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Disorders of the Auricle and Ear Canal

Terms in this set (22)

Basal Cell Carcinoma
Squamous Cell Carcinoma
Traumatic Auricular Hematoma
Requires I&D if 7 days or less
Compression bandage
Re-exam every 24 hours for several days
Refer to ENT
Auricular Cellulitis
Caused by Staph Aureus, Strep pyogenes or Pseudomonas aeruginosa.
More difficult to treat if cartilage is invovled
May require IV abx before oral abx
Perichondritis
May result from untreated Auricular Cellulitis
Disorders of the Ear Canal
Cerumen Impaction
External Auditory Canal Foreign Body
External Otitis
Malignant External Otitis
Osteoma
Neoplasia
Cerumen Impaction
MC self induced through ill-advised attempts at cleaning the ear
Cerumen Impaction Symptoms and Tx
Symptoms - ear pain, hearing loss, pressure, dizziness, feeling of fullness in the ear
Tx - Mechanical removal, irrigation, or cerumenolytic drops.
*Do not irrigate in presence of TP tubes or in children unless absolutely necessary.
External Ear Canal Foreign Body
MC in children
May be removed with a loop or hook
Do Not use irrigation due to chance of object swelling.
Insect in Ear Canal
Immobilize before removal
70% isopropyl alcohol drops or 1% Lidocaine
Flush with warm water
External Otitis
"swimmer ear"
Otalgia
Pruritis
Purulent discharge
Hx of recent water exposure or mechanical trauma
Usually caused by Gram Negative Rods or Fungi, which grow in presence of moisture
MC is Pseudomonas - Forms fluorscein and can be identified with woods lamp illumination
External Otitis Physical Findings
Erythema
Edema of ear canal skin
Purulent exudate or macerated canal
Manipulation of auricle and tragus elicits pain
TM may not be visible
TM may be erythematous
TM will move normally with pneumatic otoscopy
Aspergillus External Otitis
External Otitis Tx
Otic suspension drops with abx or pH lowering agents
- Cortisporin Otic suspension (Polymyxin B, Neomycin, and hydrocortisone)
- Fluoroquinolone Otic suspension (Use when tubes are in place or perforated TM)
- Acetasol (acetic acid and hydrocortisone) Lowers pH
Ear Wick
Used when External Ear Canal has substantial edema and prevents drops from entering.
Facilitates entry for medication
Remains in place for 48 hours
Necrotizing External Otitis
Prevalent in diabetic or immuno-compromised patients.
May evolve into osteomyelitits
ENT Emergency
Usually caused by Pseudomonas
Necrotizing External Otitis Tx
Chiefly medical
Requires hospitalization initially with several months of anti-pseudomonal abx
May require IV abx
Osteoma
Benign tumor of external auditory canal
Skin covered mounds that obscure the TM
Of no significance if they do not cause obstruction of infection
Exostoses
Bony growth on top of existing bone
MC caused by repeated exposure to cold water
Frequently Bilateral near TM's
Obstruct normal physiology
May contribute to recurrent AOE
May require surgical removal
Neoplasia
MC is SCC
Consider when external otitis does not resolve with appropriate therapy
Tends to invade lymphatics, high 5 year mortality rate.
Tx - wide surgical resection and radiation
Ramsay Hunt Syndrome
AKA Herpes Zoster Oticus
Consists of facial and neck pain, acoustic symptoms, facial palsy in the distribution of the facial nerve
Patients first note pruritis, followed by pain over face and ear
May cause vertigo, sensorineural hearing loss, tinnitus, facial paralysis, loss of taste, loss of sensation, decrease salivation
Ramsay Hunt Syndrome Tx
Oral Acyclovir, famciclovir or valacyclovir
plus
analgesics - acetaminophen, ibuprofen, opiods
Consider corticosteroids
Protect involved eye and keep lubricated
Keep associated rash dry
Typically lasts 2 weeks
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