Miscellaneous ear, nose, and throat disorders

Last updated: March 20, 2024

Summary

This article covers various ear, nose, and throat conditions, including external auditory canal atresia and nasal septal ulcers.

Nasal septal ulceration and perforation

Overview of nasal septal ulceration and perforation
	Nasal septal ulceration ^[1]	Nasal septal perforation ^[2]^[3]
Definition	Ulceration through the mucosa, submucosa, and perichondrial layers, resulting in exposure of the nasal cartilage	Perforation through all of the layers of the nasal septum (including cartilage), resulting in a communication between the nasal cavities
Etiology	Iatrogenic (e.g., due to septoplasty, tight nasal packs) Trauma (e.g., nose foreign body, nasal fracture) Substance-related (e.g., from the use of cocaine, intranasal decongestants, intranasal steroids) Autoimmune (e.g., granulomatosis with polyangiitis, systemic lupus erythematosus, sarcoidosis) Infection (e.g., tuberculosis, leprosy, syphilis) Neoplasia (e.g, carcinoma of the nasal septum)
Clinical features	Nasal whistling sound (in nasal septal perforation) Epistaxis Nasal obstruction Rhinorrhea Crusting Hyposmia
Diagnostics	Anterior rhinoscopy and nasal endoscopy Direct visualization of the ulcer and/or perforation Other possible findings: granulation tissue, excessive crusting, foreign body If diagnostics are inconclusive: Laboratory studies (e.g., serological testing for syphilis) Biopsy (e.g., to identify neoplasms, vasculitis)
Treatment	General measures: routine saline lavage, application of nasal emollients Etiology-directed treatment (e.g., penicillin in patients with syphilis)	General measures: routine saline lavage, application of nasal emollients Etiology-directed treatment (e.g., penicillin in patients with syphilis) Surgical repair Patients who are not suitable for surgery (e.g., inoperable perforation, high risk): nasal septal prosthesis

External auditory canal atresia

Definition: an absent or stenotic external auditory canal
Epidemiology: ♂ > ♀ (2.5:1) ^[4]
Etiology ^[5]
- Congenital (most common) ^[6]
  - Unilateral atresia > bilateral atresia (4:1)
  - The right ear is most commonly affected
- Acquired
  - Trauma (e.g., from a motor vehicle accident, gunshot wound)
  - Neoplasia (e.g., cutaneous carcinomas)
Clinical features
- Underdeveloped ear (e.g., small or absent auricle)
- Abnormal craniofacial features may be present (e.g., hemifacial microsomia, cleft palate)
- Hearing loss
  - Conductive hearing loss (most common)
  - Sensorineural hearing loss may be present (especially in congenital atresia because of the possibility of concomitant inner ear abnormalities)
Diagnostics
- Hearing test within the first days of life (e.g., otoacoustic emission measurements, brainstem auditory evoked potentials)
- CT scan of the temporal bone
  - Children < 5 years of age
    - Surgery planning
    - Suspicion of cholesteatoma
  - Children ≥ 5 years of age: to assess the morphology of the ear and/or detect ear abnormalities (e.g., absence of ear ossicles)
Management
- Congenital atresia
  - Unilateral atresia
    - Close observation in school and regular hearing tests
    - Early treatment of middle ear infections (to preserve hearing in the unaffected ear)
    - Hearing aids can be used in patients with speech and/or language impairment.
  - Bilateral atresia
    - Early bone conduction hearing aids (within the first weeks of life)
    - Surgical intervention (e.g., canalplasty and tympanoplasty)
- Acquired atresia: surgical repair
Complications
- Delayed speech and language development (especially with bilateral hearing loss)
- Increased risk of cholesteatoma (in patients with stenotic ear canals)
- Increased risk of acute otitis media

Children with congenital external auditory canal atresia may have other congenital anomalies; therefore, a thorough assessment is required.

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