EN4.2 | External Ear Diseases — Summary & Reflection

KEY TAKEAWAYS

External ear diseases divide into pinna conditions and EAC conditions. Key pinna conditions: haematoma auris (subperichondrial collection after blunt trauma → cauliflower ear if untreated — drain within 48–72 hours); perichondritis (Pseudomonas, lobule spared — ciprofloxacin urgently to prevent cartilage necrosis); keloid (intralesional steroid ± pressure, not excision alone). Key EAC conditions: acute diffuse OE (Pseudomonas + Staphylococcus, swimmer's ear — aural toilet then topical antibiotic-steroid drops ± wick); otomycosis (Aspergillus niger — itching > pain, black spores on KOH mount — topical clotrimazole after aural toilet); malignant OE (Pseudomonas, elderly diabetics — granulation tissue at bony-cartilaginous junction EAC floor, skull base osteomyelitis — IV ciprofloxacin for 6–8 weeks + glycaemic control); wax impaction (commonest adult conductive hearing loss — olive oil then syringing; contraindicated in TM perforation — use microsuction). Anatomical pearl: cartilaginous EAC has ceruminous glands and hair follicles; bony EAC has thin, gland-free skin adherent to periosteum — explains why bony EAC OE is so painful. Lobule sparing = perichondritis (no cartilage in lobule).

REFLECT

The hook describes a patient with malignant OE whose diagnosis was delayed because topical drops were continued despite treatment failure, and who subsequently developed a facial palsy. Reflect: what cognitive biases might lead a clinician to persist with topical treatment — anchoring on the initial diagnosis, reluctance to admit treatment failure, or failure to recognise the significance of a diabetic patient's unrelenting pain? How would you design a personal mental checklist for any diabetic patient with ear pain who returns after a week still in pain? Write two to three sentences in your reflective journal about when persistence with a treatment plan becomes a clinical error.