1. 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

2. Otitis Externa Bacterial infection of external auditory canal
Categorized by time course
Acute
Subacute
Chronic

3. Acute Otitis Externa (AOE)
“swimmer’s ear”
Preinflammatory stage
Acute inflammatory stage
Mild
Moderate
Severe

4. 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

5. Mild to Moderate Stage Progressive infection Symptoms Signs Pain
Increased pruritus
Signs
Erythema
Increasing edema
Canal debris, discharge

6. Severe Stage Severe pain, worse with ear movement Signs
Lumen obliteration
Purulent otorrhea
Involvement of periauricular soft tissue

7. Treatment Most common pathogens Four principles
P. aeruginosa and S. aureus
Four principles
Frequent canal cleaning
Topical antibiotics
Pain control
Instructions for prevention

8. Chronic Otitis Externa (COE)
Chronic inflammatory process
Persistent symptoms (> 2 months)
Bacterial, fungal, dermatological etiologies

9. Symptoms
Unrelenting pruritus
Mild discomfort
Dryness of canal skin

10. Signs Asteatosis Dry, flaky skin Hypertrophied skin
Mucopurulent otorrhea(occasional)

11. 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

12. Furunculosis Acute localized infection
Lateral 1/3 of posterosuperior canal
Obstructed apopilosebaceous unit
Pathogen: S. aureus

13. Symptoms Localized pain Pruritus
Hearing loss (if lesion occludes canal)

14. Signs
Edema
Erythema
Tenderness
Occasional fluctuance

15. Treatment Local heat Analgesics Oral anti-staphylococcal antibiotics
Incision and drainage reserved for localized abscess
IV antibiotics for soft tissue extension

16. 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

17. Bullous Myringitis Viral infection Confined to tympanic membrane
Primarily involves younger children

18. Symptoms Sudden onset of severe pain No fever No hearing impairment
Bloody otorrhea (significant) if rupture

19. Signs Inflammation limited to TM & nearby canal
Multiple reddened, inflamed blebs
Hemorrhagic vesicles

20. Treatment Self-limiting Analgesics
Topical antibiotics to prevent secondary infection
Incision of blebs is unnecessary

21. Pseudocyst of the auricle
First reported by Hartmann in 1846
Fluctuant, tense, noninflammatory swelling of the upper ear
Believed to be ass with trauma

22. 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

23. Injury of tympanic membrane
Otalgia
Bleeding
Fullness
Hearing loss: conductive HL or mixed HL
Tinnitus
Shape of perforation is split

24. 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

25. Conclusions Careful History Thorough physical exam
Understanding of various disease processes common to this area
Vigilant treatment and patience