DISEASES OF THE

EXTERNAL EAR
Dr. Alex Malambo
Otorhinolaryngology
Head and Neck Surgeon
DISEASES OF THE PINNA
Includes congenital, traumatic, inflammatory
or neoplastic disorders.
A. congenital disorders
1. Bat ear-abnormally protruding pinna Bat ear
2. Preauricular appandages –skin covered
tags due to incomplete fusion during
development
3. Preauricular pits- incomplete fusion
during development
4. Microtia- small ear
5. Anotia –no ear
6. Macrotia- big ear
DISEASES OF THE PINNA
B. Ear trauma
1. Haematoma of the auricle.
• collection of blood between the auricular cartilage and its
perichondrium
• result of blunt trauma
• Unattended hematoma can lead to cartilage death and healing by
fibrosis resulting in a cauliflower ear.
• Treatment is aspiration or incision and drainage
DISEASES OF THE PINNA
2. Lacerations, Avulsions
• Repair as soon as possible.
• Repair in layers i.e. perichondrium
and skin
• Use absorbable for perichondrium an
non absorbable for skin.
• Attempt reattachment of pinna with a
stalk still attaching
• Complete avulsed pinna can be
reattached consider viability and skill
available
3. Burns and frost bite
• In burns treat like burns and
debride as much a possible
exposed cartilage
• Staged management
• In frost bite, warm dressing 38-42
degrees
• Analgesia and antibiotics and
wait for demarcation the debride
accordingly.
DISEASES OF THE PINNA
3. Keloids
• Due to trauma i.e. piercings
• High recurrence rate post
excision
• Treatment is by excision
• And pre or post radiotherapy
• or steroids post excision
DISEASES OF THE PINNA
C. Inflammatory conditions • Treatment in early stage consists
1. Perichondritis of systemic antibiotic 7-10 days.
• It results from infection secondary to • If abscess has formed, I$D and
lacerations, haematoma or surgical send pus for M/c/s.
incisions
• Also extension of infection from
• Leave a small drain
diffuse otitis externa or a furuncle of
the meatus
• Start with symptoms red, hot and
painful pinna which feels stiff.
• Then abscess forms
DISEASES OF THE PINNA
2. Tumours
• Benign and malignant
• From skin to cartilage
DISEASES OF THE EXTERNAL AUDITORY
CANAL
The diseases of external auditory
canal are grouped as:
• A. Congenital disorders
• B. Trauma
• C. Inflammation
• D. Tumours
• E. Miscellaneous conditions.
A. Congenital disorders
1. Atresia of external canal
• may occur alone or in association with
microtia
• If occurring is due to recanalization during
development
• Maybe fibrous or bony
• TM is normal
• Atresia with microtia is more common
• Maybe associated with ME, inner ear
abnormalities
DISEASES OF THE EXTERNAL
AUDITORY CANAL
2. Branchial sinus type C. Inflammations of Ear Canal
1/Collaural fistula • Otitis externa may be divided, on
• 2 openings . In EAC and just aetiological basis, into
around the angle of the i. Infective cause
mandible
B. Trauma to Ear Canal
• From iatrogenic to accidents
DISEASES OF THE EXTERNAL
AUDITORY CANAL
ii. Reactive cause
• Eczematous otitis externa
• Seborrheic otitis externa
Eczematous OE
• Neurodermatitis

Scalp seborrheic dermatitis

DISEASES OF THE EXTERNAL
AUDITORY CANAL
INFECTIVE CAUSES 2. Diffuse otitis externa
1. Furuncle (localized acute otitis • diffuse inflammation of meatal skin which may
spread to involve the pinna and epidermal layer
external) of tympanic membrane
• is a staphylococcal infection of the hair • commonly seen in hot and humid climate and in
follicle swimmers
• severe pain, pain on movement of pinna • Also called Swimmers ear
and the jaw • Excessive sweating changes the pH of meatal skin
• Post auricular lymph node from that of acid to alkaline which favors growth
of pathogens.
• Treatment: systemic antibiotics. Analgesia • Common organisms responsible for otitis externa
and warm compressions are:
• Rule out immunosuppression in recurrent • S. aureus, Pseudo, proteus and E. coli
funiculitis • but more often the infection is mixed
DISEASES OF THE EXTERNAL
AUDITORY CANAL
• Clinical features: hot burning • Antibiotics both topical
sensation, pain, thin serous (medicated wicks) and systemic
discharge which later becomes thick
and purulent • Analgesia
• Meatal lining becomes inflamed • Topical steroids- usually
and swollen. combined in antibiotic ear drops
• May become chronic characterized
by irritation and strong desire
scratch, crusts
• Treatment: Aural toilet,
microsuctioning
DISEASES OF THE EXTERNAL
AUDITORY CANAL
3. Otomycosis
• fungal infection of the ear canal
• often occurs due to Aspergillus
or candida.
• Seen in hot and humid climate of
tropical and subtropical regions
• also seen in patients using topical
aural antibiotics for a long duration
• Clinical features: intense itching,
discomfort or pain in the ear,
watery discharge and ear blockage
• The fungal mass may arrear white,
brown or black and has been
likened to a wet piece of filter
paper.
• On microscopy hyphae is seen.
• Treatment: thorough Aural toilet,
antifungal ear drops, analgesia and
keep ear dry
DISEASES OF THE EXTERNAL
AUDITORY CANAL
4. Herpes zoster oticus
• Also called Ramsay Hunt syndrome
• Reactivation of varicella zoster
• May involve other dermatomes
• characterized by formation of vesicles
on the tympanic membrane, meatal
skin, concha and postauricular groove
• Apart from CN 7th, 8th cranial nerve
maybe involved
• Treatment: Antivirals, steroids and
analgesia
5. Malignant (necrotising) otitis externa.
• inflammatory condition caused by
pseudomonas infection usually in the
elderly diabetics, or in those on
immunosuppressive drugs
• Described as worse form of diffuse otitis
externa
• Infection spreads to involve soft tissues
around temporal bone and skull base and
osteomyelitis
• Clinical feature: excruciating pain, ear
discharge, granulation tissues in EAC.
• CN 7 palsy and other lower cranial Nerves
DISEASES OF THE EXTERNAL
AUDITORY CANAL
• Treatment consists of high doses of i.v. 7. Seborrhoeic otitis externa
antibiotics directed against
pseudomonas atleast for 6weeks
• It is associated with seborrhoeic
dermatitis of the scalp
• Aural toilet, analgesia
• Itching is the main complaint
• Treat under lying DM and
immunosuppression • Greasy yellow scales are seen in the
6. Eczematous otitis externa external canal, over the lobule and
• It is the result of hyper sensitivity to postauricular sulcus
infective organisms or topical ear drops • Treatment: ear toilet, cream
• Intense irritation, vesicle form ation, containing salicylic acid and Sulphur
oozing and crusting in the canal. • attend to scalp seborrhoea.
• Treatment: withdraw drug and give
steroid cream
DISEASES OF THE EXTERNAL
AUDITORY CANAL
D. Tumours
• Chronic otitis externa with
granulation tissue, foul smelling
discharge consider biopsy
• Especially in adults
DISEASES OF THE EXTERNAL
AUDITORY CANAL
E. Miscellaneous Conditions
1. Wax impaction/ cerumen
• Wax is composed of secretion of sebaceous
glands, ceruminous glands. hair, desquamated
epithelial debris. keratin and dirt.
• Wax has a protective function as it lubricates
the ear canal and entraps any foreign material
that happens to enter the canal
• excessive wax may be secreted and deposited
as a plug in the meatus
• Presents with hearing loss, tinnitus, itchiness
• Treatment: Ear syringing. If hard instill wax
softener for atleast 3 days
2. Foreign body
• Can be living or non living objects
• objects like seeds may swell if water instilled
• Removal can be by Forceps removal,
Syringing, Suction, Microscopic removal with
special instruments, Postaural approach
• For insects can instill oil as home remedy to
kill it
• For corrosives objects like battery remove as
soon as possible
• NOTE; syringing will removal most of the
objects
DISEASES OF TYMPANIC MEMBRANE
• Diseases of tympanic membrane
may be primary or secondary to
conditions affecting external ear,
middle ear or eustachian tube
1. Retracted tympanic membrane
• A retracted tympanic membrane
is the result of negative
intratympanic pressure when the
eustachian tube is blocked
• Prominent ME structures
DISEASES OF TYMPANIC MEMBRANE
2. Myringitis bullosa. It is a painful 5. Tympanosclerosis
condition characterised by formation of
haemorrhagic blebs on the tympanic • It is hyalinisation and later
membrane and deep meatus. It is calcification in the fibrous layer
probably caused by a virus or of tympanic membrane
mycoplasma pneumoniae.
3. Herpes zoster oticus.
4. Perforations can be traumatic or due
to infection
• Traumatic wait for 12 weeks for
spontaneous healing. If non
tympanoplasty
THE END