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    Dse Pathogenesis/ Causes Diagnosis Complications TX Prognosis Notes

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    Luka Desabelle- Justo
    This document summarizes various pathologies that can affect the external ear. It describes common deformities and malformations like prominent ears. It also discusses various inflammatory conditions like eczema and dermatitis, perichondritis, cellulitis, and necrotizing otitis externa that can involve the external ear. Additionally, it covers physical injuries and their potential complications, like auricular hematoma and burns. Foreign bodies, exostoses, and conditions like otomycosis and recurrent polychondritis are also summarized. Diagnostic criteria, treatment approaches, and potential complications are provided for each condition.

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    Dse Pathogenesis/ Causes Diagnosis Complications TX Prognosis Notes

    Uploaded by

    Luka Desabelle- Justo
    102 views5 pages
    This document summarizes various pathologies that can affect the external ear. It describes common deformities and malformations like prominent ears. It also discusses various inflammatory conditions like eczema and dermatitis, perichondritis, cellulitis, and necrotizing otitis externa that can involve the external ear. Additionally, it covers physical injuries and their potential complications, like auricular hematoma and burns. Foreign bodies, exostoses, and conditions like otomycosis and recurrent polychondritis are also summarized. Diagnostic criteria, treatment approaches, and potential complications are provided for each condition.

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    ear

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    Ent External Ear Reviewer

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    This document summarizes various pathologies that can affect the external ear. It describes common deformities and malformations like prominent ears. It also discusses various inflammatory conditions like eczema and dermatitis, perichondritis, cellulitis, and necrotizing otitis externa that can involve the external ear. Additionally, it covers physical injuries and their potential complications, like auricular hematoma and burns. Foreign bodies, exostoses, and conditions like otomycosis and recurrent polychondritis are also summarized. Diagnostic criteria, treatment approaches, and potential complications are provided for each condition.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    102 views5 pages

    Dse Pathogenesis/ Causes Diagnosis Complications TX Prognosis Notes

    Uploaded by

    Luka Desabelle- Justo
    This document summarizes various pathologies that can affect the external ear. It describes common deformities and malformations like prominent ears. It also discusses various inflammatory conditions like eczema and dermatitis, perichondritis, cellulitis, and necrotizing otitis externa that can involve the external ear. Additionally, it covers physical injuries and their potential complications, like auricular hematoma and burns. Foreign bodies, exostoses, and conditions like otomycosis and recurrent polychondritis are also summarized. Diagnostic criteria, treatment approaches, and potential complications are provided for each condition.

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    of 5

    Dse

    Pathogenesis/ Causes
    Deformities and Malformations of the EXTERNAL EAR
    Prominent Ears
    normal congenital variant

    Diagnosis

    Exostoses (true
    osteomas)

    near annulus on
    superomedial canal wall
    from ossification centers

    pale, rounded bony prominences


    on otoscopy

    Cerumen impaction

    disturbance of normal selfcleansing mechanism


    excessive cerumen secretion

    Sx:pressure sensitisation with


    hearing loss, vertigo, tinnitus

    Complications

    recurrent OTITIS
    EXTERNA
    CONDUCTIVE
    HEARING LOSS on
    high-grade stenoses
    may develop OTITIS
    EXTERNA

    DDx: cholesteatoma, tumors,


    foreign bodies, crusted blood

    Auricular appendages

    Aural fistulas
    Preauricular fistulas
    Cysts

    skin and cartilage


    from aberrant embryonic cell
    rests trapped in the area of
    1st brachial cleft
    from sites of epithelial
    retention in 1st brachial cleft

    Grade 1 dysplasia

    Grade 2 dysplacia (mild


    microtia)
    Grade 3 dysplasia
    (microtia and anotia)

    preauricular

    openings commonly found at


    preauricular sites on the helical
    rim
    infra or retroauricular continuum
    in high cervical fistulas
    -prominent ears
    -macrotia
    -Darwinian tubercles
    -auricular apex or helical
    projections
    -macacus ear with partial
    absence of helix
    small, severely misshapen
    auricle, lack subunits
    ext meatus anomaly
    absent auricular structures, atretic
    ear canal

    Tx

    Prognosis

    Notes

    surgical correction- ear


    dressing worn 2 weeks after
    op
    surgery

    no fxnal
    consequences

    NORMAL: 20-30
    deg

    removed with a hook,


    currette
    or by aural irrigation
    -hydrogen peroxide/glycerincontaining/detergents
    -posterosuperior
    -followed by otoscopy and
    tuning fork test
    CI: positive otologic hx,
    single earing ear affected,
    restless, foreign body
    excision

    ***avoid cottontipped swabs

    cerumen plug= FA,


    lysozymes, sebum,
    exfoliative debris,
    contaminants

    partial reconstruction- local


    cartilage, advancement flaps
    or preliminary expansion
    bone conducting hearing aid
    for unilateral atresia in
    children (1st months)
    surgery at 10 yrs- autologous
    carilage grafts from costal
    cartilage
    epithesis

    Stenosis and atresia of


    ear canal
    Foreign bodies

    children-beads, lego

    history, otoscopy

    middle and inner ear

    small extraction hook

    Dse

    Pathogenesis/ Causes
    adults-ear plugs, obj for
    manipulation

    Injuries and Physical Damage


    Auricular hematoma
    due to blunt trauma causing
    Auricular Seroma
    separation of skin and
    attached perichondrium from
    the auricular cartilage
    Sharp auricular injury
    Auricular avulsion
    (partial or complete)

    Diagnosis
    DDx:
    cerumen impaction, dried blood,
    ear canal tumors, cholesteatoma,
    otitis externa
    Sx: trauma itself is painful, no
    pain afterward
    DDx: recurrent polychondritis->
    spontaneous seroma
    associated injuries of the
    temporal bone, ear canal, middle
    ear or TMJ should be excluded

    Complications
    damage
    otitis externa with fetid
    discharge

    Tx
    *do not use irrigation
    general anesthesia for
    children
    Lidocaine 10% for insects

    secondary infection by
    needle aspiration->
    perichondritis

    surgery
    -perichondrium reattached
    -oil-impregnated cotton/
    contoured dressing
    *seromas may recur
    cover wound with sterile
    dressing
    refer px
    send severed parts with th px
    cool the part using moist
    gauze in plastic bag
    immersed in ice water
    -no more than 6 hr for
    reanastomosis
    local tx should not exert
    pressure on auricle
    superficial: cooled, antiinflamm
    severe:debridement

    cauliflower ear
    soft-tissue infection
    perichondritis
    necrosis

    Burns

    Grade 1: localized erythema


    Grade 2: blistering of skin
    Grade 3: deep tissue necrosis

    Frostbite

    initially as white skin, demarcated


    painful when area is rewarmed

    External Auditory Canal


    injury

    foreign bodies
    harmful manipulation
    previous trauma
    Inflammatory Dses of the Ext Ear
    Eczema and Dermatitis
    confined to the dermis
    of the Auricle
    -jewelries, soaps, cosmetics,
    listening aids, thermal injury

    tender
    bleeding, hemorrhagic bulla or
    crusted blood

    infection
    cyst
    stenosis due to scarring

    ITCHING, occasional burning with


    little pain
    erythematous skin, may be dry
    and scaly or moist and weeping
    DDx:
    perichondritis
    pyoderma, celluliis
    preauricular crease- seborrheic
    dermatitis, psoriasis

    bacterial complications
    in the p=form of
    pyoderma,
    perichondritis, cellulitis

    Perichondritis of Auricle

    SEVERE PAIN of rapid onset and


    feeling of TENSION
    effaced auricular contours
    swelling, tenderness of concha

    cartilage destruction with


    permanent auricular
    deformity

    -acute inflammation of
    skin and perichondrium

    bacterial infection dt conchal


    cavity or auricular injurylateral
    Staphylococci

    cartilage necrosis,
    permanent deformity
    chilblains on the helical
    rim with ulcerations and
    itching
    perichondritis

    gently warmed with heat


    lamp
    dextran or pentoxifylline for
    circulatory stimulation
    6 months healing then
    surgery
    reapproximate epithelium
    Gelfoam or synthetic sponge
    for bleeding

    systemic antibac against


    staph
    NSAIDs

    Prognosis

    Notes

    ear protection

    poor prognosis for


    complete avulsion

    uncomplicated

    Dse
    plus articular cartilage,
    localized

    Pathogenesis/ Causes
    Pseudomonas

    Diagnosis
    blisters
    earlobe- spared
    lymphadenopathy
    fever

    Complications

    Tx

    glomerulonephritis,
    rheumatic fever,
    rheumatic
    endochondritis

    PCN G 4x2 mega IU IV


    NSAIDs

    Prognosis

    leukocytosis, high XRP and/or


    CSR

    Auricular cellulitis

    access through concha or ext


    meatus injuries

    -acute strep infection of


    subQ involving auricle
    and surroundings

    Herpes zoster oticus or


    Ramsay Hunt syndrome

    reactivation of dormant VZV


    in ganglion cells
    CN7 and/or CN 8,
    occasionally 9, 10

    Diffuse otitis externa


    and eczema of external
    ear canal

    gram (-): Pseudomonas


    aeruginosa, Proteus mirabilis
    anaerobes
    otomycosis
    myringitis
    otitis externa

    Circumscribed otitis
    externa

    local mechanical trauma and


    contamination lead to

    DDx:
    eczema, dermatitis, cellulitis,
    zoster oticus
    recurrent polychondritis
    redness, swelling, warmth
    involved earlobe and facial skin
    malaise, fever, otalgia
    DDx:
    eczema, dermatitis perichondritis,
    zoster oticus

    ear pain or burning on one side


    vesicles errupt
    followed by hearing loss, vertigo,
    dysequilibrium
    facial nerve palsy
    clustered, herpetiform vescicles
    at meatus and concha , *pinna
    direct electron microscopy
    four-fold titer increase
    DDx:
    bullous otitis externa, otitis media,
    mastoiditis, labyrinthitis,
    cholesteatoma, tumors of ear and
    lateral skull base
    ITCHING
    pain if with infection
    crusting, purrulent aural
    discharge
    conductive hearing loss in
    obstruction
    diffuse swelling
    fetid- anaerobes
    DDx:
    acute otitis media, chronic
    suppurative otitis externa,
    otomycosis, tumor, necrotizing
    otitis externa if with otalgia
    very PAINFUL, tender swelling,
    mild hearing loss

    necrotizing fascitisanaerobes
    bacterial infection:
    staphylococci,
    pseudomonas

    acyclovir
    valaciclovir
    famiciclovir

    zoster
    meningoencephalitis

    corticosteroids if with facial


    nerve palsy

    post-zoster neuralgia in
    older patients

    antiseptic

    perichondritis
    cellulitis
    abscess
    necrotizing otitis externa

    meticulous, repeated
    cleansing and drying of ear
    canal
    antiseptic, antibiotic drops
    no more than 2 weeks

    severe course on px with


    DM

    cleaned with 70% alcohol


    applied to a SELF-

    permanent
    functional deficits
    poorer prognosis
    than idiopathic
    facial paralysis

    Notes

    Dse
    or furuncle
    -acute cartilaginous
    infection of ear canal

    Necrotizing otitis
    externa
    or Malignant otitis
    externa

    Pathogenesis/ Causes
    obstruction of hair follicles or
    glandular ducts followed by
    staph infections of
    pilosebaceous units

    older px with DM
    begin with simple otitis
    externa that becomes
    infected with Pseudomonas
    auriginosa

    Bullous otitis externa


    Flu-related otitis,
    hemorrhagic otitis
    externa

    influenza virus*
    toxic capillary damage in the
    thin eithelial layer of the
    meatal skin and on the
    tympanic membrane

    Otomycosis

    saprophytic fungi
    Aspergillus, Candida
    albicans, Mucor
    dermatophytes

    Recurrent polychondritis
    relapsing polychondritis
    systemic
    chondromalacia
    chronic atrophic
    panchondritis
    Chronic
    chondrodermatitis

    auricular perichondritis as
    initial manifestation
    auricle and nose deformities,
    chronic bronchitis, dyspnea
    dt larynx and trachea
    involvement
    cutaneous-perichondrial unit
    older px

    Diagnosis

    Complications

    Tx
    EXPANDING FOAM or
    GAUZE WICK for 1-2 days
    antibiotic ointment strips for
    crusts
    antibiotic and steroid drops
    after swelling subsides
    NSAIDs
    incision for clearly
    demarcated abscess

    Prognosis

    infection may spread to


    middle ear, skull base,
    retromandibular fossa,
    parotid compartment

    locally debrided and cleanes


    antibiotic against
    Pseudomonas for 6 weeks
    bone resection

    50% survival in
    cases that
    develop facial
    nerve palsy

    I/P: tragal tenderness,


    circumscribed swelling
    Ot: swelling, debris, tympanic
    membrane unseen
    some degree of hearing loss
    pus pocket
    DDx: foreign bodies, otitis externa
    with chronic suppurative otitis
    media, infected retroauricular
    atheroma, tumors`
    osteitis and ulceration on canal
    flooor with exposed, brownish
    bone and a fetid discharge
    moderate pain at first
    DDx:
    simple otitis externa,
    cholesteatoma, tumor, chronic
    otitis media

    severe otalgia of sudden onse


    followed by a bloddy discharge
    may develop conductive and
    sensorineural hearing loss
    DDx:
    trauma (barotrauma)
    herpes zoster oticus
    tumors
    severe itching and feeling of
    fullness
    white, yellow or black membrane
    lining swollen erythematous skin
    bony portion of the canal
    exclusively affected
    mycelia
    may develop from suppurative
    otitis media
    DDx:
    diffuse otitis externa
    systemic inflammatory disease
    Ab against cartilage tissue

    very PAINFUL epithelial nodule


    with an umbilicaterd center on the

    mastoiditis, petrostitis,
    otitis media, soft tissue
    abscess, CN 7-11
    deficits, sepsis, venous
    sinus thrombosis,
    meningitis
    middle ear or inner ear
    (labyrinthitis)

    tympanic membrane
    infection can lead to
    perforation and otitis
    media

    local anesthetic ear drops


    NSAIDs
    no specific antiviral therapy

    clean, dry
    local antimycotics
    soften with salicylate
    containing solution

    oral corticosteroids
    azathioprine
    cyclosporin

    complete excision

    refractory course
    tendency to recur

    Notes

    Dse
    nodularis helicis
    Winkler disease
    Gouty tophi

    Lymphadenosis cutis
    benigna (Bafvertedt
    disease)
    Granulating otits
    externa

    Specific otitis externa

    Pathogenesis/ Causes
    DDx:
    tumors
    gouty tophi
    near the joints and auricular
    cartilage
    Borrelia burgdoferi, tick bite
    hx
    spontaneous or sequel to
    otitis externa or surgery

    Syphillis stage 1
    Mycobacterium TB
    atypical mycobacteria

    Diagnosis
    free border helix or antihelix

    Complications

    Tx

    small, pale, freely movable


    subcutaneous nodules on the
    helical rim
    firm reddish nodule on earlobe

    no need

    circumscribed or diffuse
    granulations on the skin of the
    bony ear canal and tympanic
    membrane

    removal of granulations
    topical antibiotics and
    corticosteroids

    DDx:
    necrotizing otitis externa
    tumor
    `

    Prognosis

    >>>

    refractory

    Notes

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