This document provides an overview of common ear disorders including earache, ear trauma, tympanic membrane perforation, and conditions that should not be missed. Specific conditions discussed in more detail include otitis externa, otitis media, malignant otitis externa, mastoiditis, cholesteatoma, Ramsay-Hunt syndrome, auricle lacerations, auricular hematoma, and perforated eardrum. Diagnosis and treatment recommendations are provided for many of these conditions.

1. COMMON EAR
DISORDERS
CME TEACHING

2. OVERVIEW
• Earache
• Ear trauma
• TM perforation
• Not to miss

3. OTALGIA
(EARACHE)

4. HISTORY & EXAM
• Higher risk groups
• Recent swimming
• Piercings
• Associated features
• Aggravating factors
• Traction on the tragus or auricle

6. OTITIS EXTERNA
• Commonly Pseudomonas and/or Staph aureus, less
commonly fungal
• Dry aural toilet:
• Rolled tissue spears, 6hrly until dry
• Otodex or Sofradex 3 drops TDS 3-7d
• Use of wick if severe swelling
• Systemic Abx if febrile, pinna involved or folliculitis
(localised)
• Dry for 2 weeks

7. OTITIS MEDIA
• Usually self-limiting
• S pneumoniae, H influenzae or M catarrhalis
• Very likely if acute signs and symptoms:
• AND middle ear effusion
• AND redness of TM
• Abx if systemic features (vomiting, lethargy, temp)
• Cefuroxime PO if pen allergic*
• Effusion can persist up to 3 months
• CSOM needs aural toilet + ciprofloxacin drops**

8. LESS COMMONLY
• Malignant otitis externa
• Immunosuppressed, elderly, diabetes
• Mastoiditis
• Cholesteatoma
• Ramsay-Hunt syndrome

9. DIAGNOSIS ON EDIS “EARACHE”
• What if the ear looks completely normal?
• “TMJ syndrome”
• Dental causes
• Tonsilitis/pharyngitis
• Cervical spondylosis

10. EAR TRAUMA

11. AURICLE LACERATIONS
• Field block of the ear
• Wedge excision
• Layered closure?
• Anatomical landmarks
• Posterior pinna first
• Plaster & dressing

12. AURICULAR HAEMATOMA
• Risk of cartilage necrosis,
fibrosis and cauliflower ear
• Adequate anaesthesia
• Incision and evacuation
• Compressive dressing

13. PERFORATED EARDRUM
• Sudden pain and hearing loss
• Infection, injury, barotrauma,
explosion.
• 6-8 week resolution
• Keep dry
• Stop poking things down!

14. NOT TO BE
MISSED

15. • Febrile patients with dementia or coma
• Pinna bruising in children
• Tinnitus
• Chronic salicylate poisoning
• Carotid artery lesions