1. External ear diseases Salha Alotaibi – Alanoud alhusan
Rawan alhnaki – Waad Alshehri – Manwa Alrushidan

2. Congenital external ear diseases Congenital Disorders of Pinna and External Auditory Canal

3. Congenital conditions :
Preauricular sinus
Congenital swelling (pinna)
Collaural fistula
Congenital anomalies (pinna)
Atresia external canal
Congenital tumors of external canal

4. Preauricular sinus
Seen as a small pit along the anterior margin of ascending limb of helix.
The tract usually blends with the perichondrium of auricle
Sinus tract is usually superior and lateral to facial nerve and parotid gland
Subcutaneous cyst formation in the area is common

5. Anotia : is the total absence of the auricle , most often with narrowing or absence of external auditory canal . Microtia : there is some degree of malformation of the external ear ( peanut ear ) , as seen in down’s syndrome . Macrotia : it is excessively large pinna . Cup ear or lop ear : it is hypoplasia of upper third of the auricle . Coloboma : there is a transverse cleft in the pinna in the middle.

6. Microtia (peanut ear )
Anotia
Coloboma

7. Preauricular pit or sinus :
Depression in front of the crus of helix or above the tragus.
An epithelial track due to incomplete fusion of tubercles
Repeatedly infected causing purulent discharge, may also form abscess.
Treatment:
Surgical excision of the track if the sinus gets repeatedly infected.

8. Preauricular sinus
Preauricular tag

9. Atresia of external canal

10. Inflammatory conditions of Auricle (pinna)

11. Inflammatory conditions of Auricle are :
Perichondritis.
 Relapsing polychondritis.

12. :1/ Perichondritis common pathogens: symptoms: Treatment
It is an inflammation of perichondrium with pus between the perichondrium and cartilage.
common pathogens:
Pseudomonas aeruginosa
Staphylococcus aureus
Streptococcus Pyogenes
symptoms:
Swollen warm, tender, erythematous auricle.
Pain on deflection of auricle.
Treatment
in early stages : systemic antibiotics.
When abscess has formed it must be drained.

13. Traumatic Conditions of Auricle (Pinna)

14. Traumatic conditions of Auricle are :
Haematoma of the auricle.
 Avulsion of pinna.
Lacerations.
Keloid of auricle. 
Frostbite.

15. 1/Hematoma of the Auricle:
Auricular hematoma occurs following blunt trauma when blood and serum accumulate between the perichondrium and cartilage.
A cauliflower ear is a deformity of the ear caused by degeneration of the underlying cartilage structure of the ear.
If gets infected severe perichondritis may set in.

16. Treatment:
in the early stages following injury, simple aspiration is an option
When aspiration fails, incision and drainage should be done and pressure applied.
Prophylactic antibiotics.
if treatment is delayed and a plate of fibroneocartilage has formed, then permanent ear deformity will result unless formal surgical excision is undertaken, which has been done up to 1 month following injury
once a mature cauliflower ear has formed, then reconstructive plastic surgery is required to restore normal form to the pinna

17. How does the Cauliflower ear looks like?

18. External auditory canal diseases

19. Impacted wax
Earwax Causes. Blockage, or impaction, also occurs when the wax gets pushed deep within the ear canal.

20. Causes :
Blockage, or impaction, also occurs when the wax gets pushed deep within the ear canal. Earwax blockage is one of the most common ear problems doctors see.
The most common cause of impactions is the use of Q-tips (and other objects such as bobby pins and rolled napkin corners), which can remove superficial wax but also pushes the rest of the wax deeper into the ear canal.
Hearing aid and earplug users are also more prone to earwax blockage.

21. Symptoms : Decreased hearing Dizziness Ear pain
Plugged or fullness sensation
Ringing in the ear
Itching or drainage from the ear canal

22. The doctor may remove your earwax with a small plastic spoon called a curette, or irrigate your ear with warmed water, sodium bicarbonate , or other prescription-strength eardrops. The doctor may also use gentle suction to remove the wax.
Treatment :

23. Foreign body in the ear
Various objects may be found, including toys, beads, stones, folded paper, cotton buds, insects or seeds
Foreign bodies of the ear are relatively common.
They are seen most often in children.

24. :Symptoms
The symptoms of having a foreign body in the ear largely depend on the size, shape, and substance involved.
Pain is the most common symptom.
Deafness or discharge
Irritation to the ear canal can make you nauseated.
Cough because of stimulation of a nerve in the ear canal.
Bleeding if there is a sharp object and you try o remove it.
Buzzing in the ear if there is a live insect.
With delayed presentation, erythema and swelling of the canal and a foul-smelling discharge may be present.

25. Management:
Don’t push the object deeper into the ear canal. There is a high failure rate in removal of foreign bodies from the ear.
Removal methods :
Forceps or hook
Irrigation ( is often effective )
Suction with a small catheter held in contact with the object may be effective.

26. Infectious external ear diseases

27. Herpes zoster oticus Viral infection caused by varicella zoster virus.
Appears as a vesicles on the meatal skin, concha and post auricular groove , may involve tympanic membrane.
Symptoms include : unilateral burning pain , headache , fever, malaise , dizziness.
May involve vestibulocochlear nerve or facial nerve.
Treat it by oral steroids and antiviral.

28. otomycosis Fungal infection of external ear canal.
Organism may include : Aspergillus Niger or Candida albicans , grows in wet and temperature media.
The main symptom is pruritus , other symptoms like pain , obstructive hearing loss.
Signs are erythema of the canal , mild edema.
aspergillus have black spots appearance inside the canal , while candida appears as white deposit.
Treatment: antifungal , debridement , antihistamine , analgesia , prevent water entry.

29. Bacterial infections 1/ acute otitis externa:
Its bacterial infection of hair follicles in external canal.
Most common organism : pseudomonas aeruginosa , S.aureus.
Symptoms : sever pain , tenderness , decrease hearing , itching , dizziness.
Signs : erythema , mild edema , discharge , abscess formation in late stages.
Can affect surrounding areas: TMJ , mastoid , parotid.

30. Treatment : Analgesia, antihistamine. Local or systemic antibiotic.
ear wick.
Canal cleaning.
in case of abscess formation:
Incision and drainage.
Systemic antibiotic.

31. 2/ chronic otitis externa :
Persistent symptoms for < 2 months.
Inflammatory process diffusing include meatal skin , pinna , external part of tympanic membrane.
Also called ‘ swimmers ear ‘
Symptoms: pruritus , pain , discomfort , decrease hearing.
Signs : dryness of the area , mucopurulent discharge , erythema and swelling.
Treatment: analgesic , antihistamine , antibiotic , topical steroid , ear cleaning.

32. 3/ Necrotizing external otitis:
Seen in diabetic and immunocompromised patients.
Organism : pseudomonas aeruginosa .
Its aggressive disease start on skin goes to cartilage then temporal bone , intracranial.
Symptoms and signs : pain , purulent discharge , granulation tissue like polyps , obstructed canal.
Cranial nerve may involve cause facial palsy.

33. Investigations: Treatment: CBC , ESR elevated , CT , MRI.
Technetium-99 : bone scan reveals osteomyelitis.
Gallium scan : for soft tissues , more useful for staging the disease , diagnosis and follow up.
Treatment:
Admission , control diabetes , clear ear canal , systemic antibiotic for 6 weeks.

34. Thank you.