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Paediatrics
Published in Adnan Darr, Karan Jolly, Jameel Muzaffar, ENT Vivas, 2023
Paula Coyle, Eishaan Bhargava, Adnan Darr, Karan Jolly, Kate Stephenson, Michael Kuo
Examination: Ear/auricleSyndromic featuresOtoscopy
The External Ear
Published in Raymond W Clarke, Diseases of the Ear, Nose & Throat in Children, 2023
These include skin tags, pre-auricular sinuses, appendages, cysts and ‘accessory auricles’. They can be upsetting for parents but can usually be treated surgically if they give rise to aesthetic concerns or recurrent infection. A ‘pre-auricular sinus’ is a small blind-ending pit, lined with squamous epithelium and lying just in front of the pinna. This is usually innocuous but can become infected; it is easily removed by wide local excision, ideally when the child is about 2 years old (Figure 6.1). A ‘pre-auricular sinus’ is not to be confused with a branchial or ‘first arch’ abnormality, which is usually lower (below the tragus), and can be a marker for a complex tract (fistula) running into the ear canal (see Chapter 26). Some congenital abnormalities, including the not-uncommon ‘accessory auricle’, are shown in Figure 6.2.
Anatomy and Physiology of Hearing
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Ananth Vijendren, Peter Valentine
The auricle (pinna) is the outermost projection of the ear with its lateral surface characterised by prominences and depressions (Figure 1.1a). The body is composed of elastic fibrocartilage and is a continuous plate except for a narrow band between the tragus and anterior crus of the helix where endaural incisions can be made. The auricle functions to collect acoustic energy and direct it into the external auditory canal (EAC), and to create incident angle–dependent modifications that help with sound localisation. The EAC is a 2.4-cm-long passage formed from cartilage in the lateral third and bone in the medial two-thirds. It is lined with keratinising squamous epithelium, which facilitates migration of desquamated cells toward the external opening of the canal at a rate of 0.1 mm/day.1 The mixture of these desquamated cells, cerumen, and sebum forms wax.
Total auricular reconstruction concomitant with BONEBRIDGE implantation using a retrosigmoid sinus approach
Published in Acta Oto-Laryngologica, 2022
Danni Wang, Bingqing Wang, Ran Ren, Yue Wang, Jinsong Yang, Peiwei Chen, Shouqin Zhao, Qingguo Zhang
General anesthesia was selected. Stage III of the auricular reconstruction was first performed by the plastic surgical team. The residue was cut open, and the deformed auricular cartilage was removed to reconstruct the tragus. The flap on the surface of residual ear was translocated and connected to the lower part of the reconstructed auricle to create the auricular lobule. The residual soft tissue was removed to deepen the cavity of the auricular concha. Secondly, the previous scalp incision for expander incision was used for BONEBRIDGE implantation (see Figure 2). Lower margins of temporal muscle and the mastoid periosteum were raised forward, and a triangular incision was fabricated to expose the mastoid cortex. An implant bed for the bone conduction-floating mass transducer (BC-FMT) was drilled based on preoperative 3D plan. The implant was secured in place with 2 titanium screws. For patients with extensive dura exposure, Lifts of 2–3 mm could be used to reduce compression on the dura (see Table 1 for specific information). The incision was closed by layers, and then compression dressing was applied around the implant. Mild compression dressing was used on the reconstructed auricle.
Auricular reconstruction using Medpor combined with different hearing rehabilitation approaches for microtia
Published in Acta Oto-Laryngologica, 2021
Chenyan Jiang, Chen Zhao, Bin Chen, Lixin Lu, Yuxin Sun, Xiaojun Yan, Bin Yi, Hao Wu, Runjie Shi
The Medpor framework consists of helical and base components. These two components are shaped to form an auricle that is customized in size and shape to those of the normal or contralateral ear. Three to four holes were drilled in the base components by a Kirschner wire for fixing to the framework. The framework was sutured in place with a 4–0 prolene suture, prepared in advance, through the holes. A small drain was placed at its helical aspect and removed after 7–10 days. The TPF flap was then entirely draped over the framework and tied with a 5–0 absorbable suture. Finally, the lower one-third of the TPF was covered with the anterior-based local skin flap, and the upper two-third of the TPF was covered with full-thickness skin grafts from the lower abdomen or inguinal regions. Proper packaging and fixing were performed with a vaseline gauze and 1% chloramphenicol liquid gauze dressing (Figure 1).
Miscellaneous Ocular Symptoms in a Case of Relapsing Polychondritis
Published in Ocular Immunology and Inflammation, 2021
Ken Fukuda, Tatsuma Kishimoto, Atsuki Fukushima
Miscellaneous systemic inflammation in the right auricle as well as nasal and laryngeal cartilage was also evident together with vestibular and auditory nerve disorders. Given that RP is potentially fatal in the case of respiratory tract involvement, it is important that the condition be diagnosed early and treated promptly. RP can be misdiagnosed in its early stages as a result of the varied systemic symptoms, as in the present case, and because the diagnosis is based on clinical presentation alone in the absence of a specific diagnostic marker. The rate of misdiagnosis of RP has been reported to be 47%, with a time from symptom onset to diagnosis of 14.4 months.5 Ophthalmologists should therefore be aware that RP is a potential cause of multiple recurrent and refractory ocular inflammatory disorders associated with systemic symptoms.