Management of external ear disease

1. Ear Disease Simon Lloyd Consultant ENT Surgeon Manchester Royal Infirmary

2. Anatomy

3. Tympanic Membrane Left ear Long process of incus Pars flaccida Handle of malleus Pars tensa Light reflex

4. Middle Ear

5. Inner Ear Consists of: Semi-circular canals Vestibule Cochlea Function: Balance Hearing

6. Clinical Assessment

7. Symptoms 5 symptoms Otalgia Otorrohoea Hearing impairment Tinnitus Vertigo

8. Investigation

9. Pure Tone Audiometry

10. Familiar Sounds

11. External Ear

12. Otitis externa Inflammation of ear canal skin Aetiology: Bacterial – Staph. aureus, Pseudomonas, Proteus Fungal – Aspergillus niger, Candida albicans Viral – Herpes simplex,Herpes zoster Reactive – Eczema, Psoriasis Predisposing factors: Bathing, humidity Trauma Canal stenosis Eczema

13. Symptoms & Signs - Bacterial Otalgia - severe Purulent otorrhoea Deafness Inflammation of ear canal +/- pinna

14. Treatment Swab for sensitivities Aural toilet Splinting of ear canal (Pope wick) Topical antibiotics eg. Sofradex, Gentasone Keep dry

15. Malignant OtitisExterna Osteomylitis of temporal bone Immunocompromised patients eg. Diabetes Usually pseudomonas Extremely painful May be associated with cranial nerve palsy Have a high index of suspicion Treat aggressively with IV antibiotics for at least 6 weeks

16. Symptoms & Signs - Fungal Itching Mild otalgia Fullness Greyish white debris +/- fungal spores

17. Treatment Aural toilet Topical antifungal agents eg. Canestan

18. Furunculosis Staph. infection of hair follicle causing abscess formation Severe otalgia Requires I&D

19. Ramsey Hunt Syndrome Herpes zoster Geniculate ganglion of facial nerve Vesicular rash of pinna and ear canal (+/- mouth and tongue) Facial nerve palsy Painful Vertigo Treatment Analgesia Antiviralseg. Acyclovir Protect the eye

20. Perichondritis Inflammation of perichondrium Aetiology: Ear piercing Laceration Surgery CT disease Treatment: Antibiotics I & D (if abscess) Sequelae: Cauliflower ear

21. Foreign body in ear

22. Hyperostosis Exostosis Multiple bony swellings in deep canal Cold water Asymptomatic No treatmentunless large Osteoma Single benign bony tumour outer bony meatus No treatment unless large

23. Embryology

24. First Branchial Cleft Anomalies Pre-auricular sinus

25. First Branchial Cleft AnomaliesAccessory Auricle

26. Benign Skin Pathology SeborrhoeicKeratosis Gouty Tophi Solar keratosis

27. Benign Skin Pathology Chondrodermatitishelicisnodularischronica Keloid Scarring Darwin’s tubercle

28. Malignant Skin Pathology of The Pinna Basal Cell Carcinoma Squamous Cell Carcinoma