Furuncle of external auditory canal

Furuncle - acute purulent-necrotic inflammation of the hair follicle and surrounding connective tissue.

[1], [2], [3]

The causes of furuncle of external auditory canal

The furuncle of the external auditory canal arises in the membranous-cartilaginous part of it when infection with the pyogenous staphylococcus of the hair follicle or sulfuric or sweat gland.

The contributing factors are suppuration from the middle ear, scarification with an inadvertent cleansing of the external auditory canal from earwax, combing with itching dermatoses, beriberi, a decrease in general immunity, diabetes, severe fatigue, tuberculosis, allergy, etc.

Symptoms of furuncle of external auditory canal

The peculiarity of the clinical picture of the furuncle of the external auditory canal, in contrast to its localization on the open surface of the skin, is that it arises and develops in a confined space with abundant innervation of the nerves of pain sensitivity. Therefore, with the development of an inflammatory infiltrate, there is a significant pressure on the pain receptors causing intolerable pain, which in intensity often exceeds the pain syndrome in acute non-perforative inflammation of the middle ear. At the beginning of the disease in the external auditory canal, the patient feels a strong itching, turning into pain. The pain in the ear grows quickly and is accompanied by irradiation into the corresponding half of the head, sharply increasing with chewing movements. The latter circumstance causes the patient to refuse food. At night, the pain intensifies, becomes unbearable, because of which the patient is completely deprived of sleep. When obstructing the external auditory canal, an inflammatory infiltrate causes conductive hearing loss of the ear with lateralization of tissue sound in the diseased ear.

When otoscopy at the beginning of the disease, a limited reddish swelling is found at the entrance to the external auditory meatus, which gradually increases for several hours and partially overlaps 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 itself, in this case yellowish-greenish pus is secreted, after removal of which a small hole in the form of a crater can be found on top of the infiltrate. With several furuncles, as a rule, there is a complete overlap of the external auditory canal, the clinical course is aggravated, there is a pastost in the behind-the-ear with bulging of the auricle, which can simulate mastoiditis.

When pressing on the tragus and traction of the auricle, there is a sharp pain, which indicates an inflammation of the external auditory canal. If the furuncle is localized on the anterior wall of the external auditory canal, then severe pain occurs when the pressure on the tragus, if the focus of inflammation is located on the posterior surface of the external auditory canal, the pain arises when palpation of the ear, if the furuncle is located on the lower wall, the pain occurs when palpation 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 dissection of the furuncle, the expiration of pus and the exit of the necrotic stem, but the most common is the colonization of neighboring hair bulbs with staphylococcus and the appearance of new furuncles. This development of the process leads to furunculosis of the external auditory canal with persistent clinical course and difficult treatment. In these cases, there is regional lymphadenitis with possible abscess of the lymph nodes.

Diagnosis of furuncle of external auditory canal

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

Differential diagnosis is carried out in the following directions:

• eczema of the external auditory canal, for which severe pain, and mostly itching, is not characteristic;
• acute diffuse external otitis, which is characterized by the spread of the process outside the external ear canal into the auricle and into the bovine furrow; Diagnosis is difficult for eczema complicated by the 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 parotitis, in which formation of fistulas in the external auditory can occur; with these diseases pressing on the area in front of the tragus increases the discharge from the external auditory canal;
• with complication of the boil by BTE lymphadenitis, differential diagnosis with acute mastoiditis should be performed; Diagnosis in this direction is difficult when combining the furuncle of the external auditory canal with acute or chronic suppurative inflammation of the middle ear; at the same time they are based on the nature of swelling in the behind-eye area: with mastoiditis, puffiness and infiltration are located in the posterior region of the posterior region in the projection of the mastoid cave with smoothing of the bovine furrow, with the furuncle of the external auditory meatus with behind-the-ear adenitis in the posteriorly retroaureic region while maintaining the relief of the bovine furrow.

[4], [5], [6]

Treatment of the furuncle of the external auditory canal

The nature of treatment is determined by the stage of development of the pathological process. In the initial stage, abortive treatment is used, consisting in inserting into the external auditory canal of turunda with 60% ethanol, or treating the affected skin with an alcohol solution of iodine mixed with ethyl alcohol or 5% silver nitrate solution. Analgesics and UHF are prescribed simultaneously. In the period of abscess formation, before the spontaneous dissection of the abscess, its incision is possible. After opening of the abscess, it is shown that the cavity is washed with antiseptic solutions and antibiotic solutions. In stubborn cases, autoimmunotherapy courses are carried out with blood UFOs, parenterally administered antibiotics, immunoprotectors, vitamins, antihistamines, antistaphylococcal vaccine or anatoxin.