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Common Disorders of the External, Middle & Inner Ear

Common Disorders of the External, Middle & Inner Ear. Chapter 239. Anatomy. Otalgia. Primary Referred Innervated by CNV,VII, IX, & X; and cervical plexus

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Common Disorders of the External, Middle & Inner Ear

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  1. Common Disorders of the External, Middle & Inner Ear Chapter 239

  2. Anatomy

  3. Otalgia • Primary • Referred • Innervated by CNV,VII, IX, & X; and cervical plexus • Naso/oropharynx, sinuses, teeth, parotid gland, muscle of mastication, tonsils, Eustachian tube, herpetic neuralgia, tic douloureux all may present as otalgia

  4. Tinnitus • Perception of sound without external stimuli • Constant, pulsatile, high/low pitched, hissing, clicking or ringing • Result of damage to cochlear hair cells • Pharmacologic side effects: 10% • Aspirin • NSAIDS • Antibiotics esp aminoglycosides Tx: antidepressants if no correctable cause

  5. Sudden Hearing Loss • Occurs in three days or less • Poor prognosis if associated with vertigo and severe hearing loss • Causes: • Idiopathic • Viral infections (mumps) • Trauma (ruptured TM) • Metabolic disturbances • Ototoxic drugs

  6. Acute Diffuse Otitis Externa aka swimmer’s ear • Pruritus, pain and tenderness of external ear • Erythema and edema of EAC • Clear or purulent otorrhea with crusting • Cerumen protects the EAC and provides acidic pH with antimicrobial properties • Causes: • Psuedomonas & Staph aureus • Aspergillus (blue/green/black discoloration) & Candida • Seborrhea and psoriasis

  7. Treatment of Otitis Externa • Analgesia • Cleansing of the EAC • Acidifying agents • Topical antimicrobials with wick • (+/-)steroids

  8. Malignant Otitis Externa • Extension of simple otitis into the cartilage, periosteum and bone • Psuedomonas • Elderly, HIV, and DM • CT head • ENT consult • IV antibiotics, admission

  9. Otitis Media • Strep pneumo, H. influenza, M. catarrhalis • Chronic OM: Staph aureus, Psuedomonas, anaerobic organisms • TM with impaired mobility, red, retracted or bulging • Tx: amoxicillin, augmenting, then rocephin IM for three days

  10. Otitis Media’s many looks

  11. Complications of OM • Acute Mastoditis • Meningitis and brain abscess • Lateral sinus thrombosis • Headache, papilledema, XI nerve palsy, vertigo • Angiography or MRI • Cholesteatoma • Expanding, erosive lesion of epidermis and keratin • Destructive and if infected…life-threatening

  12. Bullous Myringitis • Bulla formation on the TM and deep EAC • Reversible hearing loss • Mycoplasma, chlamydia and viral pathogens

  13. Trauma to the Ear • Remove FB to prevent infxn and “tattooing” • Close cartilage with 5-0 or 6-0 absorbable • Firm, contoured nonpressure dressings • Hematomas require I & D and pressure dressing • Consider plastics or ENT for complete or partial avulsion • Thermal burns and frostbite • TM perforation • Cerumen Impaction

  14. Previous slide in pictures

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