Furuncle of the external ear canal

A furuncle is an acute purulent-necrotic inflammation of the hair follicle and the surrounding connective tissue.

[ 1 ], [ 2 ], [ 3 ]

Causes of furuncle of the external auditory canal

A furuncle of the external auditory canal occurs in its membranous-cartilaginous part when a hair follicle or a sulfur or sweat gland is infected with pyogenes staphylococcus.

Contributing factors include purulent discharge from the middle ear, scarification from careless cleaning of the external auditory canal from earwax, scratching from itchy dermatoses, vitamin deficiency, decreased general immunity, diabetes, severe chronic fatigue, tuberculosis, allergies, etc.

Symptoms of a boil in the external auditory canal

A feature of the clinical picture of a furuncle of the external auditory canal, in contrast to its localization on the open surface of the skin, is that it occurs and develops in a closed space with abundant innervation by nerves of pain sensitivity. Therefore, with the development of an inflammatory infiltrate, significant pressure on pain receptors occurs, causing unbearable pain, which in intensity often exceeds the pain syndrome in acute non-perforative otitis media. At the onset of the disease, the patient feels severe itching in the external auditory canal, turning into pain. Pain in the ear increases quickly and is accompanied by irradiation to the corresponding half of the head, sharply intensifies with chewing movements. The latter circumstance makes the patient refuse food. At night, the pain intensifies, becomes unbearable, due to which the patient is completely deprived of sleep. When the external auditory canal is obstructed by an inflammatory infiltrate, conductive hearing loss of the ear occurs with lateralization of tissue sound conduction to the diseased ear.

During otoscopy, at the onset of the disease, a limited reddish swelling is found at the entrance to the external auditory canal, which gradually increases over several hours and partially blocks the external auditory canal. At the top of the swelling, a yellowish "hood" is formed, under which an accumulation of pus is found. The furuncle can open on its own, in which case yellowish-greenish pus is released, after removal of which a small hole in the form of a crater can be found at the top of the infiltrate. With several furuncles, as a rule, there is a complete blockage of the external auditory canal, the clinical course is aggravated, pastosity occurs in the retroauricular region with protruding auricle, which can simulate mastoiditis.

When pressing on the tragus and traction of the auricle, a sharp pain occurs, which indicates inflammation of the external auditory canal. If the furuncle is localized on the anterior wall of the external auditory canal, then a sharp pain occurs when pressing on the tragus, if the inflammation is located on the posterior-superior surface of the external auditory canal, then pain occurs when palpating the retroauricular area, if the furuncle is located on the lower wall, then pain occurs when palpating the tissues in the projection of the lobe and slightly above the angle of the lower jaw.

The most favorable outcome is the complete elimination of the inflammatory process after the furuncle has opened, pus has flowed out, and the necrotic core has come out; however, most often, staphylococcus has seeded the adjacent hair follicles with the development of new furuncles. This development of the process leads to furunculosis of the external auditory canal with a persistent clinical course and difficult treatment. In these cases, regional lymphadenitis occurs with possible abscess formation of the lymph nodes.

Diagnosis of a furuncle of the external auditory canal

The diagnosis is established on the basis of the clinical signs described above.

Differential diagnostics are carried out in the following directions:

• eczema of the external auditory canal, which is not characterized by severe pain, but mainly itching;
• acute diffuse otitis externa, which is characterized by the spread of the process beyond the external auditory canal to the auricle and into the retroauricular groove; diagnosis is difficult in the case of eczema complicated by a furuncle of the external auditory canal;
• acute purulent otitis media; take into account the otoscopic picture, localization and nature of pain, the nature of purulent discharge and the degree of hearing loss;
• adenitis or mumps, which may cause fistulas to form in the external auditory canal; in these diseases, pressure on the area in front of the tragus increases discharge from the external auditory canal;
• In case of furuncle complication with postauricular lymphadenitis, differential diagnostics with acute mastoiditis should be performed; diagnostics in this direction is difficult in case of combination of furuncle of external auditory canal with acute or chronic purulent inflammation of middle ear; in this case, it is based on the nature of swelling in postauricular area: in case of mastoiditis, swelling and infiltration are located in posterior-superior part of postauricular area in projection of mastoid cave with smoothing of postauricular groove, in case of furuncle of external auditory canal with postauricular adenitis - in posterior-inferior retroauricular area with preservation of relief of postauricular groove.

[ 4 ], [ 5 ], [ 6 ]

Treatment of furuncle of the external auditory canal

The nature of the treatment is determined by the stage of development of the pathological process. In the initial stage, abortive treatment is used, which consists of inserting a turunda with a 60% solution of ethyl alcohol into the external auditory canal, or treating the affected area of the skin with an alcohol solution of iodine mixed with ethyl alcohol or a 5% solution of silver nitrate. At the same time, analgesics and UHF are prescribed. During the period of abscess formation, before spontaneous opening of the abscess, its incision is possible. After opening the abscess, rinsing the cavity with antiseptic solutions and antibiotic solutions is indicated. In persistent cases, courses of autohemotherapy with UFO of blood are carried out, antibiotics are administered parenterally, immunoprotectors, vitamins, antihistamines are prescribed, an antistaphylococcal vaccine or anatoxin is used.