Congenital Diseases of the

External and middle ear

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 Anomalies of the Pinna
 The pinna arises from a series of six tubercles
which develop on the first and second
branchial arch around the primitive meatus at
about the sixth week of intrauterine life. The
development is complete by the fourth month
of foetal life.
 The arrest of development may result in
various deformities.
 Cont…
 Anotia: This refers to the absence of the
pinna.
 Microtia: This is the term for an abnormally
small and deformed pinna while
 macrotia: indicates an abnormally large
pinna. The cases of absent pinna can be
given a prosthesis or treated by plastic
reconstruction using moulded rib cartilage.
Cont..
 Cont..
 Malformations of the pinna are commonly
associated with a deformed canal.
 Many minor variations in the shape of the pinna
may occur.
 N.B. Protruding (Bat) ears: (The commonest
anomaly). The ears are protruding and prominent
because the antihelix is under developed.
Treatment:
 Otoplasty at the age of 5 years before school
admission.
Anomalies of the External Auditory Canal

 The congenital abnormalities of the external

auditory canal may present as follows:
1. Complete atresia
2. Shallow depression
3. Changes in the curvature of the canal.
These conditions are usually associated with
abnormalities of the middle ear.
 Cont..
The malformed external canal is usually filled
with dense bone, sometimes cartilage and
dense fibrous tissue may also be present.
 Anomalies of the Middle Ear
• The congenital conditions of the middle ear
may present as follows.
 Ossicular Deformities

 Malleus is the most frequently malformed

ossicle. It may be fused with the incus or be
adherent to the walls of the epitympanum.
 A similar deformity may involve the incus.
 The stapes may show the congenital fixation
of its foot-plate.
 Treatment of Congenital Atresia of the
Canal and Middle Ear Deformities
• It is very important to know of the deformities
beyond the atresia so that the results of
surgery can be predicted to some extent.
When conventional radiography is of little
help, more details are provided by
tomography.
 Cont..
 Surgical exploration is the treatment of
choice. Cases having bilateral congenital
atresia should be operated early, usually
around 18 months to 2 years.
 Cont…
 This period corresponds to the timing for
acquisition of speech.
 The cases suffering from unilateral disease
develop normal speech, therefore, in such
cases surgery can be delayed.
 The aim of surgery is to reconstruct the
hearing mechanism and to create an external
meatus.
 Diseases of the
External Ear
 The diseases affecting the auricle may be
congenital, inflammatory, traumatic or
neoplastic.
 PERICHONDRITIS
 It is the inflammation of the perichondrium the
auricular cartilage.
Etiology:
 It may be due to infection mainly due to pyogenic
Bacteria, trauma of the pinna itself or to the
cartilaginous meatus due to spread of infection from
a furuncle, or may follow an operative procedure on
the ear.
 Sometimes the infection may follow an insect bite.
 Clinical Features
 The patient complains of burning pain in the
ear.
 The pinna is red hot, swollen and markedly
tender.
 Since the perichondrium carries the blood
supply to the auricular cartilage, it may get
necrosed and may break producing a
 deformed pinna.
 Treatment
 Systemic antibiotics are given in heavy doses
in addition to the analgesics and anti-
inflammatory drugs. Magnesium sulphate
paste may be applied.
 If the condition does not respond to
conservative treatment and proceeds to
abscess formation, then multiple incisions are
given to drain the pus and pressure bandage is
applied.
 HAEMATOMA OF THE AURICLE
 Accumulation of blood between the auricular
cartilage and its perichondrium.
 More common in boxers( BOXER’S EAR)
 This results in formation of a tense fluctuant
swelling under the auricular skin.
 Cont..
 A little collection of blood may not require any
treatment except pressure bandage but a big
hematoma requires aspiration or incision
drainage with pressure dressing to prevent its
recurrence.
 Etiology and Clinical Features
 Blunt trauma, Spontaneous as in elderly and
haemorrhagic blood diseases.
 The auricle is painful, swollen, bluish.
Treatment:
 Antibiotics are given to prevent secondary infection.
Recurrent injury, particularly in boxers produces a
deformity of the pinna called cauliflower ear or
boxer’s ear.
 Cont..
 Incision and evacuation under complete
aseptic condition and followed by firm dressing
to prevent recollection of blood.
 PSEUDOCYST PINNA
 A soft cystic swelling may develop on pinna
due to collection of fluid under the skin.
 There is no definite cyst wall.
 The exact etiology is not known but possibly
this extravasation of fluid is due to trauma of
which the patient may be unaware.
 Treatment
 Aspiration or incision drainage under aseptic
precautions is done followed by pressure
bandage.
 In case of recurrence, removal of the necrosed
cartilage and painting of the wound with a
weak solution of iodine is recommended.
 OTITIS EXTERNA
 It is the inflammation of the skin lining the
external auditory canal.
 Otitis externa may be acute or chronic, and
localised (furunculosis) or diffuse. It is also
classified as infective and reactive otitis
 Furunculosis
 Localized bacterial infection of a hair follicle or glands
of the skin of the outer cartilaginous part of the
external auditory canal.
 The bony meatus is not involved as it does not
contain any hair follicles or sebaceous glands.
 The infection usually follows trauma to the canal
caused by pricking at the time where person
attempts to clean the ear.
 Clinical Features
 The furuncle produces a red, swollen area in the
canal, and may partially obliterate its lumen.
 Deafness only if the furuncle is large enough to
occlude the canal.
 Pain on mastication, touching or moving the auricle.
 Discharge is purulent & scanty.
 Treatment
 furunculosis is treated by analgesics
 Packing of the canal with gauze soaked in 10
per cent icthyolin glycerine is helpful, It
reduces the oedema and supports the canal
wall thus helping to reduce the pain.
 Cont…
 Most of the cases of furunculosis are helped
by the above treatment.
 Antibiotics are given for severe cases.
Penicillinase resistant antibiotics like cloxacillin
are preferable. When the abscess is pointing, it
needs drainage.
 OTOMYCOSIS
• Its fungal infection of the ear, The common fungi
involved are Aspergillus niger, Aspergillus fumigatus
and Candida albicans.
• The disease is more frequent during the rainy season
as the increase in humidity leads to the rapid growth
of the fungus.
• The condition may follow from swimming in infected
water.
 Clinical Features
 Itching and irritation in the ear are common.
 The patient may complain of discomfort in the ear
which may amount to actual pain. Sometimes a
scanty discharge is also present.
 The canal wall is hyperaemic and the fungal debris is
seen in the canal with some discharge.
 Cont..
 Aspergillus niger produces black colonies and
Candida albicans presents as white granules
resembling wet blotting paper.
 When the debris is removed, the tympanic
membrane looks normal.
 Treatment
 The fungal debris is cleaned. Local applications of
nystatin in glycerine drops or other local fungicidal
preparations like clotrimazole are helpful.
 Two per cent salicylic acid in alcohol drops is
keratolytic and may be prescribed after removal of
the fungal debris.
 FOREIGN BODIES IN THE EXTERNAL
AUDITORY CANAL
 Foreign bodies in the ear are common in children
who may put beads, peanuts, beans, pieces of lead
pencil (inanimate), etc. into the ear, Grains of maize
and paddy are commonly found both in children and
adults particularly during the harvest season.
 Live insects like bed bugs, mosquitoes and may enter
the ear.
 Clinical Features
• The patient may present with pain in the ear and
deafness. Injury may occur to the canal wall or the
tympanic membrane by the foreign body itself or by
improper attempts at its removal.
 Treatment
 A living foreign body may be killed by instilling some
oily drops into the ear. This suffocates and kills the
insect which can be then removed by forceps or
syringe.
 Metallic foreign bodies, glass beads and small sized
food grains may be removed by syringing.
 Cont…
 If the foreign body is in the outer part of the canal,
an ear hook may be useful for its removal by expert
with the patient in the proper position.
 The foreign bodies lying deep in the meatus in
children and in patients who are apprehensive are
removed under general anesthesia.
 TRAUMATIC PERFORATIONS OF
THE TYMPANIC MEMBRANE
 Etiology: Perforation of the tympanic membrane
may occur due to foreign bodies usually pointed
objects, and improper curetting or syringing.
 The damage may also occur due to direct violence
like a slap or in blast injuries.
 The membrane may get damaged in head injury.
 Clinical Features
 The patient complains of pain in the ear, deafness
and sometimes blood-stained discharge.
 Examination reveals the perforation with teared
edges and the membrane may show areas of
ecchymosis.
 Treatment
 If the patient is seen shortly after injury, the external
canal is packed with a sterile cotton plug.
 Systemic antibiotics and decongestant drops in the
nose are used to prevent infection of the middle ear
through the eustachian tube.
 No topical drops are used in the ear. The perforation
usually heals by itself.
THANKS