Detail description of diseases of each part of external ear.

1. Diseases of external ear
Dr. Gangaprasad Waghmare
MS,PhD(Sch),PGDCS

2. External ear
Anatomically external ear consists of three structures :
• Auricle or the pinna
• External acoustic canal
• The tympanic membrane

3. Diseases of pinna
•Congenital
•Traumatic
•Inflammatory

4. Congenital
• Bat ear - Abnormally protruding ear. Concha is large with
poorly developed antihelix and scapha. Surgically corrected
after 6 years of age.
• Preauricular appendages – skin covered tags that appear on a
line drawn from the tragus to the angle of mouth.
• Preauricular sinus – Seen at the root of helix. Due to
incomplete fusion of the tubercles.
• Anotia- complete absence of pinna.
• Macrotia - excessively large pinna.
• Microtia - pinna is abnormaly smaller in size

5. BAT EAR PREAURICULAR APPENDAGES PREAURICULAR SINUS
ANOTIA MACROTIA MICROTIA

6. Trauma
• Haematoma of the auricle-
• Lacerations / avulsion of pinna
• Frostbite
• Keloid of the auricle

7. Haematoma of the auricle
• Collection of blood between
the auricular cartilage and
its perichondrium.
• Extravasated blood may clot
and then organise resulting in a
typical deformity called - cauliflower ear.
• Treatment - aspiration of
the haematoma and carefully
packing all concavities.
HAEMATOMA OF
THE AURICLE

8. Lacerations
• Should be repaired as early as possible
• Perichondrium is stitched with absorbable sutures.

9. Avulsion of pinna.
• Pinna is still attached to the head by a small pedicle of skin.
• Normally, primary retachment is considered.
• Completely avulsed pinna should be re implanted by microvascular
techniques.
Frostbite
• Injury due to Frostbite.
• Erythema and oedema, bullae formation necrosis of skin etc.
• Trearment- re warming with moist cotton pledges at 38-42°c

10. Keloid of auricle
• Follows trauma or piercing of ears for ornaments.
• Usual sites - lobule or helix.

11. Inflammatory conditions
• Perichondritis
• Relapsing polychondritis
• Chondrodermatitis nodularis chronica helicis

12. Perichondritis pinna
• Inflamation of perichondrium
with pus between perichondrium
and cartilage
• Pseudomonas / staphylococcus aureus
infection and secondary infections
from other ear pathologies.
• Burning sensation of ear,
painful movement of the ear
• Fever
• Body ache
• Pinna totally deformed – cauliflower

13. Perichondritis management
• Antibiotics based on C/S
• Local 4% aluminium acetate application
• I & D, insertion of drainage tube with multiple openings
• Pressure bandage

14. Relapsing perichondritis
• Rare autoimmune disorder involving cartilage of the ear.
• External ear becomes stenotic.
• Treatment - high doses of systemic steroids

15. Chondrodermatitis nodularis
chronica helicis
• Painful and Tender nodules appear near the free border of helix.
• Patient unable to sleep. On the affected side.
• In men at about age of 50 yrs.
• Treatment - excision of nodules with its skin and cartilage.

16. Diseases /of external auditory
canal
• Congenital
• Trauma
• Inflamation
• Tumours
• Miscellaneous

17. Congenital and traumatic
• Congenital
1. Atresia of ear canal
2. Collaural fistula
• Traumatic
1. Lacerations minor & major

18. Atresia of the external canal
• May or maynot occur in association with microtia.

19. Collaural fistula
• Abnormality of the first branchial cleft.
• Fistula has two openings :
1. situated in the neck just below and behind the angle of
mandible.
2. In the external canal or the middle ear.

20. Trauma to the ear canal
• Minor lacerations : Q tip injuries, unskilled
instrumentation by the physician.
• Major lacerations : gun shot wounds and intense injuries.
injury to the mandible is involved.

21. Inflammations of ear canal
Otitis externa
• Acute inflamation of skin lining EAC
• Aetiology
1. BACTERIAL
2. FUNGAL
3. VIRAL
LOCALIZED OTITIS EXTERNA ( FURUNCLES)
DIFFUSE OTITIS EXTERNA
MALIGNANT OTITIS EXTERNA
OTOMYCOSIS
HERPES ZOSTER OTICUS
OTITIS EXTERNA HAEMORRHAGICA

22. Furunculosis
• Inflamation of hair follicles –
staphylococcus aureus
pseudomonas & proteus
• May spread subcutaneously
– cause cellulitis
• Etiology - Scratching ear canal ,
allergy , immunocompromised patients
diabetes , depression

23. Furunculosis
• Pain
• Deafness
• Discharge – purulent
• Tenderness on moving pinna or pressing tragus
Treatment
1. 10% icthymol glycerin paint – 2 to 3 times
2. Antibiotics , analgesics
3. Prevent recurrence

24. Diffuse otitis externa
• Diffused inflammation of the
meatal skin which may spread to
involve pinna and epidermal layer
Of the tympanic membrane.
• Commonly seen in swimmers.
• Two main factors responsible :
1. trauma 2. inflammation
Common organisms :
s. aureus, B.proteus, E.coli

25. Clinicalfeatures:
AcutePhase–
hotburningsensationintheearfollowedbypainwhichis
aggravatedbymovementsofjaw.
Chronicphase–
irritationandstrongdesiretoitch.
Treatment:
AcutePhase–eartoilet
medicatedwicks
antibioticsandanalgesics.
ChronicPhase–reductionofmeatalswellingbyeartoiletand
usingagauzewicksoakedin10%icchthamolglycerine.

26. OTITIS EXTERNA

27. Otomycosis
• Fungal infection affecting external ear
• Diabetes & immunocompromised factors – predisposes
• Aspergillus niger (black headed)
• Others – candida albicans (white), aspergillus fumigatus
(green/brown)

28. Symptoms
• Irritation
• Pain
• Deafness
• Itching
• Discharge sometimes ( watery discharge with a
musty odour)
• Fungal mass might be seen

29. Otomycosis Treatment
• Thorough cleaning – syringing/ suction
• Painting with 2% salicylic acid
• Anti fungal drops eg – nystatin
• Keep ear dry
• Treatment of underlying disease (diabetes)

30. Otitis externa haemorrhagica
• Formation of haemmorrhagic bullae on
the tympanic membrane and deep
meatus.
• Mostly viral and seen in influenza
epidemics
• Treatment - antibiotics.

31. Herpes zoster oticus
• Formation of vesicles on the tympanic
membrane, meatal skin , concha and
postauricular groove

32. Malignant otitis externa
• Pseudomonas infection
• Diabetics / immunosuppresed
• Facial nerve involvement
is common
• May involve skull base,
jugular foramen
• CT scan – to know its extent

33. Management
• IV antibiotics – tobramycin, ticarcillin, 3rd
gen cephalosporin 6 – 8 weeks
• control diabetes
• Surgical debridement of devitalized bone &
tissue to be done judiciously.

34. Eczematous otitis externa
• Results from the hypersensitivity to the infectious
organisms or the topical eardrops like the chloromycetin
or the neomycin.
• Symptoms - intense irritation, vesicles formation, crust
formation and oozing.
• Treatment includes withdrawal of the steroids

35. Neurodermatitis
• Due to compulsive scratching due
psychological factors.
• Main complaint is intensive itching.
• Treatment is sympathetic psychotherapy
and secondary infection if any.

36. Seborrhoeic otitis externa
• Associated with seborrhoic dermatitis of
the scalp.
• Itching is the main complaint with greasy
yellowish scales seen in the external ear
canal.
• Treatment – ear toilet , ointment with
salicylic acid and sulphur.

37. Miscellaneous wax/cerumen
• Mixture of ceruminous and sebaceous
gland with desquamated epithelium in
EAC
• Functions – anti bacterial action , traps
dust and foreign body
• Causes of excess wax collections 1. Excess
formation 2. Less oily 3. Narrow canal 4.
Hot & dry climate 5. Stiff hair in EAC 6.
Apprehensive patients

38. IMPACTED CERUMEN IN THE
EXTERNAL AUDITARY CANAL

39. impacted cerumen symtoms &
management
• Symptoms 1. Deafness 2. Irritation & itching 3. Otalgia 4. Tinnitus
5. Cough reflex
• Treatment 1. Waxolytic agents 2. Syringing 3. Hooking with hook
or forceps

40. Foreign bodies of ear
• Non living (grain seeds, pebbles, sand
particles etc.)
• Living (insects like mosquitoes etc)
• Methods of removal 1. Forceps 2. Syringing
3. Suction 4. Microscopic removal 5. Post
aural approach

41. FOREIGN BODIES IN THE EAR

42. Diseases of the tympanic
membrane
• Retracted tympanic membrane.
• Myringitis bullosa
• Herpes zoster oticus
• Myringitis granulosa
• Traumatic rupture
• Atrophic tympanic membrane
• Retraction pockets and atelectesis
• Tympanosclerosis
• Tympanic perforations

43. Karna paligata roga
As per ashtang hruday
• kuchikarna - contraction of the karnashaskuli (pinna) due to
congenital causes
• Karnapippali - development of painless muscular immobile
sprouty outgrowths resembling pippali on the pinna
• Palishosha - emaciation of the karnapali
• Tantrika - transformation of the pinna into a strong hard wire
like emaciated structure
• Vidarika – fissured and deformed karnashashkuli

44. As per sushruta
• Paripota – due to delayed karnavedhan , causes reddish and
black painful swelling with irritation.
• Utpata – allergic reactions.
• Unmatha / gallira – forceful streching or elongation of the
earlobe
• Dukhvardhna – when improper site is selected for ear
puncturing.
• Parilehi / lehika – painful exudating mustard like eruptions
associated with itching, burning sensations on the ear.