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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


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