BRAIN ABSCESS DUE TO EAR INFECTION
Middle ear is separated from brain by a very thin plate of bone .Infection can erode this plate. Initially there is generalized inflammation. Later infection is localized to form an abscess. High index of suspicion is necessary to diagnose this condition. Patient becomes gravely ill with high fever,headache, altered level of consciousness , vomiting and fits.CT scan is ordered as soon as possible. Neurosurgeon will drain the abscess through a hole in the scull cap. Strong intravenous antibiotics are given along with anti epileptic drugs. Treatment of ear infection is deferred until the brain abscess is completely cured. Mortality is very high even in best centers. Therefore it is very important to treat ear infections properly.
This picture depicts a discoloured ear due to infection of the underlying cartilage following unheigenic high ear piercing. Our outer ear is made up of cartilage. Cartilage does not contain blood vessels. It takes nutrition from the thin outer membrane called the perichondrium. When there is a infection of perichondrium, there is a risk of cartilage being deprived of nutrition resulting in cartilage damage. This may lead to a deformed ear known as "cauliflower ear," which has a poor chance of good reconstruction. The usual infective agent in auricular perichondritis is a bacterium called Pseudomonas aeruginosa. In the early phase of infection, treatment should focus on eradicating this bacteuium. Keep the patient under close observation to check the response to antibiotics. Failure to respond to treatment requires admission to an ear, nose, and throat department.Surgical intervention is required at the earliest sign of an abscess.High ear piercing should be discouraged due to above reasons.
Battle's Sign is extreme tenderness and discolouration behind the ear in the area of the mastoid process of the skull, and is an acute sign of basilar skull fracture with local bleeding. Anyone with a history of very recent head trauma with this sign should be sent to the hospital for an immediate CT scan. Named after Dr. William Henry Battle, an English surgeon.
Accessory auricles - these look like skin tags and occur adjacent to a normally placed pinna.Sometimes there is cartilage within the tag.This can be removed by surgery. The nerve of muscles of facial expression (7th cranial nerve) is situated closer to the deep attachment of the accessory ear cartilage.If the surgeon does not keep this in mind, this nerve can get damaged during avulsion of the cartilage.
"High" piercing, which requires puncture through the cartilage of the upper two third of the pinna may cause auricular perichondritis and abscess formation. Loss of cartilage due to poor blood supply results in an unsightly deformity known as "cauliflower ear," which has a poor chance of good reconstruction. the usual infective agent in auricular perichondritis is a bacterium called Pseudomonas aeruginosa. In the early phase of infection, treatment should focus on eradicating this bacteuium. Keep the patient under close observation to check the response to antbiotics.Failure to respond to treatment requires admission to an ear, nose, and throat department.Surgical intervention is required at the earliest sign of an abscess.High ear piercing should be discouraged due to above reasons. Lacerations of the pinna can progress to severe chondritis or perichondritis and so must be fully treated by suturing under antibiotic cover.
EXAMINATION OF THE EAR UNDER THE MICROSCOPE (EUM)
Outer and middle ear conditions cannot be diagnosed without examination under magnification. Otoscope gives a magnfication of four. The ear microscope gives a higher magnification and more freedum to the doctor to use suction and other instruments in the ear. This is not a painful procedure. Therefore can be done as an out patient procedure.
When there is discharge in the ear, suction helps to visualize the drum.
Before we plan any ear surgeries, EUM has to be done.
Foreign bodies in the ear are better removed under the microscope.
If syringing fails for ear wax or foreign bodies, removal or suction under direct vision and magnification is safe and effective. Forceful injection of water can damage the drum.
EAR LOBE SEPSIS
Ear lobe sepsis after ear piercing can lead to scar tissue formation.
This picture depicts a large keloid of ear lobe following sepsis.
People with black skin are more prone to scar and keloid formation. Scar formation can be prevented if the initial ear piercing is done under sterile conditions. If the puncture site is infected, skin is exposed to the metals of the ear stud. This can lead to reaction and scar formation.
It is difficult to treat the keloid by excision only. It needs a steroid injection to prevent recurrence.