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1. DISEASES OF THE
EXTERNAL EAR
Dr. Alex Malambo
Otorhinolaryngology
Head and Neck Surgeon

2. DISEASES OF THE PINNA
Includes congenital, traumatic, inflammatory
or neoplastic disorders.
A. congenital disorders
1. Bat ear-abnormally protruding pinna
2. Preauricular appandages –skin covered
tags due to incomplete fusion during
development
3. Preauricular pits- incomplete fusion
during development
4. Microtia- small ear
5. Anotia –no ear
6. Macrotia- big ear
Bat ear

3. DISEASES OF THE PINNA
B. Ear trauma
1. Haematoma of the auricle.
• collection of blood between the auricular cartilage and its
perichondrium
• result of blunt trauma
• Unattended hematoma can lead to cartilage death and healing by
fibrosis resulting in a cauliflower ear.
• Treatment is aspiration or incision and drainage

4. DISEASES OF THE PINNA
2. Lacerations, Avulsions
• Repair as soon as possible.
• Repair in layers i.e. perichondrium
and skin
• Use absorbable for perichondrium an
non absorbable for skin.
• Attempt reattachment of pinna with a
stalk still attaching
• Complete avulsed pinna can be
reattached consider viability and skill
available
3. Burns and frost bite
• In burns treat like burns and
debride as much a possible
exposed cartilage
• Staged management
• In frost bite, warm dressing 38-42
degrees
• Analgesia and antibiotics and
wait for demarcation the debride
accordingly.

5. DISEASES OF THE PINNA
3. Keloids
• Due to trauma i.e. piercings
• High recurrence rate post
excision
• Treatment is by excision
• And pre or post radiotherapy
• or steroids post excision

6. DISEASES OF THE PINNA
C. Inflammatory conditions
1. Perichondritis
• It results from infection secondary to
lacerations, haematoma or surgical
incisions
• Also extension of infection from
diffuse otitis externa or a furuncle of
the meatus
• Start with symptoms red, hot and
painful pinna which feels stiff.
• Then abscess forms
• Treatment in early stage consists
of systemic antibiotic 7-10 days.
• If abscess has formed, I$D and
send pus for M/c/s.
• Leave a small drain

7. DISEASES OF THE PINNA
2. Tumours
• Benign and malignant
• From skin to cartilage

8. DISEASES OF THE EXTERNAL AUDITORY CANAL
The diseases of external auditory
canal are grouped as:
• A. Congenital disorders
• B. Trauma
• C. Inflammation
• D. Tumours
• E. Miscellaneous conditions.
A. Congenital disorders
1. Atresia of external canal
• may occur alone or in association with
microtia
• If occurring is due to recanalization during
development
• Maybe fibrous or bony
• TM is normal
• Atresia with microtia is more common
• Maybe associated with ME, inner ear
abnormalities

9. DISEASES OF THE EXTERNAL AUDITORY
CANAL
2. Branchial sinus type
1/Collaural fistula
• 2 openings . In EAC and just
around the angle of the
mandible
B. Trauma to Ear Canal
• From iatrogenic to accidents
C. Inflammations of Ear Canal
• Otitis externa may be divided, on
aetiological basis, into
i. Infective cause

10. DISEASES OF THE EXTERNAL AUDITORY
CANAL
ii. Reactive cause
• Eczematous otitis externa
• Seborrheic otitis externa
• Neurodermatitis
Eczematous OE
Scalp seborrheic dermatitis

11. DISEASES OF THE EXTERNAL AUDITORY
CANAL
INFECTIVE CAUSES
1. Furuncle (localized acute otitis
external)
• is a staphylococcal infection of the hair
follicle
• severe pain, pain on movement of pinna
and the jaw
• Post auricular lymph node
• Treatment: systemic antibiotics.
Analgesia and warm compressions
• Rule out immunosuppression in recurrent
funiculitis
2. Diffuse otitis externa
• diffuse inflammation of meatal skin which may
spread to involve the pinna and epidermal layer
of tympanic membrane
• commonly seen in hot and humid climate and in
swimmers
• Also called Swimmers ear
• Excessive sweating changes the pH of meatal
skin from that of acid to alkaline which favors
growth of pathogens.
• Common organisms responsible for otitis
externa are:
• S. aureus, Pseudo, proteus and E. coli
• but more often the infection is mixed

12. DISEASES OF THE EXTERNAL AUDITORY
CANAL
• Clinical features: hot burning
sensation, pain, thin serous
discharge which later becomes thick
and purulent
• Meatal lining becomes inflamed
and swollen.
• May become chronic characterized
by irritation and strong desire
scratch, crusts
• Treatment: Aural toilet,
microsuctioning
• Antibiotics both topical
(medicated wicks) and systemic
• Analgesia
• Topical steroids- usually
combined in antibiotic ear drops

13. DISEASES OF THE EXTERNAL AUDITORY
CANAL
3. Otomycosis
• fungal infection of the ear canal
• often occurs due to Aspergillus
or candida.
• Seen in hot and humid climate of
tropical and subtropical regions
• also seen in patients using topical
aural antibiotics for a long duration
• Clinical features: intense itching,
discomfort or pain in the ear,
watery discharge and ear blockage
• The fungal mass may arrear white,
brown or black and has been
likened to a wet piece of filter
paper.
• On microscopy hyphae is seen.
• Treatment: thorough Aural toilet,
antifungal ear drops, analgesia and
keep ear dry

14. DISEASES OF THE EXTERNAL AUDITORY
CANAL
4. Herpes zoster oticus
• Also called Ramsay Hunt syndrome
• Reactivation of varicella zoster
• May involve other dermatomes
• characterized by formation of vesicles
on the tympanic membrane, meatal
skin, concha and postauricular groove
• Apart from CN 7th
, 8th
cranial nerve
maybe involved
• Treatment: Antivirals, steroids and
analgesia
5. Malignant (necrotising) otitis externa.
• inflammatory condition caused by
pseudomonas infection usually in the
elderly diabetics, or in those on
immunosuppressive drugs
• Described as worse form of diffuse otitis
externa
• Infection spreads to involve soft tissues
around temporal bone and skull base and
osteomyelitis
• Clinical feature: excruciating pain, ear
discharge, granulation tissues in EAC.
• CN 7 palsy and other lower cranial Nerves

15. DISEASES OF THE EXTERNAL AUDITORY
CANAL
• Treatment consists of high doses of i.v.
antibiotics directed against
pseudomonas atleast for 6weeks
• Aural toilet, analgesia
• Treat under lying DM and
immunosuppression
6. Eczematous otitis externa
• It is the result of hyper sensitivity to
infective organisms or topical ear drops
• Intense irritation, vesicle form ation,
oozing and crusting in the canal.
• Treatment: withdraw drug and give
steroid cream
7. Seborrhoeic otitis externa
• It is associated with seborrhoeic
dermatitis of the scalp
• Itching is the main complaint
• Greasy yellow scales are seen in the
external canal, over the lobule and
postauricular sulcus
• Treatment: ear toilet, cream
containing salicylic acid and Sulphur
• attend to scalp seborrhoea.

16. DISEASES OF THE EXTERNAL AUDITORY
CANAL
D. Tumours
• Chronic otitis externa with
granulation tissue, foul smelling
discharge consider biopsy
• Especially in adults

17. DISEASES OF THE EXTERNAL AUDITORY
CANAL
E. Miscellaneous Conditions
1. Wax impaction/ cerumen
• Wax is composed of secretion of sebaceous
glands, ceruminous glands. hair, desquamated
epithelial debris. keratin and dirt.
• Wax has a protective function as it lubricates
the ear canal and entraps any foreign material
that happens to enter the canal
• excessive wax may be secreted and deposited
as a plug in the meatus
• Presents with hearing loss, tinnitus, itchiness
• Treatment: Ear syringing. If hard instill wax
softener for atleast 3 days
2. Foreign body
• Can be living or non living objects
• objects like seeds may swell if water instilled
• Removal can be by Forceps removal,
Syringing, Suction, Microscopic removal with
special instruments, Postaural approach
• For insects can instill oil as home remedy to
kill it
• For corrosives objects like battery remove as
soon as possible
• NOTE; syringing will removal most of the
objects

18. DISEASES OF TYMPANIC MEMBRANE
• Diseases of tympanic membrane
may be primary or secondary to
conditions affecting external ear,
middle ear or eustachian tube
1. Retracted tympanic membrane
• A retracted tympanic membrane
is the result of negative
intratympanic pressure when the
eustachian tube is blocked
• Prominent ME structures

19. DISEASES OF TYMPANIC MEMBRANE
2. Myringitis bullosa. It is a painful
condition characterised by formation of
haemorrhagic blebs on the tympanic
membrane and deep meatus. It is
probably caused by a virus or
mycoplasma pneumoniae.
3. Herpes zoster oticus.
4. Perforations can be traumatic or due
to infection
• Traumatic wait for 12 weeks for
spontaneous healing. If non
tympanoplasty
5. Tympanosclerosis
• It is hyalinisation and later
calcification in the fibrous layer
of tympanic membrane

20. THE END