Acute Otitis Externais an acute bacterial infection usually caused by Pseudomonas aeruginosa. The outer ear canal is
often swollen shut, and the
auricle
is very painful to touch. Treatment
is to open the ear canal, place a wick, and treat with ear drops.
The wick is made of cloth or foam rubber which will allow the ear drops
to penetrate the swollen canal. Unfortunately, most oral
antibiotics are ineffective. Oral fluoroquinolones can be
effective, but they are not approved in children.
Warning!!! ENT USA considers
ear candles to be pure quackery
and
strongly advises that they not be used.
Acute
otitis externa may also have a rarer presentation of blebs or blisters in the
ear canal. The patient shown on the right has multiple blebs in his ear
canal and on his eardrum. The purplish bleb is one that has some
hemorrhage. There was not a significant middle ear infections because his
audiogram was normal. This presentation is characteristic of a viral
infection and the patient was at risk of developing Ramsey Hunt Syndrome (facial
paralysis due to the herpes zoster virus or shingles.) Treatment
consists of antibiotic ear drops and anti-viral agents such as Famvir.
Ear
Tick: The pictures on the right show a tick imbedded in the ear canal.
Needless to say, it should be removed as soon as it is diagnosed.
Click on Pictures to Enlarge
The
pictures on the right are from a 3 year old male with a tick in the right ear.
The tick's head is tightly imbedded into the ear canal skin. Removal of the tick
results in the avulsion of a small portion of the ear canal skin. The patient
should be placed on antibiotic ear drops.
Click on Pictures to Enlarge
Ear
Ant:
The picture on the far right shows a dried ant on top of the
eardrum. Notice the serous fluid behind the eardrum in the lower
portion of the middle ear. The picture in the middle shows a bug
embedded in ear wax. The far left picture shows a large bug
impacted in the ear canal.
Click on Pictures to Enlarge
Ear Maggots:
This is a very rare condition. The patient had an insect
which lodged in the ear
and laid eggs. The parent insect was dead in the ear along with
six baby maggots.
Click on Pictures to Enlarge
Leeches
used to reattach the outer ear: When the outer ear or
auricle
is avulsed during a traumatic accident, it
must be reattached as a "free" graft. At first there is no blood
supply. The arteries attach first, after 24 hours, but the blood
cannot get out of the graft. The graft will fill with blood and
die unless it is drained. Leeches not only drain the blood, but also
secrete an anticoagulant which will aid in continued blood drainage.
View Article Maggots In Medicine - USA Today
Click on Pictures to Enlarge
Ear
Foreign Body: The far right picture is of a bean stuck in the ear. Young
children commonly place foreign bodies in the ear canal and nose.
If a vegetable foreign body is present, do not use ear drops because
they will cause the foreign body to swell. If the foreign body is
a battery, ear drops can cause an electrical reaction which can cause
severe burns to the ear. The middle and left hand pictures
show a bead in the ear. Beads are best removed using a 90 deg
micro-stapes pick. The bead is rotated until the central hole is
seen. The pick is then placed though the lumen of the bead and the
end of the 90 degree pick is used to pull the bead out of the ear canal.
To
pictures on the right show an ear canal filled with sand. Note the
myringotomy tube
in the eardrum.
Click on Pictures to Enlarge
One
of the most dangerous foreign bodies is a button battery. This
type of foreign body should be removed immediately. Prior to
removal, the use of ear drops of any kind is absolutely contraindicated.
The electrical charge of the battery will produce electrolysis of any
electrolyte-rich fluid. This produces hydroxides which will cause
a severe alkaline burn. The picture on the far right shows a
severe burn of the external auditory canal which resulted in the
exposure of bone over 180 degrees of the ear canal's circumference.
The battery was in the child's ear for approximately three days and the
picture was taken one month after the battery was removed. Healing
is slow and damage to the eardrum, facial nerve, and inner ear can
occur. Luckily in this patient the injury was confined to the ear
canal.
Learn More About Button Battery
Foreign Bodies:
***View & Read Article - Adobe Acrobat 4.0***
The pictures shown below are taken from an 39 year old male who was
working in the woods and a stick went into and broke off in his left
ear. He had pain and hearing loss but no dizziness. The tip
of the stick can be seen in the middle ear as it penetrates the eardrum.
After removal, a posterior-superior eardrum perforation was present.
The
incus
can be seen through the perforation. An eardrum
perforation in this area produces the greatest amount of hearing loss.
The patient had a 20 dB conductive hearing loss. Over 90% of
traumatic perforations will heal on there own. The lack of
dizziness and a negative fistula test indicated that the footplate
of the
stapes
and inner ear were not injured. Worsening of the hearing loss after
the eardrum heals may indicate damage to the
ossicles.
This
picture ( click on picture to enlarge ) shows a small rock in the
external auditory canal. Notice that the eardrum is retracted with
the apparent shortening of the
manubrium
and the white
tympanosclerotic
patch on the eardrum.
Click on Pictures to Enlarge
This
picture shows an impacted Cipro tablet which was ground up in water and
placed in the ear canal by a patient to treat an outer ear infection.
Click on Pictures to Enlarge
Chondrodermatitis
Nodularis Helicis:
The picture to the right shows the ear of a 74 year old female who has a
one year history of a slightly painful lesion on her auricle. The
lesion was characteristic of chrondrodermatitis nodularis helicis (CDNH). CDNH is a slow growing painful lesion which may reach a size of 2 to 4
mm. It begins as a nodule over the cartilage folds of the
ear and may progress to form a central crust and ulceration. The
cause is unknown but CDNH usually occurs on the side the patient sleeps
and may be related to trauma. The most common location is on the
mid portion of the antihelix. Treatment is to excise the
lesion and underlying inflamed cartilage. Steroid injections have
also been advocated but in my experience they have not been successful.
Click on Pictures to Enlarge
Perichondritis: The
picture to the right shows the external ear of a 57 year old diabetic
who started to develop swelling and redness of the external ear for two
days. The bacteria causing this infection is usually
Pseudomonas aeruginosa. There was little pain. The patient
was treated by cleansing the external ear canal and placement of an ear
wick. I.V. antibiotics of ceftriazone sodium (Rocephin) and
tobramycin (1.7 mg/kg every 8 hours) were given.
Click on Pictures to Enlarge
Delayed
Hypersensitivity Reaction: Contact
Dermatitis
of the Ear Canal.
Contact
dermatitis of
the ear canal and
auricle
is commonly caused by medications.
Neomycin is a topical antibiotic which can cause this. A mixing
substance in many medications called Propylene Glycol can also cause
this reaction. To the right is a patient with
contact dermatitis
to ear drops which contained Propylene
Glycol. The main reaction is on the lower portion of the outer
ear, lobule and ear canal.
Click on Pictures to Enlarge
Keloids
of the
Auricle:
Keloid formation of the
auricle's
ear lobe is a rare complication of ear ring
use. It occurs more commonly in African Americans than Caucasians.
Treatments is surgical excision followed by repeated steroid injections.
Otohematoma:
This is a collection of blood between the perichondrium and cartilage.
The picture on the right shows an otohematoma which arose overnight.
The patient was on Plavix for cardiac stents.
The most common cause of an otohematoma is from trauma and it is often
seen in wrestlers.
Treatment consists of drainage with
placement of cotton bolsters held in place with through and through
stitches. If left untreated the fluid will calcify forming a
cauliflower ear.
Click on Pictures to Enlarge
Basal
Cell Carcinoma of the
Auricle:
This is a common skin cancer. Treatment with local resection is
usually curative.
Click on Pictures to Enlarge
Ear Fungus: The ear is a warm, wet, dark place. Fungus
can readily grow here. The ear usually itches, and severe pain may
occur. Frequent cleaning and anti-fungal ear drops and sometimes oral
medications are used in treatment. The best treatment I have found is
filling the ear canal with an anti-fungal cream or painting the ear canal
with gentian violet dye. The latter seems to work the best, but the
dye stains and thus one must be careful in its application.
Click on Pictures to
Enlarge
In general dyes and acid mixtures (antiseptics)
should not be allowed to get into the
middle ear.
Gentian violet is ototoxic and should never be allowed to enter the
middle ear.
Chronic
Otitis Externa: This is a condition of the external ear
canal caused by a chronic reaction to an irritant or allergen.
Many believe it is caused by a reaction to molds or fungus.
Itching is often a symptom, but severe pain may be present. The
appearance of the ear canal ranges from dry and scaly, to one filled
with abundant exfoliated skin (See photos to the right).
Antibiotics are ineffective and the condition has been known to last for
years. One of the best treatments is filling the ear canal with an
anti-fungal cream or painting the ear canal with gentian violet dye.
The latter seems to work the best but the dye stains and may be toxic to
the
inner ear,
thus, one must be careful in its application (see above articles).
Granulomaof the External Auditory Canal:Granulomas
are often seen in the ear canals in children
with ear tubes. They are a result of the body attempting to heal
and extrude the ear tube. Often the
granuloma
forms after the inner
mucosal
layer heals behind the eardrum then grows out
the ear tube. Treatment is steroid containing antibiotic ear drops
with surgical excision reserved for persistent disease.
Click on Pictures to
Enlarge
Exposed
Bone in the External Auditory Canal: Severe infection can
cause loss of the thin layer of skin over the External Auditory Canal.
This can result in chronically exposed bone and accumulation of debris
medial (deep) to the bone exposure.
Click on Pictures to
Enlarge
Stenosisof the External Auditory Canal:
Stenosis
of the outer ear canal can occur with a
severe acute or chronic ear infection. Operative intervention is
usually required to open the ear canal.
Click on Pictures to
Enlarge
Osteoma:
This is a
benign
(not a cancer) cartilage or bony growth. It
does not need to be treated unless it elongates and touches the eardrum or
prevents proper ear drainage. It can then cause hearing loss and/or
infection.
Click on Pictures to
Enlarge
The
picture on the far right shows an anterior-superior osteoma. The left hand
picture shows an osteoma in the mid-external auditory canal.
Click on Pictures to
Enlarge
A
very large
osteoma
which was filling the entire ear canal. This
osteoma
had a very short and thin stock and was easily
removed.
Pictures Left to Right:
Pre-Op, Specimen, 1 Month Post-Op..
Ear
Canal Hamartoma: This ear canal nodule was found to be a
hamartoma. It was composed of skin, cartilage and
lymphoid tissue.
Click on Pictures to Enlarge
Exostoses:
These are benign bony growths which unlike an
osteoma
are usually multiple and have a wide base.
An
exostoses
is not a neoplasm and on histology is
composed of laminar bone.
Exostoses
may occur from chronic exposure of the ear canal to cold. This can
occur from a long history of using alcohol ear drops or from chronic
swimming in cold water. Pre-op picture of
exostoses
on the right, post op showing the eardrum
on the left. One study found a significant relationship between
surfing and exostoses of the ear canal with 60% of 373 competitive surfers
developing this condition.
View Abstract
The
picture on the right is from a patient who frequently went swimming
in cold water. He developed multiple
exostoses
which had to be surgically excised.
Click on Pictures to
Enlarge
The
picture on the right shows
exostoses
which have formed in a 55 year
old male. He had no symptoms but has impending closure of his ear
canal.
Click on Pictures to Enlarge
Adenocystic
Carcinoma: This patient is a 41 year old male who presented with a
deep right preauricular mass and a mass in the external auditory canal.
He had a right parotid Adenocystic Carcinoma nine years previously.
He was originally treated with surgical resection and post-operative
radiation therapy.
Click on Pictures to Enlarge
Hemangioma
of the External Auditory: The patient is a 71 year old male
who had a slow progressive hearing loss. On examination a bluish
mass was seen on the anterior canal was which impinged upon the eardrum.
Biopsy revealed a benign vascular growth called a hemangioma.
Ear
Canal
MastoidFistula:
This is a hole between the ear canal and the
mastoid
cavity. It is a rare surgical
complication which requires revision surgery to correct.
Click on Pictures to Enlarge
In
this patient a fluid filled cyst filled the external auditory
canal. The cyst originated in the
mastoid
and extended under the ear canal skin via a bony
fistula
in the
mastoid cortex.
Click on Pictures to Enlarge
Ear
Canal Fracture: This is a picture of a patient's ear canal
that was collapsed and fractured when his jaw was forced backward
when it was injured in a motor vehicle accident. For comparison,
the patient's normal opposite ear canal is also shown.
Click on Pictures to
Enlarge
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