Got it 👍 — here’s a structured overview of disorders of the external ear (useful for ENT study notes or exams): --- Disorders of the External Ear 1. Congenital Disorders Microtia – small or malformed pinna. Anotia – complete absence of pinna. Preauricular sinus / tags – embryological remnant near pinna. Atresia of external auditory canal – absent or narrowed ear canal → conductive hearing loss. --- 2. Trauma Auricular hematoma – collection of blood between cartilage and skin → if untreated → “cauliflower ear.” Lacerations / burns / frostbite – may lead to deformity. --- 3. Inflammatory Disorders Otitis externa (swimmer’s ear) – infection of ear canal. Causes: bacterial (Pseudomonas), fungal (Aspergillus, Candida). Symptoms: ear pain, itching, discharge, swelling. Furunculosis – staphylococcal abscess of hair follicle in outer canal. Perichondritis – infection of auricular cartilage (often after trauma/piercing). Eczema / psoriasis / allergic dermatitis – itching, scaling, redness. --- 4. Foreign Bodies Common in children: beads, seeds, insects. Symptoms: pain, discharge, hearing loss. --- 5. Tumors Benign: exostosis, osteoma, papilloma, hemangioma. Malignant: squamous cell carcinoma (most common), basal cell carcinoma, melanoma. --- 6. Miscellaneous Cerumen impaction – wax accumulation → hearing loss, tinnitus. Keloid – after ear piercing. Actinic keratosis – precancerous lesion on pinna from sun exposure. --- Key Points Disorders may involve pinna, external auditory canal, or skin/cartilage. Symptoms commonly include ear pain, discharge, itching, swelling, or hearing loss. Treatment depends on cause: antibiotics/antifungals, removal of foreign body, drainage, surgery for tumors or congenital anomalies. --- 👉 Do you want me to make this into a short tabular format (disease → features → management) for quick revision? You’re asking again about Cholesteatoma 🙂 Here’s a clear, exam-ready short note for you: --- Cholesteatoma Definition An abnormal, non-cancerous collection of keratinizing squamous epithelium in the middle ear and mastoid that enlarges and destroys bone. --- Types 1. Congenital – epithelial remnants behind intact tympanic membrane, usually in children. 2. Acquired – more common, due to: Retraction pocket (from Eustachian tube dysfunction) Migration of epithelium through a perforation Metaplasia (rare theory) --- Clinical Features Persistent, foul-smelling scanty discharge (otorrhea) Conductive hearing loss Retraction pocket or pearly white mass on otoscopy Complications: Ossicular erosion → severe hearing loss Facial nerve palsy Labyrinthine fistula → vertigo Intracranial: meningitis, brain abscess, lateral sinus thrombosis --- Diagnosis Otoscopy: pearly white debris / retraction pocket Audiometry: conductive hearing loss HRCT temporal bone: extent, ossicle status, complications --- Treatment Surgical (definitive): Modified radical mas

1. D E P A R T M E N T OF E N T
M GM M E DI C A L C O L L E GE , A U R A N G A B A D
Diseases of the external ear

3. Congenital diseases of pinna
 Anotia- complete absence of pinna and lobule
 Microtia- small pinna
 Macrotia- excessively large pinna
 Bat ear- abnormally protruding ear due to large
concha with poorly developed antihelix and scapha
 Lop ear- hypoplasia of upper third of pinna
 Cryptotia- upper third of pinna embedded under
scalp skin
 Coloboma- transverse cleft in middle of pinna

5.  Darwin’s tubercle- pointed tubercle on upper part
of helix
 Stahl’s ear- helix is flat and upper crus of antihelix
is duplicated and reaches rim of helix
 Lobule deformities- large, bifid, pixed
 Pre-auricular tags- skin covered tags that appear
on a line drawn from tragus to angle of mouth
 Pre-auricular sinus- epithelial track in front of
crus of helix or above tragus due to incomplete
fusion of tubercles

7. Traumatic diseases of pinna
 HEMATOMA
1. Cauliflower ear/ boxer’s ear
2. Collection of blood between
auricular cartilage and its
perichondrium
3. Treatment- aspiration
under aseptic precautions
and pressure dressing, if
fails then I&D with through
and through sutures,
prophylactic antibiotics

8. Lacerations & avulsions of pinna

9. Frost bite
 Erythema, oedema, bullae
formation, necrosis of skin and
subcutaneous tissue, complete
necrosis with loss of affected part
 Treatment-
1. Rewarming with moist cotton
pledgets at temperature 38-42
deg C
2. Application of 0.5% silver
nitrate soaks
3. Analgesics
4. Protection of bullae from
rupture
5. Systemic antibiotics

10. Keloid
 May follow trauma or
piercing of the ear
 Surgical removal may
lead to recurrence
 Recurrence can be
avoided by pre- and post-
operative radiation with
a total dose of 600-800
rad delivered in 4 divided
doses

11. Perichondritis
 Infections sec to lacerations,
hematoma or surgical incisions
 Common pathogens-
pseudomonas and mixed flora
 Symptoms- red, hot and
painful stiff pinna, abscess
formation between cartilage
and perichondrium with
necrosis of cartilage
 Treatment- systemic
antibiotics, 4% aluminium
acetate compresses, abscess
drainage, removal of
devitalised cartilage

13. Furuncle
 Staphylococcal infection
of hair follicle
 Symptoms- severe pain
and tenderness,
movements of pinna or
jaw cause pain
 Treatment- systemic
antibiotics, analgesics,
local heat, ear pack of
10%ichthammol
glycerine, I &D of abscess

14. Diffuse otitis externa
 Diffuse inflammation of meatal skin which may spread to
involve the pinna and epidermal layer of tympanic membrane
 Hot and humid climate, swimmers
 Trauma to meatal skin and invasion by pathogenic organisms
 Staph. Aureus, Pseudomonas, Bacillus, E.Coli
 Acute phase: hot burning sensation followed by pain during
jaw movements, thin serous discharge which later becomes
thick and purulent, meatal lining is inflamed and swollen,
severe cases- lymphnodes are enlarged and tender with
cellulitis of surrounding tissues

15.  Chronic phase: irritation and strong desire to itch,
scanty discharge which dries up to form crusts,
meatal skin is thick and swollen and shows scaling
and fissuring
 Treatment: ear toilet, insertion of medicated wicks
(antibiotic steroid preparation), local steroid drops,
aluminium acetate or silver nitrate (mild astringents)
wicks, broad spectrum systemic antibiotics,
analgesics, 10% ichthammol glycerine wick to reduce
swelling in chronic phase

17. Otomycosis
 Fungal infection of ear canal
due to Aspergillus niger, A.
fumigatus, Candida Albicans
 Hot and humid climate
 Secondary fungal growth in
patients using topical antibiotics
 Intense itching, discomfort,
pain, watery discharge with
musty odour
 Treatment: ear toilet, Nystatin
for candida, clotrimazole,
povidone iodine, 2% salicylic
acid in alcohol
 EAR KEPT DRY

18. Malignant otitis externa
 An inflammatory condition caused by pseudomonas
infection usually in elderly diabetics, or in those on
immunosuppressive drugs
 Excrutiating pain, appearance of granulations in the
ear canal
 Facial paralysis
 Infection may spread to skull base and jugular foramen
causing multiple cranial nerve palsies, anteriorly
spreads to temporomandibular fossa, posteriorly to
mastoid, medially to middle ear and petrous bone

19.  Treatment:
1. Control of diabetes
2. Toilet of ear canal
3. Antibiotic treatment for 6-8 weeks- Gentamycin+
ticarcillin, third generation cephalosporins+
aminoglycosides, quinolones

21. Impacted wax
 Wax is composed of secretion of sebaceous glands,
ceruminous glands, hair, desqaumated epithelial
debris, keratin and dirt
 Factors causing impacted wax- secretion of more
sweat or cerumen, narrow and tortuous ear canal,
stiff hair or obstructive lesion e.g. exostosis
 Symptoms- impaired hearing or sense of blocked ear,
tinnitus, giddiness, reflex cough
 Treatment- removal by syringing or instrumental
manipulation, prior sofening with wax solvents

23. Keratosis obturans
 Collection of pearly white
mass of desquamated
epithelial cells in the
deep meatus
 By its pressure effect,
causes bone absorption
leading to widening of
meatus, facial nerve may
be exposed and paralysed
 Treatment- syringing or
instrumentation

24. Diseases of tympanic membrane
 Retracted tympanic membrane
 Myringitis bullosa
 Herpes Zoster oticus
 Myringitis granulosa
 Traumatic rupture
 Atrophic tympanic membrane
 Retraction pockets & atelectasis
 Tympanosclerosis
 Perforations