Diseases of external ear

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This presentation discusses disorders affecting the external auditory canal

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Diseases of external ear

  1. 1. Diseases of external ear Dr T Balasubramanian drtbalus otolaryngology online
  2. 2. Anatomy of external canal● Length 2.5 cms● Outer 1/3 cartilagenous● Inner 2/3 bony● Postero superior wall is shorter than antero inferior wall● It is not a straight tube drtbalus otolaryngology online
  3. 3. Classification● Congenital● Inflammatory● Reactive● Trauma● Tumors drtbalus otolaryngology online
  4. 4. Congenital conditions● Preauricular sinus● Congenital swellings (Pinna)● Collaural fistula● Congenital anamolies (Pinna)● Atresia external canal● Congenital tumors of external canal drtbalus otolaryngology online
  5. 5. Preauricular sinus drtbalus otolaryngology online
  6. 6. Preauricular sinus (synonyms)● Preauricular pit● Preauricular sinus● Preauricular tract● Helical fistula● Preauricular cyst drtbalus otolaryngology online
  7. 7. Pinna (Embryology)● Begins during the 6th week of gestation● Begins from 6 hillocks (Hillocks of His)● 3 hillocks arise from caudal border of I arch● Other 3 arise from the cephalic border of II arch drtbalus otolaryngology online
  8. 8. Embryology of Pinna drtbalus otolaryngology online
  9. 9. Preauricular sinus theories● Embryological fusion: Incomplete fusion of Hillocks● Ectodermal infolding: Isolated ectodermal infolding● Incomplete closure of dorsal part of first pharyngeal groove: (accepted) drtbalus otolaryngology online
  10. 10. Mode of inheritance● Autosomal dominant● Varying degrees of penetrance● Chromosome 8q 11 (postulated) drtbalus otolaryngology online
  11. 11. Preauricular sinus (syndromes)● BOR syndrome (Branchio oto renal)● Branchio oto urethral● Branchio otic syndrome● Branchio otocostal syndrome● Cat eye syndrome● Trisomy 22 drtbalus otolaryngology online
  12. 12. Preauricular sinus clinical features● Seen as a small pit along the anterior margin of ascending limb of helix● The tract usually blends with the perichondrium of auricle● Sinus tract is usually superior and lateral to facial nerve and parotid gland● Subcutaneous cyst formation in the area is common drtbalus otolaryngology online
  13. 13. Common sites of preauricular sinus drtbalus otolaryngology online
  14. 14. Management● Complete removal with the tract● Leaving behind remanant leads to recurrence drtbalus otolaryngology online
  15. 15. Complete resource can be found here http://www.drtbalu.co .in/preauricular.html drtbalus otolaryngology online
  16. 16. Congenital swellings of pinna● Dermoid● Hemangiomas● Lymphangiomas drtbalus otolaryngology online
  17. 17. Collaural fistula● This is an anamaly of first branchial cleft● One opening in the floor of external meatus and another one behind the angle of mandible close to the anterior border of sternomastoid muscle● Fistula passes through parotid gland close to facial nerve branches drtbalus otolaryngology online
  18. 18. Congenital anamolies of pinna ● Anotia ● Microtia ● Melotia ● Polyotia drtbalus otolaryngology online
  19. 19. Congenital atresia of external meatus● Very rare congenital disorder● Caused by failure of canalization of first branchial cleft● Bony atretic plate may be present at the level of ear drum● Ossicular malformations common drtbalus otolaryngology online
  20. 20. Inflammatory conditions of pinna● Erysipelas● Perichondritis● Aural seroma drtbalus otolaryngology online
  21. 21. Erysipelas● St. Anthonys fire● Caused by streptococcus hemolyticus infection of skin of pinna● Pinna appears reddish and oedematous● Systemic symptoms (common) drtbalus otolaryngology online
  22. 22. Perichondritis Pinna● Inflammation of perichondrial lining of pinna● Can follow trauma to ear● Pinna enlarged● Cauliflower ear can be caused drtbalus otolaryngology online
  23. 23. Furunculosis ● Staph infection of hair follicle present in the cartilagenous portion of external canal ● Pain ● Tragal sign + drtbalus otolaryngology online
  24. 24. Furunculosis (clinical features)● Swelling of external canal● Tenderness● Tragal sign +● Ear drum normal● Post aural sulcus obliterated● Regional nodes enlarged and tender drtbalus otolaryngology online
  25. 25. Furunculosis (Management)● Broad spectrum antibiotics● Anti inflammatory drugs● Diabetes should be ruled out drtbalus otolaryngology online
  26. 26. Malignant otitis externa● Severe form of otitis externa caused by pseudomonas● Extensive destruction of adjacent tissues● Facial palsy is also common● Skull base involvement is also common drtbalus otolaryngology online
  27. 27. Malignant otitis externa drtbalus otolaryngology online
  28. 28. Otomycosisdrtbalus otolaryngology online
  29. 29. Otomyosis (clinical features)● Irritation● Itching● Dull pain / discharge● Ear block drtbalus otolaryngology online
  30. 30. Otomycosis (management)● Keeping the ear dry● Removal of fungal mass● Antifungal ear drops (clotrimazole)● Anti inflammatory drugs drtbalus otolaryngology online
  31. 31. Ramsay Hunt Syndrome● Caused by Herpes zoster virus● Blisters in external auditory canal● Otalgia● Lower motor neuron type facial paralysis drtbalus otolaryngology online
  32. 32. Ramsay Hunt syndrome drtbalus otolaryngology online
  33. 33. Reactive conditions● Eczematous otitis externa● Seborrhoeic otitis externa● Neurodermatitis drtbalus otolaryngology online
  34. 34. Traumatic conditions● Hematoma● Frost bite● Pseudo cyst pinna drtbalus otolaryngology online
  35. 35. Exostosis● Occurs in the bony meatus● Usually multiple● When single occurs at the bony cartilagenous junction● Associated with swiming● Usually asymptomatic drtbalus otolaryngology online
  36. 36. Adenoma external canal● Arises from sebaceous glands in the cartilagenous portion of external canal● Ceruminoma arising from ceruminous glands drtbalus otolaryngology online
  37. 37. Malignant lesions● Basal cell carcinoma● Squamous cell carcinoma drtbalus otolaryngology online
  38. 38. Miscellaneous● Cerumen● Keratosis obturans● Foreign bodies – animate and inanimate drtbalus otolaryngology online
  39. 39. Keratosis obturans ● Accumulation of desquamated kerain in external canal ● Expands the external canal ● Due to abnormal epithelial migration drtbalus otolaryngology online
  40. 40. Keratosis obturans types● Inflammatory type● Silent type● Primary auditory canal cholesteatoma – due to trauma involving bone of external canal drtbalus otolaryngology online
  41. 41. Keratosis obturans clinical features● Otalgia● Conductive hearing loss● Associated bronchitis / sinusitis drtbalus otolaryngology online
  42. 42. Other resources● Www.drtbalu.com● Www.drtbalu.co.in● http://www.otolaryngologyonline.net/● http://otolaryngology.co.in/exam/ drtbalus otolaryngology online
  43. 43. Thank you drtbalus otolaryngology online

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