THE EAR

1. THE EAR

2. External Ear Pinna Tympanic membrane External Auditory Canal

3. Pinna/Auricle Location: oval-shaped appendage on the lateral surface of the head. Auricleelasticcartilage+skin Ear lobulenocartilage (fat and subbutaneous tissue) Function: sound localization and amplification. Composition: -thin skin with hair follicles - sweat glands and sebaceous glands covers supporting structure of elastic cartilage

4. Diseases of the Pinna

5. Perichiondritis Definition: • An acute inflammation of the skin and the perichondrium that involves the articular cartilage • Most commonly due to bacterial infection stemming from a small injury in the conchal cavity or the auricle. (close attachment of the skin to the perichondrium) • Causative organisms: staphylococci, pseudomas

6. Symptoms - Severe pain (rapid onset) - Feeling of tension - Auricular contours are effaced - Swelling of the concha with marked tenderness - Earlobes are spared - Regional lymph nodes maybe painful and enlarged - Fever may occur Treatment • Systemic antibiotics • Cleaning of the auricle and ear canal • Antiseptic/antibiotic containing ointments • Oral analgesics for pain

7. Trauma EAR TRAUMA

8. Ear Trauma • Auricle- skin-covered cartilage, with only a thin padding of connective tissue. • The entire cartilage framework is fed by a thin covering membrane called the perichondrium (meaning literally: around the cartilage) • Accumulation of fluid (swelling) or blood (injury) between the perichondrium and the underlying cartilage puts the cartilage in danger of being separated from its supply of nutrients Ear deformity (lumpy, distorted)

9. Wrestler's Ear (cauliflower ear)- repeated trauma causing thickened auricle that resembles a vegetable. • wrestling is one of the most common ways such an injury occurs. • Ear lobe- devoid of cartilage, covered with adipose tissue.Instead, it is a wedge of adipose tissue covered by skin. • Tears of the earlobe can be generally repaired with good results. Since there is no cartilage, there is not the risk of deformity from a blood clot or pressure injury to the ear lobe. • Other injuries causing major deformity. • Lacerations,bite injuries, avulsion injuries, cancer, frostbite, and burns

10. External Auditory canal • S-shaped, approx 2.5 cm long • Outer 1/3  cartilage , hair, cilia, mucus, sebaceous glands, ceruminousgland (secretes a brown-like substance, wax-like cerumen “ear wax”) • Inner 2/3  bone (tympanic and squamous portion of temporal bone) , anteroposteriorly , only epithelial lining on the periostium • Skin is very thin, directly overlying the periosteum  temperature and pain sensitivity.

11. The ear's self-cleaning mechanism moves old skin cells and cerumen to the outer part of the ear. • Epithelial migration of the lining of the EAC is a well-known phenomenon and is essential for the self-cleansing mechanism of this structure. • In most cases, the epicenter of this migratory process appears to reside in the vicinity of the umbo of the tympanic membrane. • The epithelial migration takes place at a rate of approximately 0.07mm/day and serves to cleanse the canal of debris, foreign bodies, and bacteria.

12. Cerumen and Cerumen impaction Cerumen - forms a protective film in which the fatty acids, lysozymes and the creation of an acid milieu bacteriostatic and bactericidal) effectively protects the skin of the ear canal. - Consists of a combination of desquamated epithelium, thick sebaceous gland secretions, and thinner apocrine gland secretions - Water resistant, traps debris

13. Cerumen impaction - Disturbance of the normal self cleaning mechanism or excessive cerumen secretion.Cerumen plug - Sebum, exfoliative debris, contaminants Symptoms: - pressure sensation in the ear, concomitant hearing loss, occasional vertigo and tinnitus

14. Cerumenolytics • Ceruminolytics – “cerumen softeners” • Hydrogen peroxide • Mineral oil, baby oil • Commercially prepared otic drops (Otosol, Auralgan) • Water

15. Foreign Body • Classification • Animate (living) • Bugs • Mosquito • Cockroach • Lice/mites • Inanimate (non-living) • Cotton • Pebbles • Small marbles

16. Foreign Body

17. Foreign Body: treatment • Methods of removal of foreign body from the ear: • Hooking out - care is taken not to push the foreign body deeper into the ear canal or through the tympanic membrane. • Syringing • Removal under the microscope

18. Otitisexterna Definition: • Inflammation of the external auditory canal caused by factors that interfere with the normal defenses against infection. Barriers to infection: • Normal cerumen film (acidic pH, fatty acid content- antibacterial) • Lateral migration of the epithelium Predisposing factors: • Exogenous factors - Water (maceration), shampoos (alteration in pH), manipulations with cotton-tipped (overcleaning/daily) swabs, earphones/plugs • Endogenous factors - eczema, allergies, metabolic disorders • Local changes - exostoses, stenoses

20. S/Sx: • Tragal tenderness • Pain and itching of the ear canal • Erythema • Edema • Canal debris, discharge • Treatment: • Instructions for prevention • Appropriate canal cleaning • Antibiotics • Pain control (analgesics)

21. Tympanic Membrane • Separates the outer ear from the middle ear. • Consists of 2 portions: pars tensa, pars flaccida • 3 layers of the pars tensa: • Outer- cutaneous layer; smooth muscle, stratified squamous epithelium that reflects the light • Middle- lamina propria; with 2 layers of connective tissue fibers. Outer (radiate layer), inner (circular layer) • Inner- mucosal layer; single layer of squamous epithelium

22. Pars Flaccida(Sharpnell membrane) • Superior to the malleolar folds • It lacks the reinforcing fibrous layer present in the pars tensa---retracts first in response to negative pressure in the middle ear  epithelial pocket

23. Myringitis • Inflammation of the tympanic membrane • Characterized by: • inflammation • Hemorrhage • Effusion of fluid into the tissue at the end of the external car canal and the tympanic membrane. • This self-limiting disorder (resolving spontaneously within 3 days to 2 weeks) often follows acute otitis media or upper respiratory tract infection and frequently occurs epidemically in children. Bullousmyringitis

24. Causes: • Viral infection • Bacteria (pneumococci, Haemophilusinfluenzae, betahemolytic streptococci, staphylococci) • organism that may cause acute otitis media. • Symptoms: - severe ear pain - tenderness over the mastoid process - Small, reddened, inflamed blebs form in the canal, on the tympanic membrane - Fever and hearing loss are rare unless fluid accumulates in the middle ear or a large bleb totally obstructs the external auditory meatus. -Bloody discharge- with ruptured blebs - No hearing impairment

25. Treatment: • Self-limiting • Analgesics • Topical antibiotics- prevent secondary infection

26. Granular Myringitis • Localized chronic inflammation of pars tensa with granulation tissue • Sequalae of primary acute myringitis, previous otitisexterna, perforated TM • Common organisms: Pseudomonas • Proteus • s/sx: • Foul smelling discharge • Often asymptomatic • No hearing loss/significant pain • No TM perforations • “peeping granulations” • TM obscured by pus

27. Treatment: • Careful and frequent debridement • Topical anti-pseudomonal antibiotics • Steroids • 2 weeks of therapy

29. Bulging Tympanic membrane • Bulging tympanic membrane: bulging tympanic membrane occurs due to fluid collection in the middle ear cavity. Causes: - Acute otitis media - Serouseffusion - Glue ear - Tumors Total bulging - a convex-appearing tympanic membrane with loss of visualization of the lateral process and/or the manubrium of the malleus bone. - diagonal cleft in the bulging tympanic membrane where its fibers are tightly adherent to the handle of the malleus. Partial bulging - fullness of an opacified, convex tympanic membrane with preservation of the outline of either the manubrium or the lateral process of the malleus bone. - Mobility is impaired during negative and positive pressure.