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Patient Assessment
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
The skull base lies along a diagonal line running from the mastoid to the eye. Consequently, the signs of a fracture are also found along this line (Box 6.6). Because Battle’s sign and ‘panda eyes’ usually take 12–36 hours to appear, they are of limited use in the resuscitation room. A cerebrospinal fluid (CSF) leak may be missed as the CSF is invariably mixed with blood but should be suspected if clinical signs are present. This should preclude examination of the external auditory canal because of the risk of meningitis. As there is a small chance of a nasogastric tube passing into the cranium through a base of skull fracture, these tubes should be passed orally when this type of injury is suspected.
Mouth, tongue, lips and ears
Published in Richard Ashton, Barbara Leppard, Differential Diagnosis in Dermatology, 2021
Richard Ashton, Barbara Leppard
Chronic eczema on the ear usually occurs in association with eczema elsewhere. Otitis externa, i.e. eczema of the external auditory canal and meatus, is usually due to seborrhoeic eczema (Fig. 6.41), and there will be other evidence of this, e.g. scaling in the scalp (see p. 62). Psoriasis is red rather than pink and there will be typical plaques elsewhere +/- thick scaly plaques in the scalp (see p. 62). Discoid lupus erythematosus (see p. 99) usually involves the antihelix but not the external auditory canal. A biopsy will be needed to confirm this diagnosis.
Trauma
Published in Spencer W. Beasley, John Hutson, Mark Stringer, Sebastian K. King, Warwick J. Teague, Paediatric Surgical Diagnosis, 2018
Spencer W. Beasley, John Hutson, Mark Stringer, Sebastian K. King, Warwick J. Teague
Foreign bodies may also become lodged in the external auditory canal, the nose and the piriform fossa. The knee and foot are common sites for foreign bodies (e.g. pins or glass fragments on to which the child has walked or crawled). Radiopaque objects can be identified readily on radiographs and removed with the assistance of an image intensifier. Unrecognised foreign bodies may lead to infection.
A novel approach to a recalcitrant case of psoriatic otitis externa
Published in Acta Oto-Laryngologica Case Reports, 2023
N. J. McInerney, M. Riglar, P. Casserly
Otitis externa is a frequently encountered pathology by otorhinolaryngologists, with its incidence reported as 1% [1]. It is an acute inflammation of the external auditory canal, due to bacterial, fungal or non-infectious causes. Non-infectious causes can include psoriasis and atopic dermatitis. The ear has a number of inherent defense mechanisms to prevent against infection. Firstly, the tragus and anti-tragus provide a barrier to prevent macroscopic structures entering the canal. Cerumen within the external auditory canal creates an acidic environment which inhibits micro-organism growth. Alterations in canal epidermis can cause pruritus, and frequent itching can alter the skin-cerumen barrier leading to impaired cerumen production and inadequate epithelial migration which precipitates otitis externa.
Circumferential subannular tympanoplasty: surgical and hearing outcome in 224 ears with subtotal perforation
Published in Acta Oto-Laryngologica, 2022
Ripu D. Arora, Neha Thakur, Payal Kamble, Monalisa Jati, Nitin M. Nagarkar, Jagdeep S. Thakur
The surgery was performed as per the standard technique of the postaural approach tympanoplasty and temporalis fascia graft was used in all cases. The external auditory canal was accessed through an incision made in the posterior meatal flap at the bony-cartilaginous junction. The margins of the perforation were incised with micro-sickle knife and undersurface was freshened with micro-circular knife to remove the squamous epithelium. The tympano-meatal flap along with fibrous annulus is elevated all around the bony canal while keeping the pars flacida and the anterior and posterior malleolar folds intact (Figure 1). The middle ear was filled with Gelfoam(TM) and temporalis graft inserted behind the tympano-meatal flap and kept in the underlay technique. The part of the temporalis graft was firmly held between bony and fibrous annulus all around the tympanic membrane (Figure 2). After assuring stability of graft, the flap is reposited and ear canal filled with Gelfoam(TM). Patients were given antibiotics (preferably amoxicillin with clavunate combination or cefuroxime) for two weeks and systemic decongestants for three weeks as per recommended dosage and formulations. Subjects were reviewed for graft uptake at 3, 6, and 12 months after surgery.
Development of thermosensitive poloxamer 407-based microbubble gel with ultrasound mediation for inner ear drug delivery
Published in Drug Delivery, 2021
Ai-Ho Liao, Cheng-Ping Shih, Ming-Wei Li, Yi-Chun Lin, Ho-Chiao Chuang, Chih-Hung Wang
Guinea pigs were anesthetized with xylazine (Rompun; Bayer) at 10 mg/kg and ketamine (Imalgene, Merial, Lyon, France) at 80 mg/kg intramuscularly and kept warm with a heating pad. A small incision was performed in the cartilaginous portion of the external auditory canal, and the transcanal approach was executed as described previously (Liao et al., 2020). For the ultrasound microbubble treatment (USM) groups, 200 μL of a mixture of MB, 2% DEX, and 12.5% P407 gel was given through the anteroinferior part of the tympanic membrane into the middle ear cavity by using a syringe with a 25-gauge needle. The US transducer was then placed into the speculum and positioned 5 mm from the tympanic membrane. Saline was injected into the space between the tympanic membrane and the probe, and then a 1-min application of US sonication targeting the middle ear cavity at a power density of 3 W/cm2 (acoustic pressure = 0.266 MPa) was performed. These procedures were accomplished under an operating microscope (F-170, Carl Zeiss, Jena, Germany). For the control groups, the middle ear cavity was filled as described above with 200 μL of a mixture of MB, 2% DEX, and 12.5% P407 gel (for the round window soaking (RWS) group) or 2% DEX solution (for DEX only without MBs group).