Chapter 23: Noninfectious Disorders of the Ear

External Ear

• Trauma

  1. Lacerations: simple with or without involved cartilage; stellate from blunt trauma; partial or total avulsion

     • Treatment: Deep cleaning, debridement, surgical repair; may require stage or flap reconstruction; dressing, systemic antibiotics. Consider bolster to prevent hematoma.

     • Complications: Perichondritis, cartilage necrosis.

  2. Hematoma—typically occur from blunt trauma

     • Treatment: incision and drainage with through-and-through sutures and bolster dressing

       • – Systemic antibiotics (consider fluoroquinolones)

     • Complications: fibrosis, cauliflower/wrestlers ear, perichondritis

  3. Frostbite—exposure to subfreezing temperature and wind leading to disruption of endothelial layer with extravasation of erythrocytes, platelet aggregation, and sludging

     • Symptoms: pain, burning, discoloration; reduced pliability; loss of sensation.

     • Treatment: slow warming; antibiotics; anticoagulants; debridement of necrotic tissue after demarcation. No pressure or pressure dressing to the ear.

  4. Bites—lobe of ear is most common site

     • Treatment: meticulous cleaning; systemic antibiotics; surgical repair and/or debridement

       • – Human bites have greater propensity for infection.

  5. Keloids and hypertrophic scars—increased rates in African American and Histpanic population (up to 30%)

     • Treatment: steroid injection, surgical excision, pressure dressing, rarely radiation therapy

• Carcinoma of the external ear

  1. 6% of skin cancers involve the ear

  2. Lymphatic drainage—anterior auricular nodes: lateral pinna and anterior canal wall; postauricular nodes: superior and upper posterior pinna, posterior canal wall; superficial and deep cervical nodes: lobule and floor of external ear canal

  3. Metastasis assocaited with depth of invasion

  4. Staging:

     • Skin and pinna

       • – TX—Primary tumor cannot be assessed.

       • – T0—No evidence of primary tumor.

       • – Tis—Carcinoma in situ.

       • – T1—Tumor 2 cm or less.

       • – T2—Tumor larger than 2 cm but smaller than 5 cm.

       • – T3—Tumor larger than 5 cm.

       • – T4—Tumor invades deep extradermal structures (bone, muscle, cartilage).

     • University of Pittsburgh staging system for SCC involving the temporal bone

       • – T1—Tumor limited to external auditory canal without bone or soft tissue extension

       • – T2—Tumor with limited external auditory canal bony erosion or less than 0.5 cm soft tissue involvement

       • – T3—Tumor eroding full thickness bony external auditory canal with less than 0.5 cm soft tissue involvement, or tumor invovling the middle ear and/or mastoid

       • – T4—Tumor eroding the medial wall of middle ear or beyond, or less than 0.5 cm soft tissue involvement, or patient with facial nerve paresis or paralysis

     • Regional lymph nodes:

       • – NX—Regional lymph nodes cannot be assessed.

       • – N0—No regional lymph node metastasis.

       • – N1—Regional lymph node metastasis.

  5. Basal cell carcinoma—most common malignancy of the ear (45%)

     • Symptoms: erythematous lesion with raised margins; silvery scales common, occurs on the pinna and in the external canal

     • Treatment: biopsy, topical agents, wide local excision; may require cartilage excision, skin graft, or local flaps

  6. Squamous cell carcinoma

     • Symptoms: pain, bloody discharge, polyp with granular appearance, facial nerve paralysis, hearing loss

     • Treatment: biopsy, wide surgical excision, may require parotidectomy, sleeve resection of ear canal or temporal bone resection; postoperative radiation for advanced cases

  7. Malignant melanoma—7% of head and neck sites involve the ear

  8. Other tumors of the ear: adenoid cystic carcinoma, adenocarcinoma, adenoma, pleomorphic adenoma

External Ear Canal