    41. 41. Chronic Otitis Media with Cholesteatoma
    42. 42. Chronic Otitis Media with Cholesteatoma • Treatment is surgical • Aims of surgery − Remove all disease − Dry ear − +/- Restore hearing • Types of operation – Modified radical mastoidectomy – Canal wall up mastoidectomy
    43. 43. Chronic Otitis Media with Cholesteatoma Post-auricular incision Mastoid air cells drilled away Posterior ear canal removed to leave mastoid cavity
    44. 44. Inner Ear
    45. 45. Sudden Hearing Loss • Normal TM with sudden hearing loss • Aetiology unknown • Viral • Vascular • Rarely acoustic neuroma, perilymph leak • May be unsteady or vertiginous
    46. 46. Cochlea Drug Delivery
    47. 47. Sudden Hearing Loss Management • Refer urgently • Treatment options • Oral steroid • Antiviral • No evidence for efficacy • Carbogen • No evidence for efficacy • Intratympanic steroid • Reasonable evidence for efficacy
    48. 48. Hyperostosis • Exostosis – Multiple bony swellings in deep canal – Cold water – Asymptomatic – No treatment unless large • Osteoma – Single benign bony tumour outer bony meatus – No treatment unless large
    49. 49. Perichondritis • Inflammation of perichondrium • Aetiology: – Ear piercing – Laceration – Surgery – CT disease • Treatment: – Antibiotics – I & D (if abscess) • Sequelae: – Cauliflower ear
    1. A particular slide catching your eye?

      Clipping is a handy way to collect important slides you want to go back to later.

    ×