[10.31a] Common Ear Diseases (Part 1) V2.pdf

External, middle, and inner ear

What are the three main divisions of the ear?

Auricle and surrounding structures

What comprises the external ear?

Preauricular sinus and skin tags

What are two congenital cases involving the surrounding structures of the external ear?

Tympanic membrane to the cochlear promontory

What is the lateral and medial extent of the middle ear?

Bony labyrinth

What is the inner ear composed of?

Internal auditory canal

What structure houses the cochlear vestibular nerve?

Pinna

What is another name for the auricle?

1st and 2nd branchial arch

From which structures does the pinna develop?

4th to 6th week AOG

When does the development of the pinna occur?

Weerda Classification

What is the name of the combined classification of auricular defects?

First-degree dysplasia

In which classification are most structures of a normal auricle recognizable and reconstruction does not require additional skin or cartilage?

Microtia, protruding ear, and cryptotia

Name three examples of first-degree dysplasia auricular defects.

Bat ear or prominent ear

What are synonyms for a protruding ear?

Pocket ear

What is a synonym for cryptotia?

Stahl ear

What is the term for an ear with additional folds?

Colobomata

What is the term for clefts or transverse coloboma in the ear?

Bifid lobule

What is another name for lobule colobomata?

Type I

Which cup ear deformity type involves a cupped upper helix and hypertrophic concha?

Type II

Which cup ear deformity type involves severe lopping and requires rib cartilage for support?

Impetigo

What is the most common skin infection in children?

Below 5 years old

At what age is impetigo most frequently seen?

Staphylococcus aureus and beta-hemolytic Streptococcus

What are the two primary etiologic agents of impetigo?

Honey or brown sugar coated crust

What is the characteristic appearance of impetigo lesions?

Stuck on cornflakes

What is the descriptive phrase used for the crusts in impetigo?

Nagnanaknak

What is the Filipino term for the weeping characteristic of impetigo?

Not painful

Is the erythematous base of impetigo painful when the crust is scratched off?

2 to 4 weeks

How long does impetigo usually last?

Topical mupirocin or fucidin

What is the first-line management for impetigo?

Cephalexin, macrolides, or co-amoxiclav

Which oral antibiotics are used for impetigo cases nonresponsive to topical therapy?

Erysipelas

Which infectious condition affects the epidermis with a sharply demarcated raised border?

Beta-hemolytic Streptococcus (GABHS)

What is the main causative agent of erysipelas?

Pasteurella infection

Which infection, associated with cat scratch disease, is linked to erysipelas?

6th-7th decade

In what stage of life does erysipelas typically affect patients?

Fever, systemic toxicity, and chills

Name three systemic manifestations of erysipelas.

Amoxicillin

What is the outpatient management for erysipelas?

Clindamycin

What is given to erysipelas patients allergic to Amoxicillin?

Perichondritis

What condition is also known as Boxer's ear?

Pseudomonas aeruginosa

What is the primary etiologic agent of perichondritis?

Proteus spp., S. aureus, and E. coli

Name three other etiologic agents of perichondritis besides Pseudomonas.

Blunt trauma

What is the common cause attributed to the inflammation in perichondritis?

Hematoma formation

What usually occurs between the cartilage and perichondrial layer before it becomes infected in perichondritis?

Cauliflower ear

What is the resulting deformity if perichondritis is ignored?

Cartilaginous necrosis

What ensues in perichondritis after abscess formation, resulting in irreversible damage?

Fluoroquinolones

Which class of antibiotics is used to treat perichondritis?

Incision and drainage

What is the procedural management if an abscess is caught early in perichondritis?

Herpes Zoster Oticus (HZO)

What is another name for Ramsay Hunt Syndrome?

Reactivation of latent varicella zoster virus in the geniculate ganglion

What causes Ramsay Hunt Syndrome according to James Ramsay Hunt?

HZO

What is the second most common cause of atraumatic peripheral facial paralysis?

Prednisone and acyclovir

What is the best treatment for HZO if started within the first three days?

1.5 to 4 cases per 1000 patients

What is the incidence rate of HZO development?

Viral prodrome of URTI, severe otalgia, facial nerve paralysis, and vesicles in the EAC

What are the clinical manifestations of HZO?

Geniculate ganglion

Extensive involvement of which structure leads to profound hearing loss and vertigo in HZO?

Chickenpox

What other common disease is caused by the varicella zoster virus?

1 mg/kg/day for 5 days with a 10-day taper

What is the dosage for Prednisone in HZO?

800 mg, 5x daily

What is the dosage for Acyclovir in HZO?

Lid taping

What measure is taken to protect the cornea in patients with facial nerve paralysis who cannot close their eyes?

Tingling sensation

What skin sensation did the case patient report over the red patches before blisters formed?

To shorten the viral shedding period

Why is acyclovir given in HZO even though it is self-limiting?

Steroids

Which medication in the HZO regimen is responsible for faster recovery by reducing inflammation?

Keloids

What are dermal fibrotic lesions that extend beyond the margin of the initiating trauma?

Excessive disorganized collagen deposition

What characterizes the pathophysiologic process of keloids?

EGF, IL-6, and IL-8

Name three inflammatory components found in high levels in keloids.

Triamcinolone

What is the usual choice for intralesional corticosteroid injection for keloids?

5-fluorouracil (5-FU) and Mitomycin C

Name two other pharmacologic agents used or under study for keloid treatment.

Rotational flap

What type of surgical repair is used for keloids to make the closure more aesthetically pleasing?

6 cm

What is the average length of an adult ear?

20-30 degrees

What is the normal ear protrusion from the central plane of the skull?

Superficial temporal artery

Which artery supplies the lobule, tragus, and helix?

Postauricular artery

Which artery supplies the rest of the ear?

Auriculotemporal nerve (V)

Which nerve supplies the superolateral surface of the ear?

Great auricular nerve (GAN)

Which nerve supplies the inferior aspect and posteromedial surface of the ear?

Arnold nerve

Which nerve supplies the concha?

Vagus nerve (CN X)

From which nerve does the Arnold nerve branch?

Coughing

What does stimulation of the Arnold nerve trigger?

Aspiration

How is a hematoma on the ear primarily drained?

Through and through

What rule is avoided during aspiration of an ear hematoma to follow the rule of doing no harm?

Seborrheic dermatitis

Which non-malignant cutaneous condition is often associated with dandruff?

Areas rich in sebaceous glands

What is the predilection of seborrheic dermatitis?

Impacted cerumen

What ear condition is commonly seen in patients with seborrheic dermatitis due to full sebum?

History

How is a diagnosis of seborrheic dermatitis made?

Topical ketoconazole, bifonazole, or ciclopirox

Name three antifungal treatments for seborrheic dermatitis.

4 weeks

How long should treatment for seborrheic dermatitis continue even if symptoms improve?

Psoriasis

With which condition is seborrheic dermatitis closely tied?

Basal cell carcinoma (BCC)

What is the most common nonmelanoma skin cancer?

80 percent

What percentage of NMSC cases are BCC?

Squamous cell carcinoma (SCC)

Which NMSC is more aggressive than BCC?

UV radiation

What is the major risk factor for NMSCs?

Xeroderma pigmentosum

What genetic disorder predisposes individuals to NMSCs?

Cold injury, radiation, and HPV

Name three other risk factors for NMSCs besides UV radiation.

Rare

How common is metastasis in NMSCs?

Extensive local destruction

What is common in NMSCs regarding the surrounding area?

BCC

Which skin cancer appears as a small, translucent, light-colored eminence?

SCC

Which skin cancer usually presents as an ulceration with frank growth and hyperkeratosis?

Electrocautery and curettage (ED and C)

Which treatment is not favorable for NMSCs on the ear?

Osteoradionecrosis

What complication occurs when radiation causes impaired revascularization and bone death?

Preauricular sinus

What is the term for a congenital pit caused by incomplete fusion of the 6 Hillocks of His?

Not associated

Is the preauricular sinus associated with the facial nerve?

Abscess formation

What may result if the opening of a preauricular sinus becomes blocked and infected?

Recurrent infection or abscess

When is surgical excision recommended for a preauricular sinus?

Unilateral

Are most cases of preauricular sinus unilateral or bilateral?