Diseases Of The Auricle

1. Anotia: Absent auricle.

Figure 21: Anotia.

2. Microtia: Small deformed auricle.

They are often associated with (atresia of the external auditory canal).

3. Macrotia: Abnormally enlarged auricle in relation to the other auricle.

• Treatment: Plastic operation

4. Protruding (Bat) ears: (The commonest anomaly).

The ears of some children appear more prominent than usual (because the antihelix is underdeveloped). The prominence may cause unhappiness to the child once he goes to school.

Girls can generally hide their ears beneath hair, but boys cannot.

• Treatment: Corrective operation (otoplasty) is performed at the age of 4 years and on.

5. Pre-auricular fistula and sinus:

These are narrow tracks ending blindly. They are remnants of the cleft between the first and second branchial arches. They appear as shallow pinpoint depressions in the skin just in front of the helix leading to a fistulous tract. When the mouth of the track is closed, it is filled with sebaceous material and forms a cyst. When it is infected and ruptures granulations come out.

• Treatment: When it is only a dimple, it can be left alone. If recurrent infections occur, the fistulous tract has to be excised.

6. Accessory auricle: Small-elevation, formed of skin and cartilage in front of the auricle.

• Treatment: Surgical excision.

• Causes: open trauma as knife injury, bite, or pulling of an earring.

• Complications: perichondritis.

• Treatment: immediate surgical repair, antibiotics.

• Causes:

1. Blunt trauma, commonly in boxers (boxer's ear).

2. Spontaneous as in elderly and haemorrhagic blood diseases.

• Clinical picture:

The auricle is painful, swollen, bluish and cystic (if early)or soft (if late).

• Complications: perichondritis.

• Treatment: Antibiotics, aspiration under aseptic conditions (if early) or incision and evacuation ( if late ), followed by firm pressure dressing to prevent recollection of blood.

• Occurs mainly in very cold weathers (under 0º C), because of the exposed position of the auricle, the reflex vasoconstriction of the subcutaneous capillaries and crystallization of blood inside them (cold and pain sensation)≫ Accumulation of metabolites in the interstitial tissue ≫reflex vasodilatation (congested red and hot auricle) ≫acute ischemia≫necrosis of the auricle.

• Treatment: Rapid thawing ≫40º C, anticoagulants, analgesics, antibiotic. No rubbing because the tissue are friable.

Inflammation of the auricular perichondrium mainly due to pyogenic bacteria.

• Causes:

1. Infected haematoma or laceration.
2. Septic surgical incision.
3. Furunculosis of the external auditory canal.
4. Post- operative infection.
5. Criminal or animal bite.
6. Radiation

• Clinical picture: The auricle is painful, swollen, hot, reddish soft and tender. The lobule is free, because it has no cartilage. Later on deformity occurs.

• Complications: Cartilage necrosis (due to separation of the cartilage from its perichondrium by the accumulating pus) ≫fibrotic≫deformed auricle called “cauliflower ear”.

• Treatment: Intravenous antibiotics, Small incision(s), removal of necrosed cartilage≫drainage.
  

Category: ENT Notes