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 antehelical fold in the auricular cartilage. Afflicted children are often teased mercilessly and surgical correction can be carried out after the age of four. Operation consists of exposing the lateral aspect of the cartilage from behind the pinna and scoring it to produce a rounded fold (Fig. 5.1). Accessory auricles Accessory auricles are small tags, often containing cartilage, on a line between the angle of the mouth and the tragus (Fig. 5.2). They may be multiple. Pre-auricular sinus Pre-auricular sinus is a small blind pit that occurs commonly anterior to the root of the helix; it is sometimes bilateral and may be familial. Recurrent infection requires excision (Fig. 5.3). Microtia Microtia, or failure of development of the pinna, may be associated with atresia of the ear canal (Fig. 5.2). Absence or severe malformation of the external ear, as in Treacher Collins syndrome, may be remedied by the fitting of prosthetic ears attached by bone-anchored titanium screws (see BAHA, Chapter 4, page 18). 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. TRAUMA Haematoma Subperichondrial haematoma of the pinna usually occurs as a result of a shearing blow (Fig. 5.4). The pinna is ballooned and the outline of the cartilage is lost. Left untreated, severe deformity will result—a cauliflower ear. Treatment consists of evacuation of the clot and the reapposition of cartilage and perichondrium by pressure dressings or vacuum drain. AVULSION Very rarely, avulsion of the pinna may occur. If the avulsed ear is preserved, reattachment may be possible. INFLAMMATION Acute dermatitis Acute dermatitis of the pinna may occur as an extension of meatal infection in otitis externa: it is commonly caused by a sensitivity reaction to topically applied antibiotics, especially chloramphenicol or neomycin (Fig. 5.5). TREATMENT 1 The ear canal should be adequately treated (q.v). 2 If there is any suspicion of a sensitivity reaction, topical treatment with antibiotics should be withdrawn. 3 The ear may be treated with glycerine and ichthammol, or steroid ointment may be applied sparingly. 4 Severe cases may require admission to hospital. Dictum If otitis externa gets worse on treatment, it is probably due to drug sensitivity. Stop the treatment. Perichondritis Perichondritis may follow injury to the cartilage and may be very destructive. It may follow mastoid surgery or may follow ear piercing, particularly with the modern trend for multiple perforations that may go through the cartilage.Treatment must be vigorous, with parenteral antibiotics and incision if necessary. It goes without saying that if it is due to piercing the ear, the stud should be removed. Chondrodermatitis chronicis helicis Chondrodermatitis chronicis helicis occurs in the elderly as a painful ulcerated lesion on the rim of the helix. It resembles a neoplasm and should be removed for histology. TUMOURS Squamous cell and basal cell carcinomas These tumours occur usually on the upper edge of the pinna, and when small are easily treated by wedge excision (Fig. 5.6). Large tumours of the pinna or outer meatus will require more radical treatment, often with skin flap repair.

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