Trauma to the auricle and ear canal Its Complications Treatment plan Ear wax ,its composition, clinical features and management Foreign body to the ear and its types Treatment for foreign body in ear Hematoma of The Auricle Collection of blood between the auricular cartilage and its perichondrium. Often result of blunt trauma seen in boxers, wrestlers and rugby players. Extravasated blood may clot and then organize, resulting in a typical deformity called cauliflower ear (pugilistic or boxer’s ear) If hematoma gets infected, severe perichondritis may occur.

1. FOREIGN BODY & EAR
TRAUMA
DR AWAIS IRSHAD

2. Learning objectives
• Trauma to the auricle and ear canal
• Its Complications
• Treatment plan
• Ear wax ,its composition, clinical features and management
• Foreign body to the ear and its types
• Treatment for foreign body in ear

3. TRAUMATOTHE AURICLE
Hematoma of The Auricle
• Collection of blood between the auricular cartilage and its perichondrium.
• Often result of blunt trauma seen in boxers, wrestlers and rugby players.
• Extravasated blood may clot and then organize, resulting in a typical deformity
called cauliflower ear (pugilistic or boxer’s ear)
• If hematoma gets infected, severe perichondritis may occur.

4. Treatment
• Aspiration of the hematoma under strict aseptic precautions and a pressure dressing.
• Aspiration may need to be repeated.
• When aspiration fails, incision and drainage should be done and
• All cases should receive prophylactic antibiotics

5. Repaired as early as possible.
The perichondrium is stitched with absorbable sutures.
Avoid stripping of perichondrium from cartilage to prevent avascular
necrosis.
Skin is closed with fine nonabsorbable sutures.
Broad-spectrum antibiotics are given for 1 week.
Lacerations

6. Avulsion of Pinna
• When pinna is still attached to the head by a small pedicle of skin
• Primary reattachment should be considered and it is usually successful.
• Completely avulsed pinna can be reimplanted by the microvascular techniques

7. Frostbite
• Injury varies between erythema and oedema, bullae formation,
necrosis of skin and subcutaneous tissue, and complete necrosis with
loss of the affected part.

8. Treatment
• Rewarming with moist cotton pledges at a temperature of 38–42 °C,
• Rapid rewarming of frostbitten ear causes considerable pain
• Application of 0.5% silver nitrate soaks for superficial infection
• Analgesics for pain
• Protection of bullae from rupture
• Systemic antibiotics for deep infection
• Surgical debridement should wait several months as the true demarcation
between the dead and living tissues appears quite late.

9. Keloid of Auricle
• Trauma or piercing of the ear for ornaments.
• Usual sites are the lobule or helix
• Surgical excision of the keloid usually results in recurrence.
• Recurrence can be avoided
• Pre- and postoperative radiation
• Local injection of steroid after excision

10. TRAUMA TO EAR
CANAL
Minor lacerations of canal skin
• Result from Q-tip injury (scratching the ear with hair pins, needles or matchstick)
• Or unskilled instrumentation by the physician.
• Usually heal without sequelae.
Major lacerations
• From gunshot wounds, automobile accidents or fights.
• The condyle of mandible may force through the anterior canal wall.
• These cases require careful treatment.
• Aim is to attain a skin-lined meatus of adequate diameter.
• Stenosis of the ear canal is a common complication

11. IMPACTED WAX OR
CERUMEN
Wax is composed of secretion of
• Sebaceous glands
• Ceruminous glands
• Hair
• Desquamated epithelial debris
• Keratin and dirt.
protective function as it lubricates the ear canal and entraps any foreign material that
happens to enter the canal.
It has acidic pH and is bacteriostatic and fungistatic.
In some people excessive wax may be secreted and deposited as a plug in the meatus.

12. Clinical features
• Patient usually presents with impairment of
hearing or sense of blocked ear.
• Tinnitus and giddiness may result from impaction
of wax against tympanic membrane
• The onset of these symptoms may be sudden
when water enters the ear canal during bathing or
swimming and the wax swells up.

13. Treatment of wax consists in its removal by
• Syringing
• Instrumental manipulation.
• Suctioning
• Hard impacted mass may sometimes require
prior softening with wax solvents.
Treatment

14. FOREIGN BODIES OF EAR
(a) Nonliving.
Usually inserted by children
The common ones often seen are:
• A piece of paper or sponge,
• Grain seeds (rice, wheat, maize)
• Slate pencil
• Piece of chalk
• Metallic or plastic ball or pearl
 An adult may present with a broken end of matchstick used for
scratching the ear or an overlooked cotton swab.
 Vegetable foreign bodies tend to swell up with time and get tightly
impacted in the ear canal or may even suppurate.

15. b) Living
Flying or crawling insects like mosquitoes, beetles,
cockroach or an ant may enter the ear canal and
cause intense irritation and pain
No attempt should be made to catch them alive.
First, the insect should be killed by instilling oil (a
household remedy), spirit or chloroform water.
Once killed, the insect can be removed

16. Methods of removing a foreign body
include:
(i) Forceps removal
(ii) Syringing
(iii) Suction
(iv) Microscopic removal with special
instruments
(v) Postaural approach.

17. A 5 years old child presented in ENT clinic with
a complain of right ear blockage with mild to
moderate earache for last 2 days
1. What specific question you would ask in history to
elicit the diagnosis?
2. Give your differential diagnosis.
3. Give management plan of most probable diagnosis.
4. What are the types of foreign body seen in external
ear?
5. What is the composition of ear wax
6. What are the different methods of ear wax
removal?

18. History taking
• the location, duration, and severity of ear pain
• whether it is constant or intermittent. If intermittent, it is important to determine
whether it is random or occurs mainly with swallowing or jaw movement.
• associated symptoms (ear drainage, hearing loss, and sore throat).
• The patient should be asked about any attempts at cleaning the ear canal (e.g,
with cotton swab) or other recent instrumentation,
• foreign bodies, recent air travel or scuba diving, and swimming or other recurrent
water exposure to ears.

19. Differential diagnosis
• Wax
• Foreign body
• Trauma to ear