Welch Allyn A Guide To The Use Of Diagnostic Instruments In Eye And Ear Examinations - Quick Reference Guide - Manual (Page 14)

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Common Pathologies of the Ear
FOREIGN BODY
A varied selection of foreign bodies has been discovered in the ear
canals of children. In this case, a large piece of sponge rubber was
removed. In adults, a forgotten piece of cotton wool is frequently
found. The foreign body or an unsuccessful attempt to remove
it can both product secondary otitis externa or damage to the
tympanic membrane and ossicles. In young children, it is sometimes
safer to administer a short, general anesthetic.
ACUTE OTITIS EXTERNA (LEFT EAR)
Trauma (fingernails, bobby pins, cotton tipped swabs) and moisture
(after showering or swimming) are the most common factors
responsible for the development of acute diffuse otitis externa.
The skin of the ear canal is painful, infected and swollen, and it
may be impossible to visualize the tympanic membrane. There is
often a considerable amount of keratin debris in the canal which
must be removed if local treatment is to be effective. Gram negative
and anaerobic bacteria are the most common pathogens; however,
a culture of material should be a clinical consideration.
KERATOSIS OBTURANS
In this condition of unknown etiology, the bony meatus is
totally occluded by a stony, hard plug of whitish keratin debris.
Keratosis obturans is more frequently seen in patients with
bronchiectasis and chronic sinusitis. Removal of this material is
extremely difficult because of its consistency and its frequent
adherence to the underlying canal skin; a general anesthetic
may be required in some patients.
OTOMYCOSIS
Otoscopic examination in cases of otomycosis reveals a white or
cream colored, thickish debris which may have a fluffy appear-
ance due to the presence of tiny mycelia. When the infection is
caused by Aspergillus niger, it may be possible to identify the tiny
grayish-black conidiophores. The underlying external canal skin
is often inflamed and granular from invasion by fungal mycelia.
Otomycosis may follow the use of topical antibiotic ear drops.
ACUTE OTITIS MEDIA
This acute infection of the middle ear cleft frequently intensifies
upper respiratory tract infections and occurs more commonly
in children. In the early stages of acute otitis media, the tympanic
membrane varies according to the stage of the disease. In early
stages of acute otitis media, the tympanic membrane is retracted
and pink with dilatation of the manubrial and circumferential vessels.
Later, as the disease progresses, the tympanic membrane bulges,
becoming fiery red in color and may eventually perforate, releasing
pus into the external auditory canal.
SEROUS OTITIS MEDIA (RIGHT EAR)
In serous otitis media the tympanic membrane is retracted and
shows decreased mobility with pneumatic otoscopy. The handle
of the malleus is usually foreshortened, chalky-white in color, and
the lateral process is prominent. The presence of a thin, serous
effusion within the middle ear gives the tympanic membrane a
yellowish or even bluish appearance, and in cases of incomplete
eustachian tube obstruction, air bubbles or an air fluid level may
be seen.