external and middle ear disease for g ps
TRANSCRIPT
![Page 1: External and middle ear disease for g ps](https://reader030.vdocument.in/reader030/viewer/2022012316/554b3ec5b4c905b5378b49b3/html5/thumbnails/1.jpg)
A Practical Guide to Diseases of the Ear
Simon LloydConsultant ENT Surgeon
Manchester Royal Infirmary
![Page 2: External and middle ear disease for g ps](https://reader030.vdocument.in/reader030/viewer/2022012316/554b3ec5b4c905b5378b49b3/html5/thumbnails/2.jpg)
Otitis externa Acute otitis media Chronic otitis media without cholesteatoma
Chronic otitis media with cholesteatoma
Otitis media with effusion
Severe Otalgia
Otalgia for a few days Otorrhoea intermittently or for more than 3 months
Otorrhoea intermittently or for more than 3 months
Hearing loss
Mild otorrhoea Fever Possibly conductive hearing loss
Probably conductive hearing loss
Speech delay
Occasionally conductive hearing loss
Otorrhoea once otalgia resolves
Usually a child
History of swimming/holiday
Conductive hearing loss May have adenoidal symptoms
Often a child
Differentiating Types of Otitis
![Page 3: External and middle ear disease for g ps](https://reader030.vdocument.in/reader030/viewer/2022012316/554b3ec5b4c905b5378b49b3/html5/thumbnails/3.jpg)
Acute Otalgia with normal TM
![Page 4: External and middle ear disease for g ps](https://reader030.vdocument.in/reader030/viewer/2022012316/554b3ec5b4c905b5378b49b3/html5/thumbnails/4.jpg)
Otitis externa
• Inflammation of ear canal skin
• Aetiology:– Bacterial – Staph. aureus, Pseudomonas, Proteus– Fungal – Aspergillus niger, Candida albicans– Viral – Herpes simplex,Herpes zoster– Reactive – Eczema, Psoriasis
• Predisposing factors:– Bathing, humidity– Trauma– Canal stenosis– Eczema
![Page 5: External and middle ear disease for g ps](https://reader030.vdocument.in/reader030/viewer/2022012316/554b3ec5b4c905b5378b49b3/html5/thumbnails/5.jpg)
Symptoms & Signs - Bacterial
• Otalgia - severe• Purulent otorrhoea• Deafness• Inflammation of
ear canal +/- pinna
![Page 6: External and middle ear disease for g ps](https://reader030.vdocument.in/reader030/viewer/2022012316/554b3ec5b4c905b5378b49b3/html5/thumbnails/6.jpg)
Treatment
• Swab for sensitivities
• Aural toilet• Splinting of ear
canal (Pope wick)• Topical antibiotics
eg. Sofradex, Gentasone
• Keep dry
![Page 7: External and middle ear disease for g ps](https://reader030.vdocument.in/reader030/viewer/2022012316/554b3ec5b4c905b5378b49b3/html5/thumbnails/7.jpg)
Malignant Otitis Externa
• Osteomylitis of temporal bone• Immunocompromised patients eg. Diabetes• Usually pseudomonas• Extremely painful• May be associated with cranial nerve palsy
• Have a high index of suspicion• Treat aggressively with IV antibiotics for at
least 6 weeks
![Page 8: External and middle ear disease for g ps](https://reader030.vdocument.in/reader030/viewer/2022012316/554b3ec5b4c905b5378b49b3/html5/thumbnails/8.jpg)
Symptoms & Signs - Fungal
• Itching• Mild otalgia• Fullness• Greyish white
debris +/- fungal spores
![Page 9: External and middle ear disease for g ps](https://reader030.vdocument.in/reader030/viewer/2022012316/554b3ec5b4c905b5378b49b3/html5/thumbnails/9.jpg)
Treatment
• Aural toilet• Topical antifungal agents eg.
Canestan
![Page 10: External and middle ear disease for g ps](https://reader030.vdocument.in/reader030/viewer/2022012316/554b3ec5b4c905b5378b49b3/html5/thumbnails/10.jpg)
Furunculosis
• Staph. infection of hair follicle causing abscess formation
• Severe otalgia• Requires I&D
![Page 11: External and middle ear disease for g ps](https://reader030.vdocument.in/reader030/viewer/2022012316/554b3ec5b4c905b5378b49b3/html5/thumbnails/11.jpg)
Ramsey Hunt Syndrome
• Herpes zoster• Geniculate ganglion of
facial nerve• Vesicular rash of pinna
and ear canal (+/- mouth and tongue)
• Facial nerve palsy• Painful• Vertigo• Treatment
– Analgesia– Antivirals eg. Acyclovir– Protect the eye
![Page 12: External and middle ear disease for g ps](https://reader030.vdocument.in/reader030/viewer/2022012316/554b3ec5b4c905b5378b49b3/html5/thumbnails/12.jpg)
First Branchial Cleft AnomaliesPre-auricular sinus
![Page 13: External and middle ear disease for g ps](https://reader030.vdocument.in/reader030/viewer/2022012316/554b3ec5b4c905b5378b49b3/html5/thumbnails/13.jpg)
First Branchial Cleft AnomaliesPre-auricular sinus
![Page 14: External and middle ear disease for g ps](https://reader030.vdocument.in/reader030/viewer/2022012316/554b3ec5b4c905b5378b49b3/html5/thumbnails/14.jpg)
First Branchial Cleft AnomaliesPre-auricular sinus
![Page 15: External and middle ear disease for g ps](https://reader030.vdocument.in/reader030/viewer/2022012316/554b3ec5b4c905b5378b49b3/html5/thumbnails/15.jpg)
First Branchial Cleft AnomaliesAccessory Auricle
![Page 16: External and middle ear disease for g ps](https://reader030.vdocument.in/reader030/viewer/2022012316/554b3ec5b4c905b5378b49b3/html5/thumbnails/16.jpg)
Benign Skin Pathology
![Page 17: External and middle ear disease for g ps](https://reader030.vdocument.in/reader030/viewer/2022012316/554b3ec5b4c905b5378b49b3/html5/thumbnails/17.jpg)
Benign Skin Pathology
Gouty Tophi
![Page 18: External and middle ear disease for g ps](https://reader030.vdocument.in/reader030/viewer/2022012316/554b3ec5b4c905b5378b49b3/html5/thumbnails/18.jpg)
Benign Skin Pathology
Seborrhoeic KeratosisGouty
Tophi
![Page 19: External and middle ear disease for g ps](https://reader030.vdocument.in/reader030/viewer/2022012316/554b3ec5b4c905b5378b49b3/html5/thumbnails/19.jpg)
Benign Skin Pathology
Seborrhoeic KeratosisGouty
Tophi
Solar keratosis
![Page 20: External and middle ear disease for g ps](https://reader030.vdocument.in/reader030/viewer/2022012316/554b3ec5b4c905b5378b49b3/html5/thumbnails/20.jpg)
Benign Skin Pathology
![Page 21: External and middle ear disease for g ps](https://reader030.vdocument.in/reader030/viewer/2022012316/554b3ec5b4c905b5378b49b3/html5/thumbnails/21.jpg)
Benign Skin Pathology
Chondrodermatitis helicis nodularis chronica
![Page 22: External and middle ear disease for g ps](https://reader030.vdocument.in/reader030/viewer/2022012316/554b3ec5b4c905b5378b49b3/html5/thumbnails/22.jpg)
Benign Skin Pathology
Chondrodermatitis helicis nodularis chronica
Darwin’s tubercle
![Page 23: External and middle ear disease for g ps](https://reader030.vdocument.in/reader030/viewer/2022012316/554b3ec5b4c905b5378b49b3/html5/thumbnails/23.jpg)
Benign Skin Pathology
Chondrodermatitis helicis nodularis chronica
Keloid ScarringDarwin’s tubercle
![Page 24: External and middle ear disease for g ps](https://reader030.vdocument.in/reader030/viewer/2022012316/554b3ec5b4c905b5378b49b3/html5/thumbnails/24.jpg)
Malignant Skin Pathology of The Pinna
![Page 25: External and middle ear disease for g ps](https://reader030.vdocument.in/reader030/viewer/2022012316/554b3ec5b4c905b5378b49b3/html5/thumbnails/25.jpg)
Malignant Skin Pathology of The Pinna
Basal Cell Carcinoma
![Page 26: External and middle ear disease for g ps](https://reader030.vdocument.in/reader030/viewer/2022012316/554b3ec5b4c905b5378b49b3/html5/thumbnails/26.jpg)
Malignant Skin Pathology of The Pinna
Basal Cell Carcinoma
Squamous Cell Carcinoma
![Page 27: External and middle ear disease for g ps](https://reader030.vdocument.in/reader030/viewer/2022012316/554b3ec5b4c905b5378b49b3/html5/thumbnails/27.jpg)
Middle Ear
• Otitis media– Acute– Chronic otitis media +/- cholesteatoma– Otitis media with effusion– Complications
• Tympanic membrane perforation• Hearing loss– Conductive
![Page 28: External and middle ear disease for g ps](https://reader030.vdocument.in/reader030/viewer/2022012316/554b3ec5b4c905b5378b49b3/html5/thumbnails/28.jpg)
Acute Otitis Media
• Definition– Inflammation of the middle ear cleft
• Demographics– Mostly children (age 3-7)
• Aetiology– Viral (majority)– Bacterial (1y or 2y) - Strep. Pneumoniae, H. influenzae,
Bramhamella catarrhalis)• Risk Factors
– Poor sanitation/ hygiene and parental smoking– Exposure to other children– Eustachian Tube Dysfunction– ? allergy
![Page 29: External and middle ear disease for g ps](https://reader030.vdocument.in/reader030/viewer/2022012316/554b3ec5b4c905b5378b49b3/html5/thumbnails/29.jpg)
Natural HistoryInfection via ET tube (Fever)
Mucosal oedema
Hyperaemia of tympanic membrane & purulent middle
effusion
Bulging tympanic membrane (Pain)
Pressure necrosis of tympanic membrane resulting in
perforation
Mucopurulent discharge
![Page 30: External and middle ear disease for g ps](https://reader030.vdocument.in/reader030/viewer/2022012316/554b3ec5b4c905b5378b49b3/html5/thumbnails/30.jpg)
Acute Otitis Media
![Page 31: External and middle ear disease for g ps](https://reader030.vdocument.in/reader030/viewer/2022012316/554b3ec5b4c905b5378b49b3/html5/thumbnails/31.jpg)
Acute Otitis Media
• Treatment– Expectant– Paracetamol/NSAIDS– Oral amoxycillin– +/- myringotomy
• Complications– Acute
• Mastoiditis• Facial palsy• Labyrinthitis• Meningitis• Intracranial abscess• Lateral sinus thrombosis
- Long term• Tympanosclerosis
• Tympanic membrane perforation
• Ossicular damage
![Page 32: External and middle ear disease for g ps](https://reader030.vdocument.in/reader030/viewer/2022012316/554b3ec5b4c905b5378b49b3/html5/thumbnails/32.jpg)
Acute Mastoiditis
• History of acute otitis media
• Infection spreads to mastoid
• Post-auricular abscess
• Treatment– Grommet– Cortical mastoidectomy
![Page 33: External and middle ear disease for g ps](https://reader030.vdocument.in/reader030/viewer/2022012316/554b3ec5b4c905b5378b49b3/html5/thumbnails/33.jpg)
Mastoiditis Treatment
![Page 34: External and middle ear disease for g ps](https://reader030.vdocument.in/reader030/viewer/2022012316/554b3ec5b4c905b5378b49b3/html5/thumbnails/34.jpg)
Intracerebral Abscess
Ring enhancement with contract enhanced CT
![Page 35: External and middle ear disease for g ps](https://reader030.vdocument.in/reader030/viewer/2022012316/554b3ec5b4c905b5378b49b3/html5/thumbnails/35.jpg)
Lateral Sinus Thrombosis
Filling defect on MRA
![Page 36: External and middle ear disease for g ps](https://reader030.vdocument.in/reader030/viewer/2022012316/554b3ec5b4c905b5378b49b3/html5/thumbnails/36.jpg)
Tympanic Membrane Perforation
• Causes– Trauma– Otitis media– Iatrogenic eg. Grommets
• Symptoms– None– Recurrent otorrhoea– Hearing loss
![Page 37: External and middle ear disease for g ps](https://reader030.vdocument.in/reader030/viewer/2022012316/554b3ec5b4c905b5378b49b3/html5/thumbnails/37.jpg)
Tympanic Membrane Perforation
• Treatment– None–Myringoplasty–+/- ossiculoplasty
Graft is placed under perforation to allow epithelium to regrow
Myringoplasty
![Page 38: External and middle ear disease for g ps](https://reader030.vdocument.in/reader030/viewer/2022012316/554b3ec5b4c905b5378b49b3/html5/thumbnails/38.jpg)
Chronic Otitis Media
• Without cholesteatoma
– Tympanic membrane perforation
– Chronic middle ear infection– May resolve with topical or
oral antibiotics– If no resolution –
myringoplasty +/- cortical mastoidectomy
• Otorrohoea for more than 3 months• May occur with or without cholesteatoma
![Page 39: External and middle ear disease for g ps](https://reader030.vdocument.in/reader030/viewer/2022012316/554b3ec5b4c905b5378b49b3/html5/thumbnails/39.jpg)
Chronic Otitis Media• With cholesteatoma• Eustachian tube dysfunction results in tympanic membrane
retraction (attic)• Accumulation of keratin in retraction pocket• Gradual enlargement and adjacent bony destruction• Complications as for AOM above
![Page 40: External and middle ear disease for g ps](https://reader030.vdocument.in/reader030/viewer/2022012316/554b3ec5b4c905b5378b49b3/html5/thumbnails/40.jpg)
Cholesteatoma
![Page 41: External and middle ear disease for g ps](https://reader030.vdocument.in/reader030/viewer/2022012316/554b3ec5b4c905b5378b49b3/html5/thumbnails/41.jpg)
Chronic Otitis Media with Cholesteatoma
![Page 42: External and middle ear disease for g ps](https://reader030.vdocument.in/reader030/viewer/2022012316/554b3ec5b4c905b5378b49b3/html5/thumbnails/42.jpg)
Chronic Otitis Media with Cholesteatoma
• Treatment is surgical
• Aims of surgery
− Remove all disease
− Dry ear
− +/- Restore hearing
• Types of operation– Modified radical mastoidectomy
– Canal wall up mastoidectomy
![Page 43: External and middle ear disease for g ps](https://reader030.vdocument.in/reader030/viewer/2022012316/554b3ec5b4c905b5378b49b3/html5/thumbnails/43.jpg)
Chronic Otitis Media with Cholesteatoma
Post-auricular incision Mastoid air cells drilled away
Posterior ear canal removed to leave mastoid cavity
![Page 44: External and middle ear disease for g ps](https://reader030.vdocument.in/reader030/viewer/2022012316/554b3ec5b4c905b5378b49b3/html5/thumbnails/44.jpg)
Inner Ear
![Page 45: External and middle ear disease for g ps](https://reader030.vdocument.in/reader030/viewer/2022012316/554b3ec5b4c905b5378b49b3/html5/thumbnails/45.jpg)
Sudden Hearing Loss
• Normal TM with sudden hearing loss• Aetiology unknown
• Viral• Vascular
• Rarely acoustic neuroma, perilymph leak• May be unsteady or vertiginous
![Page 46: External and middle ear disease for g ps](https://reader030.vdocument.in/reader030/viewer/2022012316/554b3ec5b4c905b5378b49b3/html5/thumbnails/46.jpg)
Cochlea Drug Delivery
![Page 47: External and middle ear disease for g ps](https://reader030.vdocument.in/reader030/viewer/2022012316/554b3ec5b4c905b5378b49b3/html5/thumbnails/47.jpg)
Sudden Hearing LossManagement
• Refer urgently
• Treatment options• Oral steroid• Antiviral• No evidence for efficacy
• Carbogen• No evidence for efficacy
• Intratympanic steroid• Reasonable evidence for efficacy
![Page 48: External and middle ear disease for g ps](https://reader030.vdocument.in/reader030/viewer/2022012316/554b3ec5b4c905b5378b49b3/html5/thumbnails/48.jpg)
Hyperostosis
• Exostosis– Multiple bony swellings
in deep canal– Cold water– Asymptomatic
– No treatment unless large
• Osteoma– Single benign bony
tumour outer bony meatus
– No treatment unless large
![Page 49: External and middle ear disease for g ps](https://reader030.vdocument.in/reader030/viewer/2022012316/554b3ec5b4c905b5378b49b3/html5/thumbnails/49.jpg)
Perichondritis
• Inflammation of perichondrium
• Aetiology:– Ear piercing– Laceration– Surgery– CT disease
• Treatment:– Antibiotics– I & D (if abscess)
• Sequelae: – Cauliflower ear