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OT16 Otolaryngology
Diseases of the External Ear
Toronto Notes 2019
Pulling on the pinna is extremely painful in OE, but is usually well tolerated in otitis media
Exostoses
Definition
• bonyprotuberancesintheexternalauditorycanalcomposedoflamellarbone
Etiology
• possibleassociationwithswimmingincoldwater
Clinical Features
• usuallyanincidentalfinding
• iflarge,theycancausecerumenimpactionorotitisexterna
Treatment
• notreatmentrequiredunlesssymptomatic
Otitis Externa
Definition
• inflammation of external auditory canal or auricle
Etiology
• bacterial(90%ofOE):Pseudomonasaeruginosa,Pseudomonasvulgaris,E.coli,S.aureus • fungal:Candidaalbicans,Aspergillusniger
Risk Factors
• associatedwithswimming(“swimmer’sear”)
• mechanicalcleaning(Q-tips®),skindermatitis,aggressivescratching
• devicesthatoccludetheearcanal:hearingaids,headphones,etc.
• allergiccontactdermatitis,dermatologicconditions(psoriasis,atopicdermatitis)
Clinical Features
• acute
■ pain aggravated by movement of auricle (traction of pinna or pressure over tragus)
■ otorrhea (sticky, yellow purulent discharge)
■ CHL ± aural fullness 2° to obstruction of external canal by swelling and purulent debris
■ posterior auricular lymphadenopathy
■ complicatedOEexistsifthepinnaand/ortheperiauricularsofttissuesareerythematousandswollen
• chronic
■ pruritus of external ear ± excoriation of ear canal
■ atrophic and scaly epidermal lining, ± otorrhea, ± hearing loss ■ wide meatus but no pain with movement of auricle
■ TMappearsnormal
Treatment
• cleanearundermagnificationwithirrigation,suction,dryswabbing,andC&S • bacterialetiology
■ antipseudomonal otic drops (e.g. ciprofloxacin) or a combination of antibiotic and steroid (e.g. Cipro HC®)
■ do not use aminoglycoside if the TM is perforated, because of the risk of ototoxicity ■ introduction of fine gauze wick (pope wick) if external canal edematous
■ ± 3% acetic acid solution to acidify ear canal (low pH is bacteriostatic)
■ systemic antibiotics if either cervical lymphadenopathy or cellulitis is present
• fungaletiology
■ repeated debridement and topical antifungals (gentian violet, Mycostatin® powder, boric acid,
Locacorten®, Vioform® drops) • ±analgesics
• chronicotitisexterna(prurituswithoutobviousinfection)→corticosteroidalone(e.g.diprosalicacid)
Malignant (Necrotizing) Otitis Externa (Skull Base Osteomyelitis)
Definition
• osteomyelitisofthetemporalbone
Epidemiology
• occursinelderlydiabeticsandimmunocompromisedpatients
Etiology
• rarecomplicationofotitisexterna
• Pseudomonasinfectionin99%ofcases