Strctural diseases of the external ear

Funnel-shaped cartilaginous structures that aid in focusing and localizing sound

Pinnae

Function of the pinna (oreja)

Focus and localize sound

V o F

The lateral 1/3 of the external auditory canal is osseus and the medial 2/3 are fibrocartilage

Falso, 1/3 fibrocartilage

By what age does the external ear canal take an S-shape?

9 years old

Epithelium of the skin of the pinna

Stratified squamous epithelium

Characteristics of the cerumen

• Hydrophobic

• Acid

• Antibacterial

Nodes in the anterior and superior wall of the external ear canal and tragus

Preauricular lymph nodes

Nodes in the helix and the inferior wall of the external ear canal

Infraauricular lymph nodes

Nodes in the concha and the antihelix

Mastoid lymph nodes

Diseases that affect what joint causes otalgia?

Temporomandibular joint

A congenital malformation where the ear is small and underdeveloped

Microtia

Microtia that exhibits a mild deformity, with a slightly dysmorphic helix and antihelix

Grade I

Microtia with some auricular framework present, but tissue deficiency and significant deformity

Grade II

Microtia that is known as “peanut ear”, with no recognizable landmarks of the auricle

Grade III

Anotia or absens of the pinna

Grade IV

What is the treatment for microtia?

Staged autologous costochondral reconstruction

Surgical techniques that are used in microtia

1. Brent technique

2. Nagata technique

Stages of the Brent technique

1. Cartilage implantation

2. Lobule transfer

3. Postauricular skin grafting

Stages of the Nagata technique

1. Cartilage implantation and lobule transposition

2. Elevation of the ear

Complications of auricular reconstruction

1. Infection

2. Hematoma

3. Skin-flap necrosis

V o F

Only 10% of patients with microtia have conductive hearing loss on the affected side

Falso, 90%

Congenital anomalies of the external auditory canal

Stenosis

Atresia

Audiological testing for atresia and stenosis

Audiogram + ABR

Mainstay treatment for atresia and stenosis

Canalplasty

Increase in the distance from the helical rim to the mastoid is thought to be due to a lack of the antihelical fold

Protruding ears or Prominauris

Mainstay treatment for protruding ears in > 8 years old

Otoplasty

Complications of otoplasty in protruding ears

1. Hematoma

2. Telephone ear deformity

Anomalous fusion of the first and second branchial arches, with incomplete obliteration of the first branchial cleft

Branchial cleft anomalies

Types of branchial cleft anomalies

Type 1

Type 2

Type of branchial cleft anomaly, where it duplicates de membranous external ear canal only and with a preauricular mass that parallels to the external ear canal

Type 1

Type of branchial cleft anomaly that duplicates both the membranous and cartilaginous external ear canal and mass along the border of sternocleidomastoid muscle

Type 2

V o F

The type 1 branchial cleft anomaly is more common

Falso, type 2

Treatment for branchial cleft anomaly

Complete excision

Accumulation of blood in the subperichondrial space, usually secondary to blunt trauma

Auricular hematoma

Blunt trauma can lead to necrosis and predisposition to infection, which can cause a permanent disfigurement

Cauliflower ear

Treatment for an auricular hematoma

Drainage + Splint + Quinolone

Trauma to the ear cause by pentrating or severe blunt trauma

Auricular laceration or avulsion

What is our priority when dealing with an auricular laceration?

Expeditious repair + Prevent infection

Best option for auricular laceration with direct reattachment greater than 15mm

Microvascular replantation

V o F

Prognosis of auricular laceration is very bad

Falso, excellent cosmetic results

Rare injury resulting from cold exposure (< 10°C) that leads to vasoconstriction and endothelial injury

Auricular frostbite

How do we find the ear in auricular frostbite?

Cyanotic ear

What is the initial treatment for auricular frostbite?

Rewarming + Debridement + AINEs + Antibiotics

Medicament that has anti-thromboxane properties

Aloe vera

Late complication of auricular frostbite

Auricular ossification

Types of auricular burns

First degree

Second degree

Third degree

Fourth degree

Auricular burn that extends for the superficial layer of epidermis, erythema and moderate pain

First degree burn

Auricular burn that extends to epidermis and dermis, blisters, painful

Second degree burn

Auricular burn that extends to dermis, less painful, gray or black eschars

Third degree burn

Auricular burn that extends to subcutaneus tissue, painless, gray and black eschars

Fourth degree burn

Complication of third or fourth degree burn

Suppurative chondritis

Treatment for first degree burn

Silver sulfadiazine

Treatment for second degree burn

Debridement + Antibiotic ointment

Treatment for third and fourth degree burns

Quinolones + Mafenide acetate + Debridement