Disorders of the External Ear - A Historical Perspective PDF

D i s o rd e r s o f t h e E x t e r n a l E a r- A H i s t o r i c a l P e r s p e c t i v e Frank E. Lucente, MD KEYWORDS  External ear  Cerumen  Auricle  Otologic community The external ear, namely the auricle and external auditory canal, have challenged phy- sicians and other care gi...

D i s o rd e r s o f t h e E x t e r n a l E a r- A H i s t o r i c a l P e r s p e c t i v e Frank E. Lucente, MD KEYWORDS  External ear  Cerumen  Auricle  Otologic community The external ear, namely the auricle and external auditory canal, have challenged phy- sicians and other care givers since the dawn of humankind. The external ear has tremendous functional, and cosmetic, significance. It has been used as the site of ornamentation and social expression in various cultures over the centuries. It is also the most visible and accessible part of the delicate and complicated hearing process. Certain anatomical and physical characteristics pose special challenges. The carti- lage can vary tremendously in configuration. It has poor blood supply which makes treatment of infections which require blood-borne antibiotics difficult. The overlying perichondrium and skin can be used in the therapeutic process but the cartilage is a particular problem when it is damaged or infected. The skin of the external ear can manifest generalized dermatoses. The skin and cartilage of the external ear can also be used in the reconstruction of damaged areas, such as the opposite auricle and the nose. Anatomical deformities of the auricle can be the source of much psychological distress. Use of the auricle for ornamentation has been practiced for centuries. Certain tribal practices involve stretching the lobule and insertion of earrings or other decorative ob- jects. With its adequate blood supply, this is generally well-tolerated. However, the recent practice of piercing the cartilage and inserting objects (sometimes as part of a weight-loss or smoking-cessation program) is less well-tolerated. The auricle can also be a site for the implementation of a form of acupuncture called auriculopuncture, especially in the Orient. In 1957, Ben H. Senturia, an otologist from St. Louis, and his colleagues published a monograph, Diseases of the External Ear as part of the American Lecture Series by Charles C. Thomas Publishers.1 This work was largely based on numerous research projects on infections of the external auditory canal. They were somewhat motivated by the experience of seeing many soldiers returning from the Pacific in World War II with infections of the external auditory canal. They attempted to elucidate the causes and recommend appropriate antibiotic therapy. Research by various scientists iden- tified mixed flora at the usual cause and the general therapy consisted of a solution consisting of a combination of antibiotics effective against Gram-positive and Department of Otolaryngology, SUNY-Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203, USA E-mail address: [email protected] Otolaryngol Clin N Am 56 (2023) xix-xx https://doi.org/10.1016/j.otc.2023.06.008 oto.theclinics.com 0030-6665/23/ª 2023 Elsevier Inc. All rights reserved. xx Lucente Gram-negative bacteria within an acid medium. At this time, the Food and Drug Administration was attempting to discourage the use of combinations of medications in order to focus on single-drug therapy. Senturia testified in Washington and was suc- cessful in getting the idea of the combination of antibiotics approved. I had the pleasure of working with Dr Senturia while serving a resident in Otolaryn- gology at Washington University in St Louis. It was from the mentorship that I became interested in diseases of the external ear, and, throughout my career, it was a major focus of my practice. In 1980, Dr Senturia, Morris D. Marcus, and I published an exten- sively expanded text which included much of the original work that was in his 1957 edi- tion and added articles on tumors, trauma, foreign bodies, metabolic diseases, malformations, psychocutaneous diseases, geriatric changes and allergic disorders.2 In 1995, I was joined by William Lawson and Nelson Lee Novick in publishing an updated monograph, The External Ear,3 which resulted in an attempt to provide an otologic-dermatologic background for understanding the diverse disorders of the external ear, with more discussion of various surgical procedures that are used in the area. Treatment of external ear afflictions, long the province of otologists, now involves other professionals including audiologists and other physicians. This has posed a challenge to the otologic community with regard to training of their colleagues and, as time, compet- itors, as well as in monitoring the results and dealing with any complications. The recent introduction of over-the-counter hearing aids, self-cleaning devices for removal of cerumen, and self-administered solutions which purport to dissolve wax have taken the professional community into another area of challenges. This is based on the frequent misunderstanding of the role of cerumen. Cerumen (or ear wax as the public and commercial world frequently refer to it) is an important defense mechanism for the ear. It lubricates the canal and has antibacterial properties which help to prevent infections. It is not dirt! If undisturbed and undeterred, the ear canal skin will generally allow the wax to migrate toward the canal opening where it can be easily removed. However, if the individual used instruments, fingers, cotton swabs or other devices to try to clean the canal, they will generally push the was deeper. These devises can also injure the skin of the canal and even damage the eardrum, if done too vigorously. Experience has taught that despite one’s best efforts, the canal can become completely blocked with wax, producing hearing loss. In these instances, it is prudent for the problem to be handled by an ear care professional who can safely remove the wax, generally under microscopic control, while protecting both the canal skin and tympanic membrane. The diagnosis and treatment of various conditions involving the external ear canal and auricle continues to evolve. We have generally benefitted from advance in tech- nology, pharmacology, and education. It remains to be seen how the latest challenges will be met. Having studied this area for over 50 years, this author looks forward to following all of the developments. REFERENCES 1. Senturia BH. Diseases if the external ear. Springfield (IL): Charles C. Thomas Pub- lisher; 1957. 2. Senturia BH, Marcus MD, Lucente FE. Diseases of the external ear: an otologic- dermatologic manual. 2nd edition. New York: Grune and Stratton, Inc.; 1980. 3. Lucente FE, Lawson W, Novick NL. The external ear. New York: WB Saunders Inc; 1995.