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.
CAUSES OF FURUNCULOSIS
- Bacteria i.e. streptococcus aureus, pseudomonas pyrogens, Hemolytic streptococci, Viral & Fungal infections
Other predisposing factors include:
- 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
- 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
- Sinus thrombosis
This is bleeding from the nostrils/Nasal bleeding which may be arterial venous, or capillary
CAUSES OF EPISTAXIS
- 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;
- 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
- 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.
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
- 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.