How should I treat an acute haemotoma of the pinna?
An acute haemotoma of the pinna occurs after direct trauma due to an assault or sporting injury.
Bleeding strips the skin from the cartilage leading to cartilage necrosis and a deformed “cauliflower” ear
Deprived of the blood supply, the cartilage dies. The haemotoma may become infected leading to an abscess and subsequent deformity, which is permanent.
Immediate referral for surgical drainage is required.
How should I manage a foreign body in the ear?
This is more common in young children and often presents with a history of parental concern. It is not unusual for a foreign body to go unnoticed for some time, presenting with otorrhoea or otalgia in due course.
In adults, the culprit is usually a cotton bud or match stick that was being used in an attempt to clean the ears.
Which method of removal is used, depends on the type of foreign body, age and cooperation of patient, the skill and experience of the practitioner performing the procedure and the facilities available.
Syringing is useful in the removal of most foreign bodies, although one should avoid if vegetable material is present, as this may swell up and impact in the ear, as well as causing pain.
A blunt hook can be useful in removing small round objects that lie superficially, and are not impacted. Crocodile forceps can be helpful in grasping paper, cotton wool or pieces of sponge. Suction apparatus would be successful in removing most foreign bodies, but unfortunately most primary care centres do no possess such equipment.
Removal under general anaesthesia may be needed.
What common skin problems affect the pinna/external ear?
The pinna is particularly sensitive to excessive sunlight exposure, as it sticks out and is rarely covered by clothing. Therefore certain skin lesions are often found here. Skin lesions affecting the pinna include:-
Squamous cell carcinoma (SCC) – typically occur on the outer surface of the pinna, and have an ulcerated appearance with raised everted edges. Early assessment is crucial as they do metastasize, usually to the neck.
Basal cell carcinoma (BCC) – (‘rodent ulcers’) invade more locally and grow more slowly. They may initially present as a small lump/spot that fails to heal. As it grows, the centre may necrose, leaving a small crusted ulcer with a ‘pearly’ rolled edge. Metastases are rare. SCC and BCC are often difficult to distinguish visually.
Malignant melanoma – any suspicious pigmented lesions should be referred for urgent assessment. Metatases are common and prognosis appears to be related to tumour depth at presentation.
Solar keratoses – typically present as a single or multiple red scaly rough-surfaced patches. They become commoner with age and appear on sun-exposed sites. Many regress spontaneously, although a minority may be pre-malignant, progressing to a squamous cell carcinoma.
Gouty tophi – Deposits of urates (tophi) in the skin and cartilage can occur in those people who suffer with gout. The ears are often affected.
Congenital abnormalities of the pinna
“Bat” ears – these abnormally protruding ears are a common abnormality of the pinna and usually bilateral. They can cause much distress in school-age children as they are teased by their peers. Pinnaplasty, usually performed around the age of 5 years, will pin the ears back permanently.
Complete absence of the pinna (anotia) – often associated with absent ear canal and middle ear. Due to the different embryological development, the inner ear is usually normal. Early hearing assessment with appropriate hearing aid fitting is advised. Bone-anchored hearing aids with prosthetic pinnas are becoming increasingly popular.
Accessory auricles – these small tags usually contain cartilage remnants and are located between the tragus and the angle of the mouth.
Pre-auricular sinus – an embryological remnant which appears as a small pit, usually anterior to the root of the helix. Complete excision of the sinus tract is required if they become repeatedly infected.
ENT Doctor London is one of UK’s leading Nose Surgery London clinics, and can be contacted on 0207 580 6970.