Furunculosis is the infection of the external ear canal lined by the skin which may be localized or generalized(diffuse).

It occurs in form of a boil. An ear furuncle is a boil that develops in the ear canal. It may be as a result of infection  deep in the skin resulting in pus formation in the boil.


  • Bacteria  i.e. streptococcus aureus, pseudomonas pyrogens, Hemolytic streptococci, Viral & Fungal infections

Other predisposing factors include:

  • Allergy
  • Foreign bodies
  • Presence of infected water in the ear
  • Injury to the ear


  • Pain and tenderness on pulling the ear that is thrombing in nature
  • Itching especially if the cause is fungal
  • Swelling
  • Pus discharge(thin mucopurulent discharge)
  • Hearing loss if it occludes the meatus
  • Inflammation of the neighboring lymph nodes
  • Difficulty in chewing


  • History and physical examination
  • If there is pus discharge, then a pus swab is done for microscopy, culture and sensitivity

NB: If the discharge is whitish or black, it indicates a fungal infection,  If the discharge is yellow, it indicates a bacterial infection.

Management of furunculosis

  • Thorough cleaning of the ear by wicking
  • Then, apply an antibiotic like chloramphenicol ear drops 0.5% 2 drops 8hrly for 14 days.
  • If severe, add Caps cloxacillin 250-500mgs QID for 5 days, In children 12.5-25mgs per kg body weight.
  • Steroids like betamethasone  ear drops
  • Analgesics for pain like PCT Ig tds for 3 days or Ibuprofen
  • You can also use warm icepacks to relieve pain
  • If the cause is fungal; Use clotrimazole solution apply O.D for 4-8 Weeks Or Fluconazole 200mg O.D for 10 days.
  • Proper drying the ear by ear wicking is very important


  • Otitis media
  • Meningitis
  • Septicemia
  • Sinus thrombosis




Planning (Goals/Expected Outcomes)





Impaired Skin Integrity related to pus buildup as evidenced by tender lumps in the ear canal

Promote skin healing and alleviate discomfort.

– Administer prescribed antibiotics or antifungal medication based on the cause.                                                                                                    – Encourage warm compresses to promote drainage.                                                                                                    – Provide analgesic medication as prescribed.                                                                                                    – Educate the patient on proper ear care and hygiene.

– Medication targets the underlying infection (bacterial or fungal).                                                                                                    – Warm compresses aid in promoting drainage and relieving pain.                                                                                                    – Analgesic medication helps alleviate pain and discomfort.                                                                                                    – Patient education prevents further complications and promotes self-care.

Skin integrity was improved and the patient verbalised comfort.

Hearing loss if occluding the meatus.

Impaired Hearing related to occlusion of the meatus as evidenced by the patient verbalising reduced hearing ability.

Restore and maintain optimal hearing.

– Administer prescribed medications to reduce inflammation.                                                                                                    – Encourage the patient to keep the ear dry and avoid inserting foreign objects.                                                                                                    – Monitor hearing status and provide support as needed.

– Medication reduces inflammation, aiding in hearing restoration.                                                                                                    – Keeping the ear dry prevents further complications.                                                                                                    – Regular monitoring ensures early intervention if hearing status worsens.

Patient verbalised having had his hearing restored.

Inflammation of neighboring lymph nodes.

Impaired Lymphatic Drainage related to inflammation of neighboring lymph nodes as evidenced by swollen lymph nodes in the neck area.

Reduce inflammation and promote lymphatic drainage.

– Administer prescribed anti-inflammatory medication.                                                                                                    – Encourage gentle massage and warm compresses to the affected lymph nodes.                                                                                                    – Educate the patient on the importance of proper ear care to prevent recurrence.

– Anti-inflammatory medication reduces inflammation and promotes drainage.                                                                                                    – Massage and warm compresses enhance lymphatic circulation.                                                                                                    – Patient education supports preventive measures.

Inflammation was reduced and lymphatic drainage restored.

Difficulty in chewing.

Impaired Nutrition: Less Than Body Requirements related to difficulty in chewing as evidenced by patient verbalising pain on chewing.

Improve nutritional intake.

– Collaborate with the dietitian to plan a soft and nutritious diet.                                                                                                    – Provide small, frequent meals that are easy to chew.                                                                                                    – Monitor and record food intake.

– Soft and nutritious diet ensures adequate nutrition despite difficulty in chewing.                                                                                                    – Small, frequent meals are easier to manage.                                                                                                    – Monitoring food intake ensures nutritional needs are met.

Patient verbalised being able to eat soft meals.

Pain and tenderness on pulling the ear, throbbing in nature.

Disturbed Sleep Pattern related to pain and discomfort as evidenced by patient’s inability to get optimal sleep

Improve sleep pattern.

– Administer analgesic medication as prescribed.                                                                                                    – Encourage the patient to find a comfortable sleeping position.                                                                                                    – Provide a quiet and calm environment for sleep.

– Analgesic medication helps relieve pain and discomfort.                                                                                                    – A comfortable sleeping position and a calm environment promote restful sleep.

Sleep pattern was improved.

Presence of furuncles with pus discharge.

Risk for Infection related to compromised skin integrity

Prevent secondary infections.

– Administer prescribed antibiotics or antifungal medication.

– Teach the patient about proper wound care and hygiene.                                                                                                    – Monitor for signs of infection (increased redness, swelling, or warmth).

– Antibiotics or antifungal medication target the infection.                                                                                                    – Patient education on wound care reduces the risk of secondary infections.                                                                                                    – Regular monitoring detects early signs of infection.


Pain and tenderness on pulling the ear, throbbing in nature.

Acute Pain related to bacterial infection as evidenced by the patient pulling the ear, and having a 7/10 on a pain scale.

Alleviate pain to 1/10 on the pain scale within 1 hour

– Administer analgesic medication as prescribed.

– Encourage warm compresses to the affected area.

– Provide distractions and diversions to reduce focus on pain.

– Evaluate pain intensity using a pain scale.

– Analgesic medication helps alleviate pain.

– Warm compresses promote comfort and reduce pain.

– Distractions and diversions redirect the patient’s attention from pain.

– Regular pain assessments guide the effectiveness of interventions.

Pain was elevated with a scale reading of 1/10 within 1 hour



This is bleeding from the nostrils/Nasal bleeding which may be arterial  venous, or capillary



  • Foreign bodies in the nostrils
  • Fracture in the base of the skull
  • Nose Picking
  • Trauma like blow to the nose
  • Tumours or new growth in the nose
  • Nasal polyps
  • Rupture of an artery or blood vessel in the nasal cavity


They include systemic causes or disorders like;

    • Hypertension
    • Bleeding disorders(lack of clotting factors)
    • Renal failure
    • Genetical inheritance (i.e run in families) like in Telangiectasia(dilated small blood vessels) 
    • Allergic reactions
    • Sickle cell trait or diseases
    • Infections like Ebola, typhoid Crimean congo, Marburg fever, malaria etc.
    • Rupture of distended blood vessel
Clinical Features
  • Bleeding from the nose
  • There may be pain in bleeding nostril
  • Signs and symptoms of shock in case of severe bleeding
  • Signs of the predisposing cause like Hypertension, Kidney failure, Ebola, malaria and typhoid

Management of Epistaxis

Management depends on the  severity, cause and location of bleeding. It can be divided into pharmacological and non-pharmacological management.

Non-pharmacological management/First aid

  • Re assure the patient to allay anxiety
  • Put the patient in sit up position if not in shock and instruct him to tilt the head forward to avoid pooling the blood in the posterior pharynx.
  • Instruct the patient to pitch nostrils(the soft parts the nose) between fingers and the thumb for about 10-15 minutes and breath via the mouth and spit out any blood
  • Monitor vital observations i.e. TPR & BP to find out the underlying cause, if it is systemic
  • Apply a cold compress on the fore head using ice pads to facilitate and aid vasoconstriction.
furunculosis epistaxis nose bleed

If bleeding  persists, pharmacological treatment is required.

  • If the cause is a foreign body, it is removed if visible using forceps and antibiotics are given.
  • Pack the nose with a piece of gauze soaked with adrenaline or vitamin K or TEO using forceps to stop bleeding .It is can be left in position for 24-48 hours.
  • Cauterization with electrical cautery or diathermy machine to seal off the bleeders can be done in theatre
  • Ligaturing of the bleeding blood vessels can also be done
  • Pressure can also be inserted on the bleeding area in the nose by inflating a special balloon which is inserted in the nose.
  • In severe bleeding, the patient is resuscitate with IV Fluids like normal saline or given oral fluids to prevent to prevent shock and dehydration.
  • Blood transfusion may also be considered depending on the lost blood after doing Hb, grouping and cross-matching.

Other investigations which may be done include;

  • Blood for CBC to rule out underlying infections
  • Blood Slide (b/s) Rule out  Malaria Parasites     
  • Bleeding and clotting time


Prevention of epistaxis
  • Early treatment and control of predisposing conditions like Hypertension.
  • Treatment of hemorrhagic infections like malaria and typhoid fever
  • Avoid nose picking
  • Avoid violence that could lead to blows to the nose
  • Seeking for medical attention and advice in case of re-occurrence.
  • Severe hemorrhage leading to anemia ,hemorrhagic shock, septic shock
  • Sinusitis
  • Pneumocephalus (presence of air or gas within the cranial cavity)
  • Septal pressure necrosis
  • Neurogenic syncope during packing
  • Epiphora (from blockage of lacrimal duct)
  • Hypoxia from impaired nosal air movement)
  • Infections may result if sterility is not maintained especially in nasal packing.
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7 thoughts on “Furunculosis”

    1. Anterior Epistaxis: This is the most common type of nosebleed and originates from the front part of the nasal septum. The septum is the thin wall of tissue that separates the two nostrils. Anterior nosebleeds are usually less severe and easier to control.

      Posterior Epistaxis: This type of nosebleed originates from the back part of the nasal cavity, often deeper within the nose. Posterior epistaxis is less common but can be more challenging to manage due to the blood flow originating from larger blood vessels.

      Traumatic Epistaxis: Nosebleeds caused by trauma or injury to the nose are known as traumatic epistaxis. This could result from a direct blow to the nose, accidental injury, or medical procedures.

      Spontaneous Epistaxis: Spontaneous nosebleeds occur without any apparent external cause. They might be related to underlying medical conditions such as hypertension, blood clotting disorders, or inflammatory conditions like sinusitis.

      Recurrent Epistaxis: When nosebleeds occur frequently over time, they are termed recurrent epistaxis. This could be due to chronic irritation, dryness of the nasal mucosa, or other underlying health issues.

      Idiopathic Epistaxis: In some cases, nosebleeds have no identifiable cause and are referred to as idiopathic epistaxis. This term is used when the underlying reason for the nosebleed remains unclear even after medical evaluation.

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