Other external ear conditions

Question 1

How to remove ear wax?

Answer 1

1) Sodium bicarbonate and olive oil ear drops (wax-softening agents)
- C/I: TM perf

2) Ear syringing (can be done at GP/polyclinic)
- Ear is flushed w/ warm water to wash out wax/debris
- C/I: TM perf, grommet tube in situ, previous ear Sx, otalgia suggesting otitis externa

3) Manual removal and microsuction (only done at ENT clinics)
- For more complicated cases, e.g. previous ear Sx w altered anat

Question 2

Haematoma auris (cauliflower ear)

• etiology?
• management?

Answer 2

Etiology

• After bruising -> blood tracks between perichondrium and cartilage -> organization of clot -> dense scarring & thickening of ear
• Infection -> cartilage necrosis and gross deformity (cauliflower ear)

Management: Aspiration or I&D, then apply pressure and abx cover

Question 3

Auricular psuedocyst

• etiology
• clinical features?
• treatment?

Answer 3

Aetiology 🡪 repeated microtrauma (e.g. helmet wearing)

Clinical features 🡪 non-tender/painful, cystic swelling predominantly in concha

Treatment 🡪 excision

Question 4

Exostoses

• risk factors?
• clinical features?
• management?

Answer 4

Seen in windsurfers and swimmers (prolonged time in cold water) -> repeated periosteum stimulation and inflam -> bony growths, usually bilat

Arise from bony meatus -> causes slow occlusion of EAC -> CHL, failure of wax extrusion

Mx: drilling (a specific type of local excision)

Question 5

What is the pathogenesis of keratosis obturans?

Answer 5

• **Abnormal epithelial migration of ear canal skin -> accumulation of desquamated keratin in ear canal (resulted from failure of clearance via lateral migration)
• Causes inflamm (same pathophysio as in cholesteatoma – but instead circumferential and engulfs entire ear canal) -> irregularly widened EAC

Question 6

What are the signs and symptoms of keratosis obuturans?

Answer 6

• Usually occurs in young people, presents early in life (earwax builds up rapidly when cannot be cleared)
• hearing loss, acute, pain 2’ large plugs of desquam keratin accumulation

Question 7

what are the investigations and management of obturans?

Answer 7

• Usually only noticed on otoscopy after aural toilet -> irregularly widened EAC
• Regular aural toilet, KED
• Similar to cholesteatoma: debridement 6/12 intervals + topical meds (abx?)
• Canalplasty is possible option for abnormally-structured ear canals (from CT) for pts who do not wish for regular aural toilet and prefer the Sx option