Furunculosis

comprehensive coverage, with figure, easy to understand, simple words for nursing students

1. Presented by: Ms. Elizabeth M.Sc (N) Asst. Professor, Dept of MSN NNC, GNSU.

2. External Auditory Canal

3. Introduction Furunculosis is a localized form of otitis externa resulting from infection of a single hair follicle. Inflammation of Hair follicle. Hair follicle are only present in the lateral segment of the external auditory canal. It is therefore,confined to the lateral canal. As the infection progresses a pustule forms & this progresses to local abscess formation.

4. Risk Factor People at risk Allergy Obese over crowding Poor nutrition Teenage & young adults Contact sports Immunocompromised patients Diabetes Depression Pt on Immunosuppressive drugs Aetiology Staphylococcus aureus, pseudomonas & proteus   Local risk factors like heat, humidity, trauma & maceration. Severe conditions appear to be associated with recurrent furunculosis include hypogammaglobulinaemia & DM.

5. Clinical Feature Pain  Deafness  Purulent Discharge  Tenderness on moving pinna or pressing tragus

6. History Collection - The affected ear is extremely painful On palpation - the pinna & tragus are tender. Lab test CBC - ↑ WBC C & S Diagnosis

7. Otoscopic examination Oedema & inflammation is restricted to the lateral segment of the canal with relative medial canal & TM. If the oedema & celullitis spreads to the post-auricular crease, the condition may mistake for acute mastoiditis .

8. Management options otic Analgesics drops - Antipyrine, Benzocaine Oral /systemic antibiotics 1. Macrolide- Clarithromycin, Azithromycin, Erythromycin 2. C ephalosporin - cephalexin, Cefazolin or Quinolone - Ciprofloxacin, gemifloxacin Oral antibiotic recommended in early stage of disease.

9. Topical treatment 1. Antibiotic 2. Astringents - to reduce bleeding from minor abrasions e.g. Topical aluminium chloride , aluminium acetate solution 3. Hygroscopic agents - dehydrating agents e.g. aluminium acetate solution, Magnesium Carbonate. Glycerol & 10% Ichthammol solution is hygroscopic & antistaphylococcal action.

10. Incision & drainage. For recurrent furunculosis Eradication therapy with oral flucloxacillin for 14 days. Correction of specific biochemical abnormalities (hypoferraemia, low serum zinc) may lead to marked reduction of recurrent infections.

11. Outcome If untreated, progress to abscess then discharge to EAC. Adequate drainage the infection will resolve spontaneously. Infection may spread to deeper plain pinna, post-auricular skin, parotid gland. Repeated infection can cause permanent scarring , fibrosis &stenosis of External Auditory Canal (EAC).

12. Patient Education Warm compresses applied to the area for 20 minutes at least 3–4 times a day may ease the discomfort and help encourage to drain. It can be very contagious. Do not share clothing, towels, bedding, or sporting equipment with others Wash hands frequently Do not pop with a pin or needle. Doing so may make the infection worse.