1. EAR PAIN

2. Auricle
Hematoma
Cellulitis
Relapsing Polychondritis 2

3. Hematoma
A localized mass of extravasated blood within the auricle- “bruise” 3

4. Hematoma Must be drained to prevent significant cosmetic deformity
dissolution of supporting cartilage- cauliflower ear 4

5. Cellulitis Inflammation of the cellular tissue May include lobule
Treat with Augmentin or Keflex
Complications- perichondritis and its resultant deformity 5

6. Relapsing Polychondritis
Auricular erythema and edema
Recurrent, frequently bilateral, painful
Does not include lobule- no cartilage
Systematic- may progress to involvement of the tracheobronchial tree
Treat- Corticosteroids might forestall cartilage dissolution

7. External Otitis

8. Otitis Externa Otalgia Pruritus Purulent discharge
Often recent water exposure or mechanical trauma

9. Examination Erythema Edema Purulent exudate
Auricular pain with manipulation
TM- moves normally with pneumatic otoscopy

10. Treatment Avoid moisture
Otic drops containing aminoglycoside antibiotic and anti-inflammatory corticosteroid--neomycin sulfate, polymyxin B sulfate, and hydrocortisone
Ear wick

11. Auricular Pruritis Common site- meatus usually self induced
excoriation
overly zealous ear cleaning
Otitis Externa??
Dermatologic condition
seborrheic dermatitis
psoriasis

12. Treatment Regeneration of Cerumen “blanket”
Avoid drying agents- soap & water, swabs
Mineral oil
0.1% Triamcinolone- topical corticosteroid
Oral antihistamine
Stop messing with it!!!!

13. Malignant External Otitis
Persistent external otitis
Evolves into Osteomyelitis of the skull base
Diabetic or Immunocompromised
Pseudomonas aeruginosa

14. Clinical Findings Persistent foul aural discharge
Granulation in the ear canal
Deep otalgia
Progressive cranial nerve palsies
(VI, VII, IX, X, XI, XII)
Diagnosis confirmed with CT
osseous erosion

15. Treatment Prolonged (antipseudomonal) ATB therapy
IV or Oral ciprofloxacin
Occasional surgical debridement

16. Serous Otitis Media Caused by negative pressure Blocked auditory tube
Transudation of fluid
children- tubes more narrow, more horizontal
common after URI
adults- persistent--think cancer

17. Clinical Findings Dull, hypomobile TM Air bubbles in middle ear
Conductive hearing loss

18. Treatment Autoinflation Oral corticosteroids Oral ATB
All else fails, ventilating tubes

19. Barotrauma
Negative pressure tends to collapse and lock the auditory tube
Rapid altitudinal change
Air travel
Scuba diving

20. Treatment Swallow, yawn, autoinflate Systemic or topical decongestants
pseudoephedrine
phenylephrine nasal spray
If persists on ground after treatments listed above…
Myringotomy provides immediate relief
Ventilating tubes- frequent flyer

21. Acute Otitis Media
Bacterial infection of the mucosally lined air-containing spaces of the temporal bone.
Usually precipitated by viral URI which causes auditory tube edema…accumulation of fluid that becomes secondarily infected with bacteria
Streptococcus pneumoniae (49%), Haemophilus influenzae (14%), Moraxella catarrhalis (14%)

22. H&P Findings Otalgia Aural pressure Decreased hearing Fever erythema
Decreased mobility of TM
TM bulge
perforation eminent

23. Treatment ATB Decongestants Tympanocentesis Ventilating tubes ppx
amoxicillin
erythromycin
sulfonamides
Decongestants
Tympanocentesis
Ventilating tubes
ppx
sulfamethoxazole

24. Chronic Otitis Media Chronic infection
Perforation of TM usually present
Mucosal changes
P. aeruginosa, Proteus, Staphylococcus aureus

25. Clinical Findings Hallmark- purulent aural discharge Pain- on/off
Conductive hearing loss

26. Treatment Removal of debris earplugs to protect against water exposure
ATB drops for exacerbations
Definitive- surgical TM repair
eliminate infection
reconstruction of TM

27. Cholesteatoma* Special variety of chronic otitis media
Most common cause is prolonged auditory tube dysfunction, with resultant chronic negative middle ear pressure that draws inward the upper flaccid portion of the tympanic membrane.
*see picture

28. Cholesteatoma Creates a squamous epithelium-lined sac
Becomes obstructed and fills with desquamated keratin and becomes chronically infected
Typically erodes bone, causes destruction of nerves, may spread intracranially

29. Cholesteatoma Physical examination Treatment
epitympanic retraction pocket or marginal tympanic membrane perforation that exudes keratin debris
Treatment
surgical marsupialization of the sac or its complete removal

30. Mastoiditis- complication of OM
Postauricular pain and erythema
Spiking fever
X-ray reveals coalescence of the mastoid air cells due to destruction of their bony septa
IV ATB and myringotomy for culture and drainage
Mastoidectomy if other fails...

31. Petrous apicitis- complication of OM
Medial portion of the petrous bone between the inner ear and clivus may become a site of persistent infection
Foul discharge, deep ear and retro-orbital pain, and sixth nerve palsy
Prolonged ATB therapy and surgical drainage

32. Otogenic skull base osteomylitis- complication of OM
Osteomyelitis of the skull base
Usually due to P aeruginosa

33. Facial paralysis- complication of OM
Acute-
Results from inflammation of the nerve in its middle ear segment, perhaps through bacterially secreted neurotoxins
Myringotomy for drainage and culture
IV ATB
prognosis excellent

34. Chronic
Evolves slowly due to chronic pressure on the nerve in the middle ear or mastoid by cholesteatoma
surgical correction of the underlying disease
prognosis less favorable

35. Sigmoid sinus thrombosis - complication of OM
Trapped infection within the mastoid air cells adjacent to the sigmoid sinus may cause septic thrombophlebitis
Systemic sepsis- spiking fevers, chills
Increased intracranial pressure- HA, lethargy, nausea and vomiting, papilledema
Diagnosis- MR venography
Tx- IV ATB, surgical drainage

36. Central Nervous System Infection - complication of OM
Otogenic meningitis- most common intracranial complication of ear infection

37. Non-auditory causes of earache
Temporomandibular joint dysfunction
chewing (soft foods, massage)
psychogenic
dental malocclusion (dental referral)
Glossopharyngeal neuralgia
refractory to medical management, may respond to decompression of ninth nerve

38. Non-auditory causes of earache
Infections and neoplasia that involve the oropharynx, hypopharynx, and larynx
persistent earache demands specialty referral to exclude cancer of the upper aerodigestive tract