Head and Neck: Ear Anatomy and Pathologies

Inspecting the auricle

Looking at auricle and surrounding tissue for: Deformity, lumps, lesions

Any appliances?

Any pain/discharge/inflammation?

Pressure on tragus = OE

Pressure on mastoid process = OM

Otitis Externa

Infection causing pain and swelling in ear canal.

Otitis Media

Middle ear infection, indicated by mastoid pressure pain.

Chondrodermatitis Helicis

Chronic inflammatory lesion

Starts as a painful, tender pustule

Helix or antihelix

May ulcerate or crust dt influence

Distinguish from carcinoma via biopsy

Ear Carcinoma

Basal/Squamous cell carcinoma or malignant melanoma

Common in fair skin

Possible growth & ulceration

NB - biopsy

Cutaneous Cyst (Sebaceous cyst)

Benign, closed, firm sac, dome shape lump

In dermis, attached to epidermis

Possible inflammation

Keloid

Overgrowth of scar tissue

Dt: Trauma

On ear lobe/cartilaginous area

On/around area of trauma

Tophi

Uric acid crystal deposit - dt chronic tophaceous gout

Hard nodules on helix/antihelix

May discharge - white chalky crystal

Rheumatoid Nodules

Small lump on helix/antihelix

Associated with chronic RA

Possible ulceration

Lepromatous Leprosy

Multiple papules and nodules dt chronic infection

Acute Otitis Externa

"Swimmers ear"

Skin of ear is swollen and tender

Auricle and meatus is narrowed, moist, and red

Hard to see TM

Cx's:

Trauma (fingernail, bobby pins)

Moisture (swimming)

Chronic Otitis Externa

Red, itchy, thickened skin with keratin debris in canal.

Ear Drum inspection

1. Colour - pinkish-grey

2. Contour

3. Cone of light - 4 or 8 'o' clock

4. Handle of malleus

5. Short process - white elevation

6. Pars flaccida - superior

7. Pars tensa - inferior

8. Incus - can see shadow

9. Umbo - COL fans ant. & inf.

10. Circumferential & manubrial blood vessels

Red reflex of ear

Dilation of blood vessels supplying tympanic membrane

Follows prolonged examination

Mimics acute OM

NB - beware of false +ve

Exostosis

Hard round outcroppings

Along auditory meatus

Multiple - usually bilateral

Slow growing

Asymptomatic - rare to occlude meatus

Risk factors:

Bony external canal stimulation with cold water

Foreign Body

Varied

Causes conductive HL

May result in:

Secondary OE

TM or occicle damage

Cerumen Impaction "Wax impaction"

Build up over time (asymptomatic)

Occludes all structures pos. to site

Causes:

Conductive HL

Otalgia

Fullness

Itching

Otomycosis

Fungal infection

White coloured thick debris

Fluffy appearance (Mycelium growth)

Underlying skin is red, tender, & swollen

Acute Otitis Media

Bacterial infection

After URTI

Common in children

Red, bulged TM

Possible perforation (pus)

-

Sxs:

Otalgia

Fever

Conductive HL

Atrophic OM (Retracted drum)

Pulled medially

Malleolar folds tight and outlined

Short process protrudes & prominent

Handle of malleus pulled inward - looks horizontal

Serous Effusion

Causes:

Viral URTI

O. Barotrauma

Eustachian tube cannot equalise air pressure in middle ear with outside ear

~

Air is absorbed & replaced with serous fluid (amber colour) - NB

~

Sxs:

Fullness/Popping

Mild conductive HL

Otalgia

~

Perforated Drum

Holes in eardrum from:

Infection

Trauma

~

Classed as:

Central

Marginal

~

Scarring causes loss of landmarks

Heals in tympanosclerosis

Traumatic perforated drum

Dt: Variety - e.g. blast injury

Any shape/size - small, clean cut

Generally along pos. pars tensa

Possible fresh blood visible

Spontaneous healing

Infected perforated drum

Follows OM

Pressure build up ruptures TM

Irregular edges

Pars tensa/flaccida

Otorrhea along meatus

(Discharge characteristics - volume, frequency, colour, consistency, odour, blood streaked)

Tympanosclerosis

Deposition of hyaline material in TM layers - follows perforated TM

"Hyalinization"

Large, chalky, white patches with irregular margins

Usually doesn't impair hearing

Cholesteatoma

Skin cell build up in middle ear

Cyst like growth

Congenital or dt chronic OM

Sxs:

Discharge

No pain or HL

Meniere's Disease

Endolymph build-up affecting vestibular system of the ear

Sxs:

Vertigo, tinnitus, dizzy, temp. HL

Unilateral

Episodes (20 mins - 24 hrs)

Drop attacks

Confused with labyrinthitis

Labyrinthitis

Viral/Bacterial inner ear infection

Swelling both branches of vestibulocochlear nerve or labyrinth (affects balance and hearing)

Sxs:

Dizzy, vertigo, N&V, LOB, tinnitus

Possible nystagmus and blurred vision

Risk factors:

URTI

Smoking

Alcohol

Meds

Stress

Diagnosis = Rule out other cx of sxs

Vestibular battery test

Vestibular Neuritis

Mimics labyrinthitis

Swelling of 1 branch of vestibulocochlear nerve (vestibular portion only - affecting balance)

Sxs:

Dizzy

Vertigo

N&V

LOB

Difficult concentration

No auditory sxs

Whisper Test

Estimate hearing by whispering into one ear.

Weber Test

Test for lateralization of sound perception.

Rinne Test

Compare air and bone conduction of sound.

AC>BC : N = Sensineural HL

BC>AC = Conductive HL

Sensineural HL

Disorder of inner ear or cochlear nerve

Upper tone of words disproportionately lost

Hearing worse in noisy environment

Speaks loudly (can't hear voice)

Can't see problem

Onset middle - later years

Weber = lateralises to good ear

Rinne = Positive AC>BC

Cx:

Sustained exposure to loud noise, drugs, inner ear infections, trauma, tumour, presbycusis

Conductive HL

Disorder of external/middle ear

Minor sound distortion

Hearing better in noisy environment

Speaks softly

Can normally see abnormality in ear canal

Onset in childhood & young adult up to 40

Weber = lateralises to bad ear

Rinne = Negative - BC>AC or BC=AC

Cx:

Ear canal obstruction, OM, perforated drum, otosclerosis

Common ear related complaints

✓Otalgia

✓Muffling or distortion of hearing

✓Hearing loss/deafness

✓Tinnitus

✓Discharge

✓Masses or lesions

Referrals

ENT specialist

Audiologist

Speech and hearing therapist