EN4.{1-2,5,9} | Ear Symptoms and External Ear Disorders — Glossary

Bacterial infection of the EAC skin (predominantly Pseudomonas aeruginosa and Staphylococcus aureus); characterised by severe otalgia, positive tragal tenderness, EAC oedema and erythema; treated with aural toilet followed by topical antibiotic-steroid drops.

Acute infection of the middle ear cleft, most commonly in children; presents with otalgia, fever, conductive hearing loss, and a dull/bulging TM; treated with analgesics ± amoxicillin in young children or severe cases.

The auricular branch of CN X (vagus) supplying the posterior EAC and adjacent auricle; mediates referred otalgia from hypopharyngeal and laryngeal carcinoma; also mediates the ear-cough reflex.

The 'unsafe' type of CSOM: attic or marginal TM perforation with cholesteatoma, foul-smelling discharge, progressive bone erosion, high risk of intracranial complications; requires mastoidectomy.

Systematic cleaning of the external auditory canal by dry mopping, suctioning under otomicroscope, or gentle irrigation; essential first step in treating OE and otomycosis, because topical drops cannot penetrate debris-filled or oedematous canals.

Branch of CN V₃ (mandibular division of trigeminal) supplying the anterior EAC, tragus, TMJ, and lower molars; mediates referred otalgia from dental pathology and TMJ dysfunction.

A protein found exclusively in CSF (and vitreous humour); its detection by electrophoresis in ear discharge is the definitive diagnostic test for CSF otorrhoea.

Haemorrhagic vesicular eruption on the tympanic membrane surface causing severe acute otalgia; associated with viral infection (including Mycoplasma pneumoniae); treated with analgesics and topical antibiotic drops.

Stimulation of the semicircular canals by a temperature differential created when cold or hot fluid is introduced into the EAC; creates convection currents in horizontal semicircular canal endolymph → nystagmus and vertigo; the physiological basis of the caloric test; the complication mechanism of non-body-temperature ear syringing.

Permanent fibrocartilaginous thickening and deformity of the pinna resulting from an untreated or repeatedly reaccumulating haematoma auris; the perichondrium lays down fibrosis replacing the normal cartilaginous architecture.

A perforation in the pars tensa that does not reach the annulus (peripheral fibrocartilaginous rim); the defining otoscopic finding of tubotympanic (safe) CSOM; the rim of residual TM is visible all around the perforation edge.

Ear wax; produced by ceruminous glands (modified apocrine glands) in the outer one-third of the EAC; consists of fatty secretions, desquamated epithelium, and lysozyme; serves antibacterial, antifungal, and waterproofing functions; normally migrates laterally by epithelial migration.

A substance that softens or dissolves cerumen; used to prepare the ear canal before syringing; includes olive oil (lubricates and softens), 5% sodium bicarbonate (emulsifies wax), and hydrogen peroxide 3% (effervesce and soften).

Modified apocrine glands in the skin of the outer one-third (cartilaginous) EAC; produce cerumen (wax) which has antibacterial, antifungal, and waterproofing properties; absent in the bony (inner two-thirds) EAC.

A sac lined by stratified squamous epithelium filled with accumulated desquamated keratin (keratinous debris) in the middle ear or mastoid; progressive bone-eroding capacity via collagenase and pressure; causes ossicular erosion, facial nerve damage, labyrinthine fistula, and intracranial complications.

Chronic inflammation of the middle ear lasting >3 months with persistent TM perforation and intermittent or continuous purulent discharge; classified as tubotympanic (safe, mucosal) or atticoantral (unsafe, squamosal/cholesteatoma).

Referred otalgia from temporomandibular joint (TMJ) dysfunction; characterised by pre-auricular pain worsened by jaw movement, TMJ tenderness on palpation, and sometimes clicking; mediated via the auriculotemporal branch of CN V.

Cerebrospinal fluid leaking from the ear after a basal skull fracture; appears as clear, watery, profuse discharge; identified by the halo ring sign on filter paper and confirmed by beta-2 transferrin assay.

Bilateral, multiple, broad-based bony projections from the anterior and posterior walls of the bony EAC caused by repeated cold-water exposure ('surfer's ear'); progressively narrow the canal, predisposing to wax impaction and OE; symptomatic cases treated by surgical canalplasty.

The narrowest point of the external auditory canal, located at the bony-cartilaginous junction; the most common site of wax impaction and the site where granulation tissue forms in malignant OE.

Elongated styloid process or calcified stylohyoid ligament causing referred otalgia and throat discomfort on swallowing; diagnosed by CT and palpation of the tonsillar fossa under anaesthesia; treated by styloidectomy.

A wax removal technique using a Higginson's syringe or electronic irrigator to direct warm water (37°C) against the posterosuperior EAC wall; the returning water carries the wax out; contraindicated in perforated TM, previous ear surgery, only-hearing ear, active otitis externa, and cleft palate.

A compressed polymer wick (Pope wick) or ribbon gauze soaked in glycerine and ichthammol inserted into a severely oedematous EAC; expands on contact with moisture, maintaining canal patency and delivering topical medication by capillary action; removed after 48–72 hours.

Stimulation of the posterior EAC skin (via Arnold's nerve, the auricular branch of CN X) provoking a cough or, rarely, vagal syncope; a recognised hazard of EAC instrumentation such as syringing.

A branch of the cervical plexus (C2–C3) supplying the lower auricle, mastoid skin, and parotid region; mediates referred otalgia from cervical spondylosis and C2–C3 disc disease.

A subperichondrial collection of blood following blunt trauma to the pinna; presents as smooth fluctuant swelling of the helix/antihelix sparing the lobule; must be drained within 48–72 hours before organisation into fibrocartilaginous tissue (cauliflower ear).

A large rubber bulb syringe used for ear irrigation; the standard instrument for ear syringing in primary care; generates a controllable stream of water; should be filled with water at body temperature (37°C).

The tympanic branch of CN IX (glossopharyngeal); forms the tympanic plexus on the promontory; mediates referred otalgia from tonsillitis, peritonsillar abscess, and oropharyngeal carcinoma.

A double-ended ENT instrument: one end is a small blunt wax hook for engaging behind wax plugs; the other end is a holder for cotton wool (for aural toilet); used for manual wax removal under direct vision.

Accumulation of desquamated keratin in the EAC causing expansion of the bony canal by pressure erosion; presents with conductive hearing loss; distinguished from EAC cholesteatoma (which causes localised, not diffuse, bony erosion); treated by regular microsuction.

An intracranial complication of atticoantral CSOM/cholesteatoma in which the lateral (sigmoid) sinus is thrombosed by direct spread of infection; presents with spiking fever (picket fence fever), headache, and signs of raised intracranial pressure; requires surgical drainage and anticoagulation.

Skull base osteomyelitis caused by Pseudomonas aeruginosa spreading from the EAC via Santorini's fissures; predominantly in elderly diabetics and immunocompromised patients; hallmark finding is granulation tissue at the EAC floor at the bony-cartilaginous junction; treated with prolonged IV ciprofloxacin.

Skull base osteomyelitis caused most commonly by Pseudomonas aeruginosa in elderly diabetics or immunocompromised patients; presents with severe otalgia, granulation tissue at the EAC floor, and cranial nerve palsies; life-threatening; treated with prolonged IV anti-pseudomonal antibiotics.

A perforation reaching the annulus of the TM, typically in the posterosuperior pars tensa; an atticoantral/unsafe CSOM finding that suggests cholesteatoma extending medially into the middle ear.

Surgical exenteration of the mastoid air cells; types: cortical (canal wall up — preserves posterior EAC wall, requires second-look), modified radical (canal wall down — opens mastoid cavity, lower recurrence, requires lifelong cavity care), radical (removes all middle ear structures).

Wax removal using low-pressure suction through a fine cannula under direct visualisation via an otomicroscope or binocular loupes; does not use water; safe in perforated ears and post-surgery ears; considered the gold standard technique.

Surgical repair of an isolated TM perforation using a graft (most commonly temporalis fascia); performed when the ear is dry for ≥3 months; closes the perforation and protects against recurrent infection.

Surgical incision of the tympanic membrane to drain middle ear fluid or pus; must be performed in the antero-inferior quadrant to avoid the ossicular chain (superiorly) and the jugular bulb (inferiorly).

An ear that is the patient's sole functioning hearing ear, with profound hearing loss in the other ear; any complication of wax removal causing hearing loss in this ear leaves the patient profoundly deaf; wax removal in an only-hearing ear must be performed by an ENT specialist using microsuction.

Pain in or around the ear; classified as primary (otogenic — arising from ear structures) or referred (non-otogenic — referred from distant sites via shared nerve pathways).

Inflammation of the external ear canal skin, typically bacterial (Pseudomonas, Staphylococcus aureus); characterised by otalgia, ear discharge, tragal tenderness, and canal oedema; managed with aural toilet and topical antibiotic-steroid drops.

Fungal infection of the EAC, most commonly Aspergillus niger (black spore heads on white hyphae) or Candida albicans (white curd-like deposits); characterised by pruritus predominating over pain; diagnosed by KOH wet preparation; treated with aural toilet and topical clotrimazole.

Discharge from the external auditory canal; may originate from the external ear or middle ear; characterised by its colour, consistency, odour, and associated symptoms to determine the source.

Aminoglycoside-containing topical ear preparations (gentamicin, tobramycin, neomycin) that can cause cochlear and vestibular toxicity when instilled into a perforated ear via round window absorption; contraindicated in CSOM with TM perforation. Safe alternative: ciprofloxacin drops.

The small triangular superior area of the tympanic membrane, in the attic above the lateral process of the malleus; lacks the middle fibrous layer; prone to retraction → attic retraction pocket → cholesteatoma; perforation here = atticoantral/unsafe CSOM.

Bacterial infection of the pinna perichondrium and subperichondrial space, most commonly caused by Pseudomonas aeruginosa; presents as hot, red, tender diffuse pinna swelling with characteristic lobule-sparing; treated urgently with ciprofloxacin to prevent cartilage necrosis.

The vascular connective tissue layer covering the auricular cartilage of the pinna on both surfaces; sole blood supply to the avascular elastic cartilage; its separation from cartilage (by haematoma or pus) causes cartilage avascular necrosis.

Technique to straighten the EAC for instrument access in adults: pulling the pinna upward and backward straightens the cartilaginous portion of the canal by drawing the cartilage posterosuperiorly; in infants, traction is downward and backward.

Bacterial infection of the EAC skin developing 24–48 hours after ear syringing, due to residual water in the canal causing maceration of skin; prevented by drying the canal after syringing; treated with topical antibiotic-steroid drops.

The target for the water jet during ear syringing; directing the jet here allows water to pass behind the wax plug and return carrying the wax; directing the jet directly at the TM risks TM perforation.

Reactivation of varicella-zoster virus (VZV) in the geniculate ganglion of the facial nerve (CN VII); presents with severe otalgia, vesicles in the EAC and concha, peripheral facial palsy, and sometimes sensorineural hearing loss and vertigo; treated with early antivirals + steroids.

Ear pain arising from pathology at a site remote from the ear, transmitted via a nerve that supplies both the ear and the diseased site; commonest referred pathways are CN V (dental/TMJ), CN IX (oropharynx), CN X (hypopharynx/larynx), and C2–C3 (cervical spine).

Small anatomical fissures in the floor of the cartilaginous EAC that communicate with the parotid gland and skull base; in malignant OE, Pseudomonas tracks along these fissures into the skull base, explaining the rapid spread of infection.

Pain elicited by gentle pressure on the tragus or traction on the pinna; positive in acute otitis externa (EAC skin inflammation); negative in acute otitis media (pain arises from the middle ear, not EAC skin).

A perforation of the tympanic membrane caused by a procedural injury (e.g., syringe jet directed at the TM, or vigorous instrumentation); presents as sudden pain during the procedure, fresh blood, and visible ragged-edged perforation; managed by stopping the procedure, dry cotton wool, ENT referral.

The 'safe' type of CSOM: central perforation of the pars tensa, mucoid-purulent discharge, mucosal disease without cholesteatoma, rare complications; treated conservatively or by tympanoplasty.

A small metal instrument with a ring or hook at one end; used under direct vision to engage behind a wax plug and draw it laterally; most effective for soft, posteriorly-placed wax; requires careful technique to avoid EAC skin trauma.