5-Conditions of the pinna
Congenital
Protruding ears
Sometimes unkindly known as ‘bat ears’, the terms protruding or prominent should be used. The underlying deformity is the absence of the anti-helical fold in the au- ricular cartilage (Figs 5.1 and 5.2). Affected children are often teased mercilessly and surgical correction can be carried out after the age of four. The operation consists of exposing the lateral aspect of the cartilage from behind the pinna and scoring it to produce a rounded fold (Pinnaplasty).
Accessory auricles
Accessory auricles are small tags, often containing cartilage, on a line between the angle of the mouth and the tragus (Fig. 5.3). They may be multiple.Pre-auricular sinus
Pre-auricular sinus is a small blind pit that occurs most commonly anterior to the root of the helix; it is sometimes bilateral and may be familial. If they become recur- rently infected they are best excised (Fig. 5.4).
Microtia
Microtia, or failure of development of the pinna, may be associated with atresia of the ear canal (Fig. 5.3). Absence or severe malformation of the external ear, as in Treacher Collins syndrome (Fig. 5.5), may be remedied by the fitting of prosthetic ears attached by bone-anchored titanium screws . A bone-anchored hearing aid can be fitted at the same time, although it is often fitted at a much earlier age than prosthetic ears in order to allow speech development.
Inflammation
Acute dermatitis
Extension of meatal infection in otitis externa can cause acute dermatitis of the pin- na, as can a sensitivity reaction to topically applied antibiotics, especially chloram- phenicol or neomycin (Fig. 5.6).
Treatment of otitis externa/dermatitis
1 Clean the ear canal thoroughly (q.v.).
2 If there is any suspicion of a sensitivity reaction, stop topical treatment with antibiotics.
3 The ear may be treated by a glycerine and ichthammol wick, or an emollient ointment.
4 Apply steroid ointment sparingly.
5 Severe cases may require admission to hospital.
Perichondritis
Perichondritis may follow injury to the cartilage, mastoid surgery or ear piercing, particularly with the modern trend for multiple perforations that go through the cartilage. Treatment must be vigorous, with parenteral antibiotics and incision if necessary. If it is due to piercing the stud should be removed.
Extension of meatal infection in otitis externa can cause acute dermatitis of the pin- na, as can a sensitivity reaction to topically applied antibiotics, especially chloram- phenicol or neomycin (Fig. 5.6).
Treatment of otitis externa/dermatitis
1 Clean the ear canal thoroughly (q.v.).
2 If there is any suspicion of a sensitivity reaction, stop topical treatment with antibiotics.
3 The ear may be treated by a glycerine and ichthammol wick, or an emollient ointment.
4 Apply steroid ointment sparingly.
5 Severe cases may require admission to hospital.
Perichondritis
Perichondritis may follow injury to the cartilage, mastoid surgery or ear piercing, particularly with the modern trend for multiple perforations that go through the cartilage. Treatment must be vigorous, with parenteral antibiotics and incision if necessary. If it is due to piercing the stud should be removed.
Chondrodermatitis chronicis helicis
Chondrodermatitis chronicis helicis occurs in the elderly as a painful ulcerated le- sion on the rim of the helix. It resembles a neoplasm and should be removed for histology.
TumoursSquamous cell and basal cell carcinomas
These skin tumours occur usually on the upper edge of the pinna. They are related to exposure to sunlight and when small are easily treated by local excision. Large tumours of the pinna or outer meatus will require more radical treatment, often with skin flap repair
Chondrodermatitis chronicis helicis occurs in the elderly as a painful ulcerated le- sion on the rim of the helix. It resembles a neoplasm and should be removed for histology.
TumoursSquamous cell and basal cell carcinomas
These skin tumours occur usually on the upper edge of the pinna. They are related to exposure to sunlight and when small are easily treated by local excision. Large tumours of the pinna or outer meatus will require more radical treatment, often with skin flap repair
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