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External Ear Canal Pictures (Photographs)
External Ear & Ear Canal  Pictures
       External (Outer) Ear Canal Pictures
  
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Acute Otitis Externa is 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.

 
Viral Infection of the Outer Ear CanalHerpes Zoster (Shingles) Infection of the External Auditory CanalAcute 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.  

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Tick in External Auditory CanalTick in External Auditory CanalTick in External Auditory Canal



 

  
 

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.

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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
 

Ant in Ear - External Auditory CanalInsect in Ear - External Auditory CanalLarge Insect in Ear Canal

 

 


Maggots in the Ear CanalMaggots Taken From the Ear CanalEar 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.

 

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Maggots in the Ear CanalMaggots in the Ear CanalMaggots in the Ear CanalMaggots in the Ear Canal

 
Leech Therapy for Ear Reattachment
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
 
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Bean in the Ear - External Auditory CanalBead in the Ear - External Auditory CanalBead Removed From the Ear - External Auditory Canal
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. 

Sand in the External Auditory Canal - Foreign Body EarSand in the External Auditory Canal - Foreign Body EarTo pictures on the right show an ear canal filled with sand.  Note the myringotomy tube in the eardrum.
 

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Exposed Bone In Ear Canal from a Button Battery Foreign BodyExposed Bone In Ear Canal from a Button Battery Foreign BodyButton BatteryOne 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.

Eardrum Perforation from a Stick  Stick Foreign Body  Stick Foreign Body Perforating the Eardrum with It's Tip in the Middle Ear  Stick Foreign Body Perforating the Eardrum with It's Tip in the Middle Ear

 
Rock Foreign Body in the Ear CanalThis 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.    

 
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Cipro Table Foreign Body in the Ear CanalThis 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.    
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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. 

  
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Perichondritis and Facial Cellulitis
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

 

  
Proplylene Glycol Contact Dermatitis of the Ear Canal - Allergy
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.

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Ear Keloid from a Pierced Ear RingAuricular Keloid from a Pierced Ear RingEar Keloid from a Pierced Ear Ring
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
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.  

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Basal Cell Carcinoma of Ear - Helix and Auricle
Basal Cell Carcinoma of the Auricle:  This is a common skin cancer.  Treatment with local resection is usually curative.  

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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.

Otomycosis - Fungus in the Ear Canal Otomycosis - Fungus in the Ear Canal Otomycosis - Fungus in the Ear Canal Otomycosis - Fungus in the Ear Canal  

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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. 

The round window as access route for agents injurious to the inner ear.
Am J Otolaryngology, 1988 Nov-Dec;9(6):327-35
Spandow O, Anniko M, Moller AR.

Ototoxicity of common topical antimycotic preparations.
Laryngoscope, 2000 Apr;110(4):509-16.
Tom LW.


Chronic Otitis ExternaChronic Otitis ExternaChronic Otitis Externa
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).
 
Ear Canal GranulomaGranuloma of 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.   

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Exposed Bone in the Ear CanalExposed Bone in the Ear Canal
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.

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Stenosis of 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

 
Osteomas of the External Auditory Canal
External Auditory Canal OsteomaExternal Auditory Canal OsteomaOsteoma 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. 

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External Auditory Canal OsteomaExternal Auditory Canal OsteomaThe picture on the far right shows an anterior-superior osteoma.  The left hand picture shows an osteoma in the mid-external auditory canal.  

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External Auditory Canal Osteoma - Post OpResected External Auditory Canal OsteomaExternal Auditory Canal OsteomaA 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
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
 
Ear Canal ExostosesEar Canal ExostosisExostoses:  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  
  
  
Ear Canal ExostosesThe 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

External Auditory Canal ExostosesThe 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 of the External Auditory (Ear) Canal
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

Ear Canal Hemangioma
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 Mastoid Fistula
Ear Canal Mastoid Fistula:  This is a hole between the ear canal and the mastoid cavity.  It is a rare surgical complication which requires revision surgery to correct.

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External Auditory Canal Mastoid CystIn 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

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Ear Canal FractureNormal Ear Canal and Eardrum
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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