725-Disorders of the External Ear

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Pre-auricular Tags

*Minor indentations that are present in the preauricular area at birth.

*Occur at slightly higher rates in individual with HL (CHL or SNHL) especially in some syndromes

* children with tags/pits should be screened at birth

* Higher prevalence in some ethnic groups (10% in chinese)

Preauricular Tags

Minor skin tags that are present in the preauricular area at birth.

*Occur at slightly higher rates in individual with HL (CHL or SNHL) especially in some syndromes

* children with tags/pits should be screened at birth

* Higher prevalence in some ethnic groups (10% in chinese)

Clinical terminology of the various branchial abnormalities

*Cyst

*Cysts: Has no communication with the body surface (we can't see it)

Clinical terminology of the various branchial abnormalities

*Sinus

*Sinus: Communicates with a single body surface, either the skin or pharynx

*Abnormality of otic hillocks

*if infected--> refer to ENT!

Clinical terminology of the various branchial abnormalities

*Fistula

*Fistula: communicates with two body surfaces (hole gets all the way thru)

Disorders of the External Ear and Ear Canal that are NOT congenital

* Cerumen Impaction/Foreign Bodies/Collapsing Canals

*External Otitis

*Tumors of ear canal

*Abnormalities/lesions of the pinna

*results of trauma

*TM Abnormalities: myringitis, tympanosclerosis, perforations, (really ME)

Disorders of the External Ear and Ear Canal that are NOT congenital

- Pressure Atrophy

o In older adults with HA who never change tubing, which presses down
o Benign

Disorders of the External Ear and Ear Canal that are NOT congenital

-Hypertrichosis Lanuginosa Acquisita

Also called "Wolf Man Ear"

Associated Conditions:

-Medications: Phenytoin, streptomycin, penicillamine,minoxidil
-Porphyria (metabolistic)--werewolf myth
-Pregnancy
-Malnutrition/Anorexia
-Malignancy (due to a cancer)

Auricular Hematoma

*Collection of blood between cartilage of pinna and connective tissue.

Due to:Trauma

Resulting in: Scarring or thickening of the cartilage

Treatment: Surgical and prevention!

If go untreated can lead to: Cauliflower ear

Lesions of the Pinna- "Cauliflower Ear"

What it is: solidified hematoma

Cause: Repeated trauma

Common in wrestlers, rugby players

Can result in: HL if it causes Stenosis.

Damage to pinna- Frostbite

Damage to pinna- Burn

Neomycin Allergy

*Neomycin is a commonly used antibiotic

* Small % of patients have an allergic reaction

*Intense itching and/or pain

recommend: cut back on the neomycin and if not go away go see your doctor.

Keloids

What is it: Excessive scar tissue formation following trauma or surgery to pinna

* Usually is benign

*More common in racial groups with more skin pigment

*Treatment: Steroid injection, pressure. In some cases surgery (however note that can aggravate the lesion)

Carcinoma

due to: sun exposure

* 6% of all malignant lesions are found on or near the pinna

* Diagnosis is often delayed

*IF you see a lesion make sure pt is aware of it and refer to a physician

*looks like a sore (presentation varies)

*watch also for moles/melanomas

External Otitis

What is it? Infection in the skin of the external auditory canal

-Also called "swimmers ear" ; more prominent in hot/humid environment

-Caused by: fungus/bacteria

-can develop following laceration of canal (something that breaks the skin)

Symptoms:
*redness
*Ear pain;especially if tragus is palpated
*otorrhea (drainage)
*Aural fullness
*tenderness/pain
*fever
*cellulitis (occasionally)=tissue growth that is red and shiny
*Mild conductive loss if there is edema (swelling) of EAM

-Refer to: doctor right away!

-Can be: serious especially in elderly or immune compromised

-Can turn into Malignant (necrotizing) External Otitis

Malignant (necrotizing) External Otitis

Symptoms: progressive pain & drainage, granulation tissue in ear canal

-Severe infection caused by bacterial agent

-can spread thru eardrum to middle ear space and mastoid system

-can cause massive bone destruction in external, middle and inner ear

-can cause occasional facial nerve palsy

Treatment: IV antibiotics, hyperbaric tx, control of blood glucose, debridement (removal of infected tissue)

Important: to have pt seek treatment fast,

Mx: Streptomycin, ototoxic drug is used to treat this!

*common in elderly and people with diabetes.

Fungal Infection

yeast/fungal infection= otomycosis

Our role with all otitis externa:REFER

Physician will usually: clean, deride use steroid/antibiotic drop to reduce swelling and bacteria oral antibiotic sometimes used pain/itch medication prescribed Give water precautions

--> Can be chronic problem
-->Can be infectious
--> custom swim ear plugs may be prescribed after pt cured!

External Otitis: Audiological Implications:

*Can be difficult 2 perform hearing test because pt may be in too much pain to use headphones

* Use gloves

* Sterilize or use disposable inserts

* Don't use same equipment in both ears

* Physician referral

Keratosis Obturans

Sheet of skin

-desquamated keratinous material (dead skin) from bony part of canal

Dermatitis

*inflammation of the skin

*itchy, dry flaky skin, often allergic reaction, more open to infection

Impacted Cerumen

Impacted cerumen

-Incidence: 2-6% adults
-34% nursing home/institutionalized

Mechanical Obstruction: -qtips -HA

- Decreased expulsion-aging

-many colors
-Dry vs wet: genetics/affected by diet.

Collapsing canals (stenosis)

outer ear, ear canal weak cartilage

*headphone alert!

- most common in elderly (40% in nursing home pop) and very young children (3.5%)

-demonstrate w pressure on pinna

-->ABG mostly 1K-8K frequencies possible 25/30 dB

--> Expected imminence results; normal

-->can be unilateral/may differ in degree

Foreign Bodies in Ear canal

-Can be a wide range of objects

- Impacted in cerumen or not
-may require surgery
-can be uncomfortable if object is touching the TM
-note: if insect, do not try to remove with H2O-insect might swell
-refer to physician

Hyperceruminosis

Too much wax

* Common in kids and certain syndromes.
*It is caused by defective production or clearance
* Blockage can also result from obstruction of the canal, overly tortuous canals, stenotic canals- can be more stenotic with age.

Blockage of cerumen-->effect on hearing

Symptoms: Tinnitus, fullness, rarely vertigo, coughing or pain

* May not be noticed until 95% occluded

* often sudden

*Flat 30-40 dB conductive loss w/complete

* lesser amounts may affect high (why?)

* More likely in institutionalized, elderly and children

Cerumen removal

treatment: frequent removal

before removing:

* take careful Pt hx to rule out TM perf, ear disease, previous ear surgery, diabetes, AIDS, anticoagulants meds

--> Otoscopic examination

-->preremoval audiometry and immitance (up to 40 dB conductive HL)

Use: suction, wire loop or blunt hook

-irrigation at body temperature (NOT if perf or otitis externa) too warm or too cold=can cause dizziness

-use chemical agents to soften wax.

* Be careful not to force wax in or lacerate EC or TMI

* also if hair in wax can be painful if you remove

* Cough reflex can be elicited in the deep portion of the canal

-->Most reliability exposure to our profession, dangerous in diabetics and/or other people with poor circulation.

ex:Possible ossicular dislocation, TM perf, bleeding etc.

Polyps

-thickened nodules of skin in canal (these don't hurt usually)

-->extreme version protruding out of ear on image

(Tumors & growths of the external ear and canal)

Osteomas

Osteoma= bony tumors-benign, smooth nodule of spongy bone covered w. skin

*usually in junction of bony and cartilaginous (third way in)

* some can cause HL if block sound

* usually unilateral & in kids

* can be removed surgically- skin graft rarely necessary

(Tumors & growths of the external ear and canal)

Exostoses

-benign bony lesions deep in EAC (can continue to grow)

**Due to exposure to cold water = "surfers ear"

-Treatment: surgical if block canal

-Ear plugs can be used to prevent recurrence (cold water in ear canal can cause it to grow)

(Tumors & growths of the external ear and canal)

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