Diseases of The External Ear

Diseases of the external
ear
Dr Ahlam Alzuway

CERUMEN:
 Is a combination of the secretions produced by sebaceous and ceruminous gland
(modified apocrine sweat glands emptying into hair follicles, present only in the
dermis of the cartilaginous portion of EAC), admixed with desquamated epithelial
debris. This combination forms an acidic coat with normal PH of 6.5 to 6.8 which
is inhospitable environment for pathogens that aids in the prevention of EAC
infection.
 There are genetically and racially determined differences in the physical
characteristics of cerumen that vary its appearance and consistency and may be
associated with immunoglobulin and lysozyme content.
TRAUMA TO THE EXTERNAL EAR
AURICULAR HEMATOMA:
 Usually develops after blunt trauma, due to disruption of a perichondrial blood vessel.
 Blood accumulation in the subperichondrial space results in separation of perichondrium from the cartilage.
If the cartilage is fractured, blood passes to the subperichondrial plane on both sides. This creates a bluish
swelling, usually involving the entire auricle.
 If the lesion is not treated early, the blood organizes into a fibrous mass, causing necrosis of the cartilage
because of interference with its circulation. This mass forms into a twisted scar, especially after repeated
trauma, creating the deformity known as “cauliflower ear”.
 Treatment: Evacuation of the hematoma and application of pressure to prevent re-accumulation of blood.
Simple needle aspiration is inadequate, the most effective treatment is adequate incision (in the scapha,
paralleling the helix) and drainage (sharp ring curettes may be used to remove any organized clots), with
through-and-through nylon suture-secured bolsters (eg. Dental rolls), to be removed after 7 days.
LACERATIONS:
• Results from sharp trauma.
• An attempt should be made to repair, preserving all remaining viable tissue.
• When the auricle is not totally severed, it can be reattached most of the time
BURNS:
 Classified in three degrees of severity: erythema (first degree), blistering (second
degree), and full-thickness destruction (third degree).Untreated, they may lead to
perichondritis.
Treatment:
 Gentle cleansing and topical antibiotic applications.
 Prophylactic use of antipseudomonal antibiotics. The antibiotic may be injected sub-
perichondrially.
 In the late stage, débridement and skin grafting may be necessary.
FROSTBITE:
 The auricle is particularly susceptible to frostbite because of its exposed location and lack of subcutaneous or adipose
tissue to insulate the blood vessels.
 The anesthesia that develops in the area exposed to severe cold deprives the patient of any warning of impending danger.
 Initially, there is vasoconstriction, leaving the ear, especially the edges of the helix, blanched and cold. Hyperemia and
edema follow and are caused by a marked increase in capillary permeability. Ice crystallization of the intracellular fluid
may be primarily responsible for this. The ear becomes swollen, red, and tender, and bullae may form under the skin,
resembling a first-degree burn.
 Treatment:
o Ear should be rapidly warmed using sterile cotton pledgets at 38 to 42°C.
o The ear should be treated gently owing to the risk of further damage to the already traumatized and devitalized tissue.
o Necrotic tissue is débrided.
o Topical thromboxane inhibitor aloe vera is applied… Analgesics and prophylactic antibiotics may be necessary
INFECTION AND INFLAMMATION OF THE EXTERNAL EAR
I. AURICLE:
1. Cellulitis:
• A bacterial infection (usually caused by grampositive cocci such as Staphylococcus

or Streptococcus and rarely Pseudomonas). Usually follows abrasion, laceration, or
ear piercing.
• In the absence of a history of trauma, a topical allergic reaction or relapsing polychondritis
should be considered.
• The auricle is red, swollen, painful, and tender to manipulation.
Erysipelas:
• A cellulitis caused by group A B-hemolytic Streptococcus.
• It is marked by systemic toxicity with fever and chills, erythema, pain, and swelling.
• It is contagious.
• Treatment includes oral or intravenous antibiotic (Penecillin G is of choice) and wound care.

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Diseases of the external

• A bacterial infection (usually caused by grampositive cocci such as Staphylococcus

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