Disorders of External Ear MCQs

Malignant otitis externa = Skull base osteomyelitis is locally destructive infection of bony EAC which is part of skull base. It is mostly seen in old diabetics and caused by Pseudomonas. Radionucleide gallium(good for prognostic evaluation) and technetium scan(good for diagnosis) are helpful in the management. Also ESR is a good tool to monitor disease activity. \ Reference : Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra, 8th Edition, Chapter name: Some Memorable Nuggets for Rapid Review, Page number: 548

Malignant Otitis Externa is an inflammatory condition caused by pseudomonas infection usually in the elderly diabetics, or in those on immunosuppressive drugs. Its early manifestations resemble diffuse otitis externa but there is excruciating pain and appearance of granulations in the ear canal.

Necrotizing otitis externa, also called malignant otitis externa, is caused by pseudomonas infection in an elderly patient with diabetes. Symptoms include severe otalgia, facial nerve palsy can occur. Reference: Diseases of Ear, Nose, AND Throat by PL Dhingra, Pg.548

This patient is middle aged with long standing blood tinged ear discharge and ear ache worse at night. She also has granulations in the middle ear. All these point to a diagnosis of Malignancy of the middle ear. Reference: Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra, 8 th Edition, Page - 130, 131.

EAC OCCLUSION BY WAX COLLECTION : Some people produce more wax which leads to EAC occlusion by wax collection. This will lead to conductive hearing loss (30 dB CHL approx.) Treatment is PARADICHLOROBENZENE (wax dissolving drops), use these drops for a few days and the suction clearance or syringing is done. SYRINGING-direction of water is Posterosuperior. Use water at body temperature. In syringing avoid cold water because it can lead to vertigo because of inner ear stimulation. Reference: Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra, 8 th Edition, Page - 49, 63.

Keratosis Obturans : EAC skin sheds off to produce keratin inside EAC. EAC skin migrates outwards, bringing keratin and wax out of EAC. Rarely this skin migration pattern is absent, that will lead to collection of keratin+ wax as an expansile mass in ear, this disease is called KERATOSIS OBTURANS. Treatment is surgery called CANALPLASTY. \ Reference : Diseases of Ear, Nose and Throat & Head \and Neck Surgery by P L Dhingra, 8th Edition, Chapter name: Diseases of External Ear, Page number: 64

Cholesteatoma : It is the ectopic presence of skin in the middle ear cleft. It is pearly white in colour. It is of 4 types : Primary Acquired Cholesteatoma (mc) Secondary Acquired Cholesteatoma Tertiary Acquired Cholesteatoma Congenital Cholesteatoma Congenital Cholesteatoma: We use LEVENSON’S CRITERIA to diagnose congenital cholesteatoma . It presents as PEARLY WHITE MASS behind INTACT TYMPANIC MEMBRANE It is UNSAFE due to bone erosion . Bone Erosion leads to Complications, so it is called UNSAFE CSOM. Treatment : Surgery → MRM ( Modified Radical Mastoidectomy) also called as Tympanomastoid Exploration. Reference : Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra, 8th Edition, Chapter name: Cholesteatoma and Chronic Otitis Media, Page number: 80

PINNA HAEMATOMA: It is due to trauma. It is a sub-perichondrial hemorrhage. Treatment is aspiration or drainage + pressure bandage. Otherwise it will lead to Necosis of cartilage which will lead to PINNA DEFORMITY known as BOXER EAR/CAULIFLOWER EAR. Reference : Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra, 8th Edition, Chapter name: Diseases of External Ear, Page number: 58