Transcript 上海市第六人民医院
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 上海市第六人民医院 Shanghai Sixth People’s Hospital Otitis Externa Bacterial infection of external auditory canal Categorized by time course Acute Subacute Chronic 上海市第六人民医院 Shanghai Sixth People’s Hospital Acute Otitis Externa (AOE) “swimmer’s ear” Preinflammatory stage Acute inflammatory stage Mild Moderate Severe 上海市第六人民医院 Shanghai Sixth People’s Hospital 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 上海市第六人民医院 Shanghai Sixth People’s Hospital Mild to Moderate Stage Progressive infection Symptoms Pain Increased pruritus Signs Erythema Increasing edema Canal debris, discharge 上海市第六人民医院 Shanghai Sixth People’s Hospital Severe Stage Severe pain, worse with ear movement Signs Lumen obliteration Purulent otorrhea Involvement of periauricular soft tissue 上海市第六人民医院 Shanghai Sixth People’s Hospital Treatment Most common pathogens P. aeruginosa and S. aureus Four principles Frequent canal cleaning Topical antibiotics Pain control Instructions for prevention 上海市第六人民医院 Shanghai Sixth People’s Hospital Chronic Otitis Externa (COE) Chronic inflammatory process Persistent symptoms (> 2 months) Bacterial, fungal, dermatological etiologies 上海市第六人民医院 Shanghai Sixth People’s Hospital Symptoms Unrelenting pruritus Mild discomfort Dryness of canal skin 上海市第六人民医院 Shanghai Sixth People’s Hospital Signs Asteatosis Dry, flaky skin Hypertrophied skin Mucopurulent otorrhea(occasional) 上海市第六人民医院 Shanghai Sixth People’s Hospital 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 上海市第六人民医院 Shanghai Sixth People’s Hospital Furunculosis Acute localized infection Lateral 1/3 of posterosuperior canal Obstructed apopilosebaceous unit Pathogen: S. aureus 上海市第六人民医院 Shanghai Sixth People’s Hospital Symptoms Localized pain Pruritus Hearing loss (if lesion occludes canal) 上海市第六人民医院 Shanghai Sixth People’s Hospital Signs Edema Erythema Tenderness Occasional fluctuance 上海市第六人民医院 Shanghai Sixth People’s Hospital Treatment Local heat Analgesics Oral anti-staphylococcal antibiotics Incision and drainage reserved for localized abscess IV antibiotics for soft tissue extension 上海市第六人民医院 Shanghai Sixth People’s Hospital 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 上海市第六人民医院 Shanghai Sixth People’s Hospital Bullous Myringitis Viral infection Confined to tympanic membrane Primarily involves younger children 上海市第六人民医院 Shanghai Sixth People’s Hospital Symptoms Sudden onset of severe pain No fever No hearing impairment Bloody otorrhea (significant) if rupture 上海市第六人民医院 Shanghai Sixth People’s Hospital Signs Inflammation limited to TM & nearby canal Multiple reddened, inflamed blebs Hemorrhagic vesicles 上海市第六人民医院 Shanghai Sixth People’s Hospital Treatment Self-limiting Analgesics Topical antibiotics to prevent secondary infection Incision of blebs is unnecessary 上海市第六人民医院 Shanghai Sixth People’s Hospital Pseudocyst of the auricle First reported by Hartmann in 1846 Fluctuant, tense, noninflammatory swelling of the upper ear Believed to be ass with trauma 上海市第六人民医院 Shanghai Sixth People’s Hospital Treatment Medical 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 上海市第六人民医院 Shanghai Sixth People’s Hospital Injury of tympanic membrane Otalgia Bleeding Fullness Hearing loss: conductive HL or mixed HL Tinnitus Shape of perforation is split 上海市第六人民医院 Shanghai Sixth People’s Hospital 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 上海市第六人民医院 Shanghai Sixth People’s Hospital Conclusions Careful History Thorough physical exam Understanding of various disease processes common to this area Vigilant treatment and patience 上海市第六人民医院 Shanghai Sixth People’s Hospital