of external ear外耳疾病课件

. Diseases of the External Ear Nerve supply -auriculotemporal branch of trigeminal nerve -auricular branch of vagus nerve (Arnolds nerve) -tympanic branch of glossopharyngeal nerve (Jacobsons nerve) -facial nerve -cervical roots C-2 and C-3 Otalgia TMJ Tonsils Throat Tube (Eustachian tube) Teeth Tongue Tics (Glossopharyngeal) Trachea Thyroid Tendons EXTERNAL EAR Infection - Acute otitis externa “Swimmers ear” - Necrotizing otitis externa “Malignant otitis externa” - Perichondritis - Otomycosis - Herpes Zoster Oticus “Ramsey Hunt Syndrome” - Bullous myringitis Acute otitis externa - microtrauma in EAC - symptoms : otalgia, hearing loss, fullness, pruritus - signs : erythema, edema, tenderness of tragus, foul smell secretions - Common Pathogen; Pseudomonas aeruginosa S. aureus, Staphylococcus sp. Proteus mirabilis Gram negative - Treatment : Cleansing EAC Topical ear drop (antibiotic + steroids ) Ofloxacin ear drop Ear wick Oral antibiotic (Ciprofloxacin) Analgesic drug Avoidance Necrotizing otitis externa - Malignant otitis externa - Common Pathogen; Pseudomonas aeruginosa - symptoms Tc Ga scan - Hyperbaric oxygen therapy Perichondritis - pain, redness - Hx : trauma - Pseudomonas aeruginosa Treatment: - dressing - antibiotic drug ( ciprofloxacin ) - severe ; debridement cellulitis Erysipelas : acute infection of dermis Cellulitis : acute infection of dermis and subcutaneous Common Pathogen; Streptococci Staphylococci Treatment ; Antistaphylococcal antibiotic supportive treatment Otomycosis - itching, mild otalgia - Aspergillus niger, Candida Treatment: -cleansing EAC -antiseptic paint -avoidance from irritation -1% Clotrimazole solution (Candid ear drop) Herpes Zoster Oticus - Hx : Varicellar Zoster exposure - otalgia, headache, malaise, dizziness - vesicular eruption Ramsay Hunt Syndrome - facial nerve paralysis - May cause SNHL, vertigo Treatment: -Local ear care -analgesics -antiviral therapy; acyclovir (800 mg) x 5 times/day 10 days -FN paralysis (Ramsay Hunt ); Prednisolone 1-2 mg/kg/day -surgical decompression: if progressive or not improved Bullous myringitis - blebs on ear drum or ear canal - Viral cause, Mycoplasma pneumoniae Treatment: - wait and see : cure in 2 -3 days - incision of blebs if severe pain - oral antibiotics Allergy Contact Dermatitis -Symptoms: Burning, itching, pain -Signs: Variable erythema,oozing,hyperpigmentation -Most common: Nickel (earrings) -Treatment: avoidance topical corticosteroids Trauma Hematoma of Auricle -Etiology: trauma accumulation of blood between perichondrium and cartilage. -DDx : perichondritis, cellulitis Treatment: Repeated aspiration Pressure dressings. Complication: “cauliflower ear“. Auricular injury Simple: - cleansing with antiseptic solutions - conservative debridement - cosmetic - antibiotics Awareness : contaminated or extensive wounds 5 . 52 30 Foreign Bodies of EAC Insects. immobilize ; natural oil topical 2% lidocaine remove with instruments Materials: remove with instruments Instruments Otoscope vs Microscope alligator forceps, right-angle hook, suction, etc Topical otic antibiotics if localized reaction Local anesthesia or General anesthesia Cysts Sebaceous cysts : hair follicles. discrete, mobile mass secondary infected Treatment : complete excision. Pre-auricular cyst and fistula faulty fusion of mesodermal hillocks. fistula opening in front of the incisura. recurrent infection Treatment : complete excision (injection of methylene blue for identification) Keloids -hypertrophy of connective tissue in traumatized areas. -Most common area: ear lobule Treatment : corticosteroid intralesion complete excision (large size) 5 . 52 38 Squamous Cell Carcinoma - most common : ulceration, granulation - s/s : otalgia, otorrhea, headache - DDx : malignant otitis externa - Treatment : wide surgical excision postoperative radiation therapy Middle Ear Otosclerosis Definition: - primary bone dyscrasia - Involvement of oval window results in footplate fixation and persistent conductive hearing loss Abnormal bony overgrowth Symptoms : Conductive Hearing loss ; gradual onset , slow progress If lesion involve cochlear may mixed HL or SNHL Bilateral Otosclerosis 70% No previous infection or trauma Age 20 yr, Most common 30-40 yr Autosomal dominant Female:Male=2:1 Signs : Usually normal examination. normal tympanic membrane. Schwartzes sign: red discoloration under drum - active focus on promontory Weber lateralizes to involved ear Investigation Audiogram : Conductive hearing los