Outer Ear

Question 1

What is the ear split up into

Answer 1

External
Middle - from TM to oval window
Inner

Question 2

What is the pinna / auricle and what epithelium and structures make up

Answer 2

External structure of ear
Stratified keratinised epithelium
Elastic cartilage underneath

Question 3

What does it continue as

Answer 3

Concha continues as external auditory measures

Question 4

Is it good at sound localisation

Answer 4

No so minimal loss if obstruction

Function is to capture and transmit sound to EAM

Question 5

What supplies the pinna

Answer 5

Mandibular branch of trigeminal (V3)

Question 6

What supples the external auditory meatus

Answer 6

Anterior = facial

Posterior =vagus

Question 7

What is lateral 1/3 made up of

Answer 7

Skin and cartilage
Sebaceous glands to produce wax
Thick hair
Protective barrier

Question 8

What is medial 1/3 made up of

Answer 8

Skin and bone
No hairs or cilia
Doesn’t produce wax

Question 9

How does skin grow in the external ear canal

Answer 9

Umbo of the tympanic membrane outwards
Shed in lateral 1/3 and trapped in wax
Why you shouldn’t remove wax

Question 10

What are outer eat problems

Answer 10

Auricle haematoma
Foreign boy
Otitis externa
Mastoiditis

Question 11

How do you Rx haematoma

Answer 11

Drain

Question 12

How does foreign body present

Answer 12

Foul discharge
Pain
Hearing loss 
Unilateral
Requires removal
Gental syringing may help

Question 13

What is otitis externa

Answer 13

Inflammation of external ear canal
Usually unilateral
Can be acute or chronic

Question 14

What is most common causes

Answer 14

Bacteria = most common - 
- S.aureus / S.epidermis
- Pseudomonas with hearing aid 
Can get fungal 
- Increased risk after prolonged Ax
Seborrheic dermatitis
Contact dermatitis

Question 15

What are the symptoms

Answer 15

Ear pain - acute on moving pinna
Itch
Discharge
Temporary conductive hearing loss

Question 16

What is seen O/E

Answer 16

Red or white swollen EAM
May not be able to see TM due to swelling
May have lots of pus / purulent discharge
Try see TM to look for perforation which can cause 2 otitis external

Question 17

What are RF

Answer 17

Swimming
Eczema - seborrheic / contact
Absence of wax from self cleaning 
Asthma
Allergic rhintiis
Foreign body
Immunosuppression e.g.DM

Question 18

What should you ask about / examine

Answer 18

Fever
Tinnitus
Discharge
Examine nose + throat 
Look behind ear for swelling / scar
Lymph nodes

Question 19

What can’t you rule out

Answer 19

Otitis media / perforation as can’t see tympanic membrane

Question 20

What is treatment

Answer 20

Antibiotic ear drops + steroid = 1st line
- Gentamicin - CI if perforated TM so if can’t see don’t give
- Ciprofloxacin (unlicensed)
- Neomycin
- Have brand names
Steroid ear drop to reduce inflammation
Anti-fungal
Can give capsule if severe - fluxloaxcillnin = 1st line for oral
IV if malignant
Syringe out debris so more effective
Refer ENT if fail to respond to topical Ax
Avoid water

Question 21

What is chronic otitis externa

Answer 21

Chronic infection in EAM

Usually staph or fungal

Question 22

What are the symptoms

Answer 22

Chronic discharge
Hearing loss
Severe pain

Question 23

How do you Rx

Answer 23

Cleansing of external ear

Anti-fungal and Ax ear drops

Question 24

What is malignant otitis externa

Answer 24

Caused by spread of otitis externa into bony ear canal

Question 25

What causes

Answer 25

S.Aureus | Pseudomona's

Question 26

What are RF

Answer 26

Immunosuppressed Chemotherapy Elderly DM in 90% of cases

Question 27

What are the symptoms

Answer 27

``` Failure to response to Ax OM temporal bone Persistent and foul smelling discharge Pain out of proportion Ear pain Temporal headache Purulent otorrhoea Hearing loss Fever Dysphagia Hoarseness Facial nerve dysfunction ```

Question 28

How do you Dx

Answer 28

Refer any non resolving otitis external with worsening pain to ENT CT scan Can do swab for sensitivity

Question 29

How do you Rx

Answer 29

Surgical debridement IV Ax to address OM and cover pseudomona's Ciprofloxacin Gent - not used if TM perforated as ototoxic

Question 30

What is CI if malignant

Answer 30

Syringing ear

Question 31

What can referred ear pain be from

Answer 31

Mostly from teeth

Question 32

What can a pinna haematoma cause

Answer 32

Cartilage of ear starved of blood supply | Leads to cauliflower ear

Question 33

When do you give Ax

Answer 33

``` Red oedematous narrow canal Conductive hearing loss Discharge Regional LN Cellulitis behind ear Fever ```

Question 34

How do you manage excessive wax

Answer 34

Topical ear drop - olive oil Microsution Syringe Suction in ENT clinic

Question 35

What do you do for recurrent otitis media

Answer 35

Can insert inflation tube