Developmental Anatomy DISEASES OF PINNA 1.Congenital Disorders a. Anotia b. Skin tags c. Microtia d. Macotia e. Bat ear f. Collapsed ear e. Folded over helical rim g. Bumps and cleft h. Cup ear i. Crytotia j. Positional problems k. Unusual malformations l. Stahl’s ear m. Polyotia n. Preauricular pit 2.Trauma to auricle a. Hematoma of the auricle b. Frostbite c. Burns 3. Inflammatory Disorders a. Peicondritis b. Relapsing Pericondritis DISEASES OF EXTERNAL AUDITORY CANAL 1.Inflammatory Disorders a. Furuncle b. Diffuse Otitis Externa c. Benign Necrotizing Externa d. Malignant Otitis Externa e. Herpes Zoster Oticus f. Otomycosis g. Aural Papillomatosis

1. DISEASES
OF
EXTERNAL
EAR

2. OVERVIEW
• 2.Trauma to auricle
• a. Hematoma of the auricle
• b. Frostbite
• c. Burns
• 3. Inflammatory Disorders
• a. Peicondritis
• b. Relapsing Pericondritis
• DISEASES OF EXTERNAL AUDITORY
CANAL
• 1.Inflammatory Disorders
• a. Furuncle
• b. Diffuse Otitis Externa
• c. Benign Necrotizing Externa
• d. Malignant Otitis Externa
• e. Herpes Zoster Oticus
• f. Otomycosis
• g. Aural Papillomatosis
•
• Developmental Anatomy
• DISEASES OF PINNA
• 1.Congenital Disorders
• a. Anotia
• b. Skin tags
• c. Microtia
• d. Macotia
• e. Bat ear
• f. Collapsed ear
• e. Folded over helical rim
• g. Bumps and cleft
• h. Cup ear
• i. Crytotia
• j. Positional problems
• k. Unusual malformations
• l. Stahl’s ear
• m. Polyotia
• n. Preauricular pit

3. • b. Malignant
• - Squamous cell
carcinoma of auricle
• - Squamous cell
carcinoma of External
auditory canal
• - Malignant Melanoma
• - Basal cell carcinoma of
Auricle
• DISEASES OF TYMPANIC
MEMBRANE
• 1. Myringitis bullosa
• 2. Myringitis granulosa
• 2. Other diseases of External
auditory Canal
• a. Cerumen impaction
• b. Exostosis of External auditory
canal
• c. Foreign bodies of ear
• d. Primary Auditory canal
Cholesteatoma
e. Acquired atresia and
stenosis of meatus
• 2. Tumors of External ear
• a. benign
• - Vascular tumors
• - Cysts
• - Keloid
• - Winker’s nodule
• - Keratoacanthoma
• - Adenoma

4. DEVELOPMENTAL ANATOMY
• Auricle or pinna - from 6 mesodermal thickenings (auricular
hillocks/tubercles) around the 1st
pharyngeal cleft, Auricular
hillocks of the mandibular arch - tragus, crus of helix, and
helix.
 Auricular hillocks of the hyoid arch - antihelix, antitragus,
and ear lobule.

5. • External auditory meatus - from ectodermal 1st
pharyngeal
cleft.

6. DISEASES OF PINNA
• A
• ANATOMY OF PINNA
• Female - 59 mm
• Male - 63 mm .
• Between the level of the
eyebrow and a line a few
millimetres beneath the
nasal columella.

7. 1. CONGENITAL
DISORDERS
• ANOTIA
• Total anotia is rare.

8. SKIN TAGS
• Preauricular skin tags- very common
• Sometimes the lesion involves only skin but usually
the tag contains a long tail of cartilage extending
into the cheek .
• Management : elective excision of the skin tag and
cartilage spindle - A vertical ellipse.

9. MICROTIA
• The standard microtia- small dependent lobe
hanging beneath a cartilage nubbin.
• In a small number of patients, a narrow strip of
normal skin separates two small ear remnants

10. MACROTIA
• Excessively large ear
• The scaphal hollow is too big, causing the ear to
appear top-heavy
• OR the lobe is too big, causing the ear appears
bottom-heavy.
• Management :
• excessively large upper ear- An anterior crescent of
skin and cartilage be removed from the scaphal
hollow of the ear.
• oversized lobe- a wedge of tissue is removed

11. BAT EAR ( PROMINENT EAR OR
PROTRUDING EAR)
• The prominence due
to an absent antihelical
fold OR conchal bowl is
excessively deep.
• .
• Management:

13. COLLAPSED EAR
• Helical rim is adequate but
the scaphal hollow is folded
backwards to rest on the
conchal hollow.
• Management : Undoing soft
tissue tethering between the
scaphal and conchal
cartilages and splinting these
structures apart with a
cartilage graft.
• The conchal hollow - donor
site.

14. FOLDED OVER HELICAL RIM
• Helical rim cartilage is sharply folded over to
provide a double layer covered in a single skin
envelope- ear looks pinched.
• Management : the folded-over cartilage excised
and then repositioned behind the scaphal hollow to
open up the upper pole.

15. BUMPS AND CLEFT
• Bump : Common finding
• Swelling lies at the point at which hillocks 3 and 4
normally fuse.
• Cleft : not a common finding .
• a groove or notch due to poor fusion of hillocks 6
and OR a significant portion of the lobe is missing
due to absence of hillock 6

16. CUP EAR ( LOP EAR )
• Definition: Helical rim is
constricted to give a
prominent, cone-
shaped ear.
• Difficult to correct.

17. CRYPTOTIA ( POCKET EAR OR HIDDEN EAR)
Only the lower two-thirds of an ear is visible and the
upper auricular sulcus seems lost.
• Management : small Ear Buddies splint should be
applied - as soon as possible after birth
• Later surgery

18. POSITIONAL PROBLEMS
• Ears- too low set or hitched upward
• axis of the ear may be abnormal(excessively
vertical) such that patients complain about their
ears, but are unsure of what is wrong.
• Management :
• conchomastoid sutures to adjust the slope

19. UNUSUAL MALFORMATIONS
• Vascular malformations
including capillary
haemangiomata and port
wine stain can involve the
ear.
• Giant naevus- Hypertrophy
of the lobe
• Neurofibromatosis- enlarged
and malpositioned ear
• Lymphangiomata - present
on the ear and sometimes
occlude the meatus

20. STAHL’S EAR ( ABNORMAL FOLDS OR THIRD CRUS )
• Management:
• easily and temporarily
corrected by finger
pressure
• Surgery
• A direct wedge
excision of the Stahl’s
bar by splint-

21. SPLINTAGE
• Treatment splintage
• Indications:
• prominent ears, Stahl’s bars,
lop ears cryptotia and kinks
of the rim
Started in the first few days of
life.

22. POLYOTIA OR MIRROR EAR
• Definition: persistent preauricular tissues are so large
that they resemble an extra ear

23. PREAURICULAR PIT OR SINUS
• Management : Excision
• Frequently asymptomatic.
• Recurrent infections occur which fail to settle with
antistaphlococcal antibiotics- surgical excision.
• ( with active facial nerve monitoring and avoid
local anaesthetic infiltration)

25. 2. TRAUMA TO THE
AURICLE
• HAEMATOMA OF THE AURICLE
• Trauma- sports-related
• painless and inflammation -minimal.
• classic ‘cauliflower’ or ‘wrestler’s’ ear- If left
untreated
• Management :
• Evacuation- recurrence.
• To prevent recurrence –
• Local pressure dressings.
• A drain left in the incision site.
• A posterior incision, with excision of a disc of
cartilage and placement of a suction drain.
Through-and-through ‘mattress’ or ‘quilting’
sutures to apply compression, with or without
materials- distribute the compression more evenly

26. FROSTBITE
• Auricle - particularly susceptible to frostbite
Vasoconstriction
• Hyperemia and edema ( due to marked increase in
capillary permeability).
• swollen, red, and tender ear with bullae under the
skin- resembling a first-degree burn
• Management:
• Rapid warming- Wet sterile cotton pledgets at 38 to
42°C are applied until the ear is thawed
• . Analgesics and prophylactic antibiotics

27. BURNS
• Untreated perichondritis.
• Prophylactic use of antipseudomonal antibiotics.).
• Application of mafenide acetate (Sulfamylon)
cream.
• Débridement and skin grafting.
• Failure to evacuate blood within 7-10 days -
secondary changes in the perichondrium and
cartilage & permanent deformity.

28. 3. INFLAMMATORY
DISORDERS
• PERICHONDRITIS
• classification :
• Erysipelas of external ear
• Cellulitis of external ear
• perichondritis
• chondritis.
• Secondary to trauma.
• Common Organisms :
• Pseudomonas aeruginosa
• Staphylococcus aureus

29. RELAPSING PERICHONDRITIS
• polychondropathy/ systemic chondromalacia
/chronic atrophic polychondritis.
Definition :a rare disease of episodic inflammation and
degeneration involving multiple cartilaginous structures,
usually those of the upper respiratory tract, as well as
connective tissue at various other sites.
• Diagnosis: Signs :
• 1. McAdam et al.
• 2. Damiani and Levine
• Management :
• steroids-)
• Immunosuppressants-
• NSAIDs4 , colchicine.
• Anti-CD4 monoclonal antibody , oral minocycline
have recently

30. DISEASES OF EXTERNAL
AUDITORY CANAL

31. FURUNCLE ( LOCALISED OTITIS EXTERNA )
 Definition : A localizedform of otitis externa resulting
from infectionof a single hair follicle
 Symptoms: pain , discharge
 Aetiology : Staphylococcus aureus
 recurrent furunculosis: eradication therapy with
nasal mupirocin

32. DIFFUSE OTITIS EXTERNA
• Definition : A generalized condition of the skin of the
external auditory canal that is characterized by
general oedema and erythema associated with
itchy discomfort and usually an ear discharge
• Aetiology : Pseudomonas aeruginosa
• Management :1. Aural Toilet
• 2. Topical medication – Aural wick
• Glycerol and ichthammol (90:10 percent

33. BENIGN NECROTIZING EXTERNA
• Benign necrotizing otitis externa / Benign necrotizing
osteitis of the external auditory meatus canal
• Definition :clinical condition of idiopathic necrosis of a
localized area of bone of the tympanic ring, with
secondary inflammation of the overlying soft tissue and
skin.
• Aetiology :
• Unknown
• Tympanic bone is particularly susceptible to
osteonecrosis because of its ‘relatively poor blood
supply’.
• Repeated local trauma

34. • Sign :
• characteristic positive
findings of a small area
of deficient skin and
soft tissue in the
external auditory
meatus revealing a
segment of necrotic
superficial bone

35. • D/D :
• Canal cholesteatoma-
presence of a lining of
squamous epithelium.

36. • Outcomes :
• Separation of the sequestrum, followed by epithial growth to
cover the bony defect
• progressive necrosis with exposure of the facial nerve and
jugular bulb.
• Management :
• removing the bony sequestrum once it separates
spontaneously with local toilet and local treatment to control
any infection.
• oral antibiotic
• early surgical removal of the sequestrum down to healthy
bone.
• Adjunctive hyperbaric oxygen

37. MALIGNANT OTITIS EXTERNA
• Definition :
• An aggressive and potentially life-
threatening infection of the soft tissues of
the external ear and surrounding
structures, quickly spreading to involve
the periostium and bone of the skull base.
• Mainlt affects Haversian system of
compact bone and
• Involvement of the pneumatized portion
of the temporal bone -late finding. The
otic capsule is spared.
• Bacteriology : Pseudomonas aeruginosa-
most common.
• Aspergillus - rarely

38. • Clinicopathological Staging

39. • Mainlt affects Haversian system of compact bone
and
• Involvement of the pneumatized portion of the
temporal bone -late finding. The otic capsule is
spared.
• Bacteriology : Pseudomonas aeruginosa- most
common.
• Aspergillus - rarely

40. • Predisposing Factors :
• elderly diabetic- – 1. impaired leukocyte mobility
 2. microangiopathy –
 ‘hyperglycexternal auditory canalia’ -
 Children- more common facial nerve palsy and
involvement of the middle ear.
 Refractory or suspected malignant otitis externa in
children or adults-.

41. • Diagnosis :
• combination of pain, granulations, otorrhea and
resistance to local therapy for at least eight to ten
days .
• Diabetes or other immunocompromised state,
Pseudomonas aeruginosa onculture, a positive
bone scan and cranial nerve palsy -confirmatory
factors

42. • Investigations :
• Technetium (Tc-99m)
radionuclide bone scans.
• Gallium (Ga-67) - more
sensitive monitor of infection,.
• SPECT
• MRI

44. • Outcome :
• extensive skull base osteomyelitis- Involvement of
clivus and contralateral temporal bone, anteriorly
into the sphenoid, carotid, temporomandibular joint
and parapharyngeal space.
• Cranial nerve involvement :
• Facial nerve- most common
• IX, X and X
• VI or XII – rare
• :can spread to the central venous sinuses,
extradural space and meninges
• usual terminal events : Infective thrombophlebitis or
thrombosis of the internal carotid artery

45. • Management :
• Aural Toilet
• Systemic Antibiotics: Duration; at least six weeks
and in advanced cases, several months.
• ciprofloxacin with or without an aminoglycoside
and/or ceftazidime
• Oral rifampicin
• Implantable gentamicin
• Hyperbaric oxygen
• Surgery

46. KERATOSIS OBTURANS
• the accumulation of a large
plug of desquaminated keratin
in the external auditory meatus
• Pathology :
• geometrically patterned keratin
plug within the lumen of an
expanded external auditory
canal . The keratin squames
are shed from the complete
circumference of the deep ear
canal forming a lamina (onion
skin) arrangement.,

47. • Aetiology :
• due to abnormal epithelial migration of the ear canal
skin.
• two types;
• 1. inflammatory nature - secondary to an acute
problem, such as a viral infection, causing
inflammation of the ear canal - temporarily alters the
epithelial migration. cured by removal.
• 2.the silent type - disease that carries on and on -
caused by abnormal separation of the keratin that
persists even after the first removal and will need
subsequent removals.

48. • Management:
• Removal often under general anaesthetic.
Canalplasty if recurrent
• Baed on extent of the cholesteatoma erosion;
• can be seen- conservative treatment .
• Cannot be seen - patients are treated with excision
of necrotic bone and cholesteatoma via the
mastoid and repair of the defect using temporalis
fascia. OR canal wall-up procedure with repair of
the defect

49. PRIMARY AUDITORY CANAL
CHOLESTEATOMA
• Definition : invasion of squamous tissue from the ear
into a localized area of bony erosion.
• Pathology :
• keratin is derived primarily from a sac that involves
the bone of the ear canal with bony fragments
within it and random keratin in the lumen of the ear
• Aetiology :
• piece of exposed bone of the primary auditory
canal becomes infected , sequests and the
epithelium migrates into this bony abnormality-
cholesteatoma.

52. HERPES ZOSTER OTICUS
• Definition :
• herpetic vesicular rash on the
concha, external auditory canal
or pinna with a lower motor
neurone palsy of the ipsilateral
facial nerve.
• Nomenclature:
• called as Ramsay Hunt syndrome
type 1 as Hunt actually described
three neurological syndromes –
only one of which involved the
facial nerve and the ear

53. • Pathology :
• end-stage of a severe infection originates from the
external auditory canal and progresses through cellulitis,
chondritis, periostitis, osteitis and finally osteomyelitis.
(following surgery to the temporal bone.)
• Infection is thought to spread out of the cartilaginous
external auditory canal through the fissures of Santorini,
con genital defects in the floor of the external auditory
canal.
• Once periostitis develops, this progresses rapidly across
the skull base.
• facial nerve and other cranial nerve palsies
• periostitis
• osteomyelitis

54. • Zoster sine herpete is a facial palsy caused by the
zoster virus, but with no rash.
• Management :
• Acyclovir and prednisolone within three days of the
onset – significant improvement.
• Early treatment of herpes zoster infections with
antiviral agents - significantly reduce the
prevalence of post-herpetic neuralgia.
• Complete facial palsies have a poor prognosis if not
treated early.
• The elderly have a poor prognosis for return of facial
nerve function

55. OTOMYCOSIS (fungal otitis externa)
Predisposing Factors :
hot, humid climates
secondary to prolonged treatment with topical
antibiotics.
Diabetes and immuno compromised states
Clinical Findings :
A black, grey, green, yellow or white discharge with
debris – resemble wet newspaper.

56. • Management :
• Aural toilet and removal of the debris
• Topical antifungal drops( e.g. Locorten-Vioform)
• Resistant otomycosis- exclude fungal infection
elsewhere, including athelete’s foot.

57. AURAL PAPILLOMATOSIS
• Definition : extremely rare
condition involving papillomas
filling the external auditory canal.
• Aetilogy: Human papilloma virus
type 6 (HPV-6)
• Management :
• Primary resection- Successful .
• CO2 laser removal.
• Surgical excision
• Immune-response modulator -5%
imiquimod (Aldara)- Topical

58. CERUMEN IMPACTION
• Definition: a mixture of secretions and sloughed
epithelial cells.
• Management:
• Manual debridement - trauma to the canal skin,
infection, or tympanic membrane perforation.
• Irrigation- flushing the wax out by a jet of warm
water- should not be done, if a tympanic membrane
perforation or myringotomy tube is present.
• Cerumenolytics - avoided ; active infections of the
ear canal, tympanostomy tubes, or tympanic
membrane perforation . Best option- manual
removal of cerumen, ideally using a binocular
microscope,

59. Exostosis of the external auditory canal
• Definition : benign growth of periosteal bone, which
forms a smooth, sessile, hemispherical swelling in the
deep part of the meatus, adjascent to the tympanic
membrane.
• Multiple, bilateral.
• Arise from the anterior or posterior walls of the
external auditory canal.
• Incidental finding.
• Relationship with cold water exposure
• Small - Incidental finding and aymptomatic
• stenosis > 80 % of the canal lumen- history of recurrent
otitis externa, chronic infection, wax and debris
accumulation and conductive hearing loss

61. • Management :
• Majority - no treatment ( Asymptomatic )
• General advice - avoidance of cold water
• Surgery :
• Indications :
• refractory to medical treatment,
• causing recurrent or persisting otitis externa,
frequent cerumen obstruction causing hearing loss
cases where wider access is required for middle ear
surgery

62. • Meatoplasty
• via a postaural ( recommended ) or transmeatal
approach
• very careful elevation and preservation of the skin
overlying the exostoses.
• The bone of the exostoses is removed by high
speed drill, using both cutting and diamond burrs

63. FOREIGN BODIES OF EAR
• Management :

64. ACQUIRED ATRESIA AND STENOSIS OF
MEATUS
• Definition : ‘intraluminal sequelae of either
intraluminal or extra luminal processes of varying
aetiology, resulting in a blind sac in the external
acoustic meatus

65. 1. SOLID 2. MEMBRANOUS
Continuous block of
either fibrous or fibrous
and bony material which
is continuous with the
structure of the tympanic
membrane and is of
variable extent.
• safe form & surgical
treatment very
challenging
• Typified by fibrous tissue
that has a covering of
ear canal skin on both
sides, thus separating
the ear canal into a
medial and lateral
segment
• associated
cholesteatoma &
erosion

66. • Diagnosis: CT
• Aetiology :
• Inflammation,
• Surgery
• Management :
• Medical
• wet phase : 1. removal of the medial granulations by
aspiration and cauterization with silver nitrate or
trichloroacetic acid
• 2. the ear pack with ribbon gauze or a wick
• conductive hearing impairment (if bilateral) : hearing aid

67. • Surgical :
• Fibrous Atresia
• Membranous :
• small atretic plate – trans canal approach
• Very thick lesion : retro auricular approach

68. TUMORS OF THE
EXTERNAL EAR
• BENIGN TUMORS
1. Vascular Tumor
 Capillary hemangioma
 Spider nevus: Small & fixed. Treatment, when
necessary- needle coagulation of the central vessel.
 Cavernous hemangioma: “strawberry tumor,” -
increases rapidly in size during the first year of life but
usually regresses thereafter.
 Lymphangioma : multiple pale circumscribed
lesions, like a cluster of fish or frog roe

69. • 2. Cysts
• Common – Sebaceous cysts.
• Sites: on the posterior surface of the
lobule, in the skin over the mastoid
process, and in the skin of the
inferior or posterior parts of the
cartilaginous portion of the canal .
• These soft, nontender swellings( May
become infected and may be
confused with furuncles)
• Treatment - excision.
• Infection, if present, is treated first

70. • 3. Keloid
• Most commonly seen - pedunculated tumors on the
lobule following ear piercing.
• Also occur in mastoidectomy and endaural scars,
• disfigurement or stenosis of the canal.
• Treatment - excision followed by periodic injection
of a small amount of corticosteroids.

71. • 4. Winkler’s Nodule (Chondrodermatitis
Nodularis Chronica Helicis)
• Benign nodular growth usually
occurring on the rim of the helix in older
men.
• Appearance : firm elevated nodular
lesion with a grayish crust on the
surface- exquisite tenderness with
digital compression, out of proportion to
its size.
• Aetiology: unknown.
• Treatement:
• pain relief- injection of a corticosteroid.
• Definitive treatment - full-thickness
excision including a wedge of cartilage

72. • 5. Keratoacanthoma
• A benign tumor resembling carcinoma
• ? related to actinic exposure.
• The common location of the tumor - anterior to the
tragus.
• Appearance: a central crater that contains a
keratin plug- The lesion tends to grow rapidly after
its initial appearance and then slowly regresses.

73. 6.Adenoma
• Symptoms are minimal unless the growth
completely occludes the canal. Pain suggests
malignancy.
• A ceruminoma - adenoma of sweat gland origin
• Treatment - surgical excision.

74. MALIGNANT TUMORS OF THE
EXTERNAL EAR
• 1.Squamous Cell Carcinoma of the
Auricle
• present as ulcerated lesions with an
area of surrounding erythema and
induration
• Occur more often on the helix
• Treatment: wide excision and
reconstruction.

75. 2.Squamous Cell Carcinoma of the
External Auditory Canal
• Malignancy should be suspected whenever otalgia
or bleeding is associated with the tumor and a
biopsy should be taken with local anesthesia using
a cupped biopsy forceps
• CT or MRI - the extent of a carcinoma
• Treatment -wide surgical excision and
postoperative radiation therapy. Anterior canal
tumors may spread through Santorini’s fissures into a
preauricular lymph node

76. 3.Malignant Melanoma
• Diagnosis should be suspected when a pigmented
lesion begins to increase in size or change in color.
• 4.Basal Cell Carcinoma of the Auricle
• presents as painless, well-circumscribed ulcers with
raised margins.

77. DISEASES OF TYMPANIC
MEMBRANE

78. MYRINGITIS BULLOSA
( Myringitis bullosa haemorrhagica )
• vesicles in the superficial layer of the
tympanic membrane (The vesicles
occur between the outer epithelium
and the lamina propria of the tympanic
membrane.1
• Influenzavirus
• Mycoplasma pneumoniae
• Sudden onset of severe, usually
unilateral, often throbbing pain in the
ear- most common presentation.
• Bloodstained discharge
• Hearing impairment
• blood-filled, serous or serosanginous
blisters

79. • Diagnosis
• In cases without middle ear affection and without
sensorineural hearing loss- only analgesics.
• middle ear is affected, antibiotics can be used as
in the treatment of acute otitis media.
• In children less than two years of age, acute bullous
myringitis should be treated as acute otitis media.
Antibiotics have also been recommended in cases
with sensorineural hearing impairment

80. MYRINGITIS GRANULOSA
• granulating myringitis,, otitis
externa granulosa.
• A specific form of external otitis
characterized by granulation tissue
on the lateral aspect of the
tympanic membrane with possible
involvement of the external ear
canal.

81. • Aetiology :
• High-ambient temperature, swimming, lackof hygiene,
local irritants and foreignbodies.
• postoperative complication of tympanic membrane
grafting.
Symptoms :
• foul-smelling discharge, Little or no pain.
• Sensation of fullness or irritation in the ear.
• Signs :
• moderate amount of purulent secretion
• The tympanic membrane is covered with secretions
that sometimes crust.
• aural toilet- the granulation tissue is revealed.

82. • Management :
• Debridement of the ear at frequent intervals
Specific topical antimicrobial drops or powder with
or without steroids for at least two weeks
• Removal of granulations by physical methods
Application of caustic agents (chromic acid,
formalin, silver nitrate)
• Removal of granulations by physical methods,
underlay perichondrium and skin grafting
• Laser evaporization of granulation

83. OSTEORADIONECROSIS OF
TEMPORAL BONE
• Definition :
• Exposure and necrosis of a variable portion of
previously irradiated petrous temporal bone which
fails to heal over a period of three months.
• Aetiology :
• high-dose radiotherapy administered to and
around the petrous temporal bone for malignancies
of the parotid gland, external auditory canal,
middle ear, maxilla, nasopharynx and pituitary.
• .

84. Two forms
Localized Diffuse (Extensive )
• More severe symptoms
of pain and otorrhea
• mild otalgia and
otorrhoea, with small
areas of exposed bone
in the external auditory
canal

85. LOCALIZED DIFFUSE( EXTENSIVE)
• when the petrous
bone was in the
periphery of the
irradiated field.
• CT - small areas of
sequestration
• Management
conservatively-
toilet, careful
removal of
sequestra, local
antibiotics and
analgesics.
• irradiation is directed at the
petrous temporal bone
• CT - widespread bony
destruction.
• Complications : Erosion of
the facial canal and
extension to the inner ear
can occur, as well as
intracranial complications,
brain abscesses, meningitis
and death.
• Treatment : Radical surgical
debridement and repair.

86. THANK YOU