External Ear Disorders

Question 1

What is the most common malignant tumor of the skin?

Answer 1

Basal Cell Carcinoma

Question 2

Sun exposure/exposed sites

Presents as a painless ulcer/nodule

Rolled, pearly border

Answer 2

Basal Cell Carcinoma

Question 3

What is the most common neoplasm of the ear canal?

Answer 3

Squamous Cell Carcinoma

Question 4

Presents as a hard, non-tender, red, indurated papule, nodule, or
plaque

Prolonged UV light exposure/exposed sites

Often arises from actinic keratosis

Incidence increases with age

Answer 4

Squamous Cell Carcinoma

Question 5

In cases of squamous cell carcinoma, the cure rate is what percentage with lesions of the auricle?

Answer 5

90%

Question 6

Usually asymptomatic

Common around the ear

Well defined, non-tender, soft, mobile

Cystic mass that is slow growing

Spontaneous drainage is not uncommon

Answer 6

Epidermal Inclusion Cyst

Question 6

Inflammation of auricular cartilage

Tender, red, tense auricle

Spares the lobe

Secondary to cellulitis, frostbite, trauma

+/- discharge or crusting

Answer 6

Perichondritis

Question 6

What are some complications of perichondritis?

Answer 6

Relapsing polychondritis

Cartilage destruction

deformity

Question 7

What are some differential diagnoses to consider when evaluating for a possible epidermal inclusion cyst of the ear?

Answer 7

Furuncle

Lipoma

Pyogenic granuloma

Question 8

Painful swelling following blunt trauma

Common in boxers and wrestlers

Present as a tender, tense, fluctuant collection of
blood - The overlying skin can be erythematous or ecchymotic

Answer 8

Auricular Hematoma

Question 9

What is the treatment for an auricular hematoma?

Answer 9

I&D ASAP after injury

Splint

Prophylactic antibiotics

Prevent reaccumulation of blood

Question 10

What are some complications of an auricular hematoma?

Answer 10

Infection

Recurrence of hematoma

Cauliflower ear (Due to fibrocartilage overgrowth)

Septic or aseptic necrosis

Question 11

In the cases of an auricular hematoma, what is the time frame to treat to avoid a cauliflower deformity?

Answer 11

48-72 hours

Question 12

What is the function of cerumen?

Answer 12

Cerumen cleans, protects, and lubricates the EAC

Question 13

Ear wax produced in what part of the EAC? distal 1/3

Answer 13

distal 1/3

Question 14

What must you rule out before performing otomicroscopic debridement?

Answer 14

MUST rule out perforation first!!

Question 15

What are some differential diagnoses to consider when evaluating for cerumen impaction?

Answer 15

Foreign body
Tumor
Furuncle
Blood clot from TM perforation

Question 16

What are some causes of a cerumen impaction?

Answer 16

cerumen over-production
tortuous canal
Q-tip cleaning

Question 17

In an external ear canal foreign body, what are some common presenting symptoms?

Answer 17

pain, discharge, aural fullness, hearing loss, itching, tinnitus

Question 18

AKA Swimmers Ear

Infection of the EAC caused by a bacterial, viral, or fungal etiology

Seen most often in the summer months secondary to retained moisture in EAC

Answer 18

Otitis Externa

Question 19

In otitis externa, what are some common presenting symptoms?

Answer 19

Otalgia out of proportion to PE findings
Pain with traction to tragus or helix
Pruritis
Purulent or watery discharge
Erythematous/edematous EAC
+/- conductive loss
Rarely fever

Question 20

What are the two most common organisms in otitis externa?

Answer 20

Staph and Pseudomonas

Question 21

In a case of otitis externa, if you see a discharge colored green, you should suspect which organism?

Answer 21

Pseudomonas

Question 22

In a case of otitis externa, if you see a discharge colored yellow, you should suspect which organism?

Answer 22

S. Aureus

Question 23

In a case of otitis externa, if you see a discharge that is "cheesy", you should suspect which organism?

Answer 23

Candida

Question 24

In a case of otitis externa, if you see a discharge that is "fluffy", you should suspect which organism?

Answer 24

Aspergillus

Question 25

What are some complications of otitis externa?

Answer 25

Myringitis Conductive hearing loss Cellulitis Osteomyelitis of skull base

Question 26

What is the drug of choice for otitis externa?

Answer 26

Ciprodex

Question 27

Persistent foul otorrhea, canal granulation, deep otalgia and progressive palsies (VI, VII, IX, X, XI, or XII) Begins in the floor of ear canal, may extend into middle fossa floor, clivus and contralateral skull base Typical agent: P. aeruginosa Diabetic and the immunocompromised

Answer 27

Malignant Otitis Media

Question 28

What location does malignant otitis media occur?

Answer 28

Occurs in the cartilaginous-boney junction

Question 29

What is the most common organism in malignant otitis media?

Answer 29

P. aeruginosa

Question 30

List some possible pathogens responsible for viral otitis externa

Answer 30

varicella measles herpes virus

Question 31

Otologic complication of varicella zoster virus reactivation Clinical presentation typically includes ipsilateral facial paralysis, ear pain, and vesicles in the auditory canal and auricle

Answer 31

Herpes zoster oticus (Ramsay Hunt syndrome)

Question 32

What is another name for Ramsay Hunt syndrome?

Answer 32

Herpes zoster oticus

Question 33

What is the most common external ear canal neoplasia?

Answer 33

Squamous Cell Carcinoma

Question 34

Congenital anomaly (Narrow or closed EAC) Often malformation of pinna and middle ear structures as well

Answer 34

Atresia

Question 35

Present as fistulas, cysts, and sinuses Prone to infection

Answer 35

First Branchial Cleft Anomalies