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Diseases of External Ear

Diseases of External Ear. Dr SK Ng Department of ENT NT East Cluster The Chinese University of Hong Kong. Terminology. Otalgia- ear pain Otorrhea- ear discharge Tinnitus- sound perception without corresponding acoustic signal Vertigo- hallucination of movement.

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Diseases of External Ear

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  1. Diseases of External Ear • Dr SK Ng • Department of ENT • NT East Cluster • The Chinese University of Hong Kong

  2. Terminology • Otalgia- ear pain • Otorrhea- ear discharge • Tinnitus- sound perception without • corresponding acoustic signal • Vertigo- hallucination of movement

  3. Congenital • Acquired

  4. Embryological development of the Pinna

  5. Preauricular Sinus Accessory Auricle Telephone Cupped Ear

  6. Microtia

  7. Anotia

  8. Problems • Hearing • Cosmesis

  9. Air Conduction Hearing Aid

  10. Bone Conduction Hearing Aids

  11. Disadvantages of ConventionalBone Aids • Poor quality of sound amplification • Discomfort & skin irritation • Stigma

  12. Cosmesis • Conventional approach • No treatment • Prosthetic ear glued to the head • Surgical reconstruction of pinna

  13. Universally poor results with rib cartilage grafts

  14. Osseointegrated Implants

  15. Preauricular sinus Asymptomatic: NO treatment Infected: Antibiotics +/- Drainage if abscess Definitive treatment: Excision

  16. Acquired Diseases of Auricle

  17. Perichondritis/ perichondral abscess • Infection involve the perichondrium • Severe pain, often associate with fever • Treated by i.v. antibiotics +/- drainage if pus

  18. Can lead to ear deformity

  19. Pinna laceration • Wound cleaning, remove foreign body • Simple suture • Antibiotics if cartilage exposed • Need to rule out other injuries e.g. head injury

  20. Hematoma auris • Caused by trauma • Treatment: incision, drainage +pressure dressing

  21. Can lead to deformed ear if untreated— The cauliflower ear

  22. Tumors • Benign • Malignant

  23. Diagnosis: biopsy Treatment: Surgery RT Surgery + RT

  24. Diseases of External Ear Canal

  25. Otitis externa • Clinical features: • Otalgia/ Itchy ear • Ear discharge • Hearing loss- only in severe cases • Inflammed canal skin • Canal exudates

  26. Types • Bacterial: Acute diffuse otitis externa • 1. Trauma • 2. Prolonged water exposure • Common causal micro-organisms: Pseudomonas

  27. Treatment • Aural toilet • Antibiotic ear drops • Systemic antibiotics usually not required

  28. Fungal: • Prolonged antibiotic ear drops • Immuno-compromnised

  29. Treatment of fungal OE • remove predisposing factors • Topical antifungal agent

  30. Otitis externa • In immunocompromised patients • i.e. DM, steroid, HIV, Chemotherapy • Beware of Malignant Otitis Externa • involve bone of skull base, • severe pain • potentially fatal • treat by prolonged high dose i.v. antibiotics+/- surgery

  31. Impacted ear wax • Treatment needed when impaction causing symptoms: • Hearing loss • Otitis externa • Pain

  32. Treatment: NaHCO3 ear drops Syringing microsuction Impacted ear wax

  33. Foreign bodies • Syringing • Removed under operating microscope • For living insects: killed with olive oil before • retrieval attempt

  34. Small exostosis

  35. When large, can cause symptoms: • Impacted ear wax • Recurrent otitis externa • Treatment if symptomatic: • Surgical removal

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