RT Book, Section
A1 Chan, Yvonne
A1 Goddard, John C.
SR Print(0)
ID 1172370123
T1 Noninfectious Disorders of the Ear
T2 K.J. Lee’s Essential Otolaryngology: Head and Neck Surgery, 12e
YR 2019
FD 2019
PB McGraw-Hill Education
PP New York, NY
SN 9781260122237
LK accesssurgery.mhmedical.com/content.aspx?aid=1172370123
RD 2024/04/20
AB TraumaLacerations:  simple  with  or  without  involved  cartilage;  stellate  from  blunt  trauma;  partial  or  total  avulsionTreatment:  Deep  cleaning,  debridement,  surgical  repair;  may  require  stage  or  flap  reconstruction;  dressing,  systemic  antibiotics.  Consider  bolster  to  prevent  hematoma.Complications:  Perichondritis,  cartilage  necrosis.Hematoma—typically  occur  from  blunt  traumaTreatment:  incision  and  drainage  with  through-and-through  sutures  and  bolster  dressing–  Systemic  antibiotics  (consider  fluoroquinolones)Complications:  fibrosis,  cauliflower/wrestlers  ear,  perichondritisFrostbite—exposure  to  subfreezing  temperature  and  wind  leading  to  disruption  of  endothelial  layer  with  extravasation  of  erythrocytes,  platelet  aggregation,  and  sludgingSymptoms:  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.Bites—lobe  of  ear  is  most  common  siteTreatment:  meticulous  cleaning;  systemic  antibiotics;  surgical  repair  and/or  debridement–  Human  bites  have  greater  propensity  for  infection.Keloids  and  hypertrophic  scars—increased  rates  in  African  American  and  Histpanic  population  (up  to  30%)Treatment:  steroid  injection,  surgical  excision,  pressure  dressing,  rarely  radiation  therapyCarcinoma  of  the  external  ear6%  of  skin  cancers  involve  the  earLymphatic  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  canalMetastasis  assocaited  with  depth  of  invasionStaging: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  paralysisRegional  lymph  nodes:–  NX—Regional  lymph  nodes  cannot  be  assessed.–  N0—No  regional  lymph  node  metastasis.–  N1—Regional  lymph  node  metastasis.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  canalTreatment:  biopsy,  topical  agents,  wide  local  excision;  may  require  cartilage  excision,  skin  graft,  or  local  flapsSquamous  cell  carcinomaSymptoms:  pain,  bloody  discharge,  polyp  with  granular  appearance,  facial  nerve  paralysis,  hearing  lossTreatment:  biopsy,  wide  surgical  excision,  may  require  parotidectomy,  sleeve  resection  of  ear  canal  or  temporal  bone  resection;  postoperative  radiation  for  advanced  casesMalignant  melanoma—7%  of  head  and  neck  sites  involve  the  earOther  tumors  of  the  ear:  adenoid  cystic  carcinoma,  adenocarcinoma,  adenoma,  pleomorphic  adenoma