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Disease of the External Ear
Shankai Yin Prof Dept of Otolaryngology, the sixth hospital affiliated to Shanghai jiaotong university Otolaryngology institute at Shanghai jiaotong university
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Otitis Externa Bacterial infection of external auditory canal
Categorized by time course Acute Subacute Chronic
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Acute Otitis Externa (AOE)
“swimmer’s ear” Preinflammatory stage Acute inflammatory stage Mild Moderate Severe
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Preinflammatory Stage
Edema of stratum corneum and plugging of apopilosebaceous unit Symptoms: pruritus and sense of fullness Signs: mild edema Starts the itch/scratch cycle
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Mild to Moderate Stage Progressive infection Symptoms Signs Pain
Increased pruritus Signs Erythema Increasing edema Canal debris, discharge
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Severe Stage Severe pain, worse with ear movement Signs
Lumen obliteration Purulent otorrhea Involvement of periauricular soft tissue
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Treatment Most common pathogens Four principles
P. aeruginosa and S. aureus Four principles Frequent canal cleaning Topical antibiotics Pain control Instructions for prevention
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Chronic Otitis Externa (COE)
Chronic inflammatory process Persistent symptoms (> 2 months) Bacterial, fungal, dermatological etiologies
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Symptoms Unrelenting pruritus Mild discomfort Dryness of canal skin
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Signs Asteatosis Dry, flaky skin Hypertrophied skin
Mucopurulent otorrhea(occasional)
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Treatment Similar to that of AOE
Topical antibiotics, frequent cleanings Topical Steroids Surgical intervention Failure of medical treatment Goal is to enlarge and resurface the EAC
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Furunculosis Acute localized infection
Lateral 1/3 of posterosuperior canal Obstructed apopilosebaceous unit Pathogen: S. aureus
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Symptoms Localized pain Pruritus
Hearing loss (if lesion occludes canal)
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Signs Edema Erythema Tenderness Occasional fluctuance
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Treatment Local heat Analgesics Oral anti-staphylococcal antibiotics
Incision and drainage reserved for localized abscess IV antibiotics for soft tissue extension
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Granular Myringitis (GM)
Localized chronic inflammation of pars tensa with granulation tissue Toynbee described in 1860 Sequela of primary acute myringitis, previous OE, perforation of TM Common organisms: Pseudomonas, Proteus
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Bullous Myringitis Viral infection Confined to tympanic membrane
Primarily involves younger children
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Symptoms Sudden onset of severe pain No fever No hearing impairment
Bloody otorrhea (significant) if rupture
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Signs Inflammation limited to TM & nearby canal
Multiple reddened, inflamed blebs Hemorrhagic vesicles
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Treatment Self-limiting Analgesics
Topical antibiotics to prevent secondary infection Incision of blebs is unnecessary
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Pseudocyst of the auricle
First reported by Hartmann in 1846 Fluctuant, tense, noninflammatory swelling of the upper ear Believed to be ass with trauma
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Treatment Medical Care Surgical Care
No medical treatment is uniformly effective. Surgical Care surgical incision and pressure dressing aspiration followed by a pressure dressing intralesional steroids Surgical curettage and fibrin sealant
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Injury of tympanic membrane
Otalgia Bleeding Fullness Hearing loss: conductive HL or mixed HL Tinnitus Shape of perforation is split
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Treatment Antibiotic to prevent infection
Aseptic external auditory canal with alcohol Prevent super respiratory infection Prohibit nasal blow Prohibit ear drops It takes 3-4 w to heal the ear drum If 3 months later, perforation still exists, myringoplasty is indicated
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Conclusions Careful History Thorough physical exam
Understanding of various disease processes common to this area Vigilant treatment and patience
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