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  • Writer's pictureDr. Koralla Raja Meghanadh

Circumscribed Otitis Externa: Boil in Ear

Updated: Jun 26


Otitis externa, an ear infection in the ear canal (external part of the ear or outer ear), can be broadly divided into two types.

  1. Diffuse Otitis Externa:

    1. Occurs across the ear canal. E.g., Swimmer's ear, Otomycosis, etc.

    2. Caused by pseudomonas aeruginosa bacteria or fungus like Aspergillus Niger, Candida.

  2. Circumscribed Otitis Externa:

    1. It occurs only at the end of the ear canal and is confined to a small area.

    2. Caused by Staphylococcus Aureus.


Circumscribed otitis externa along with candida infection
The patient has both a Candida fungal infection (otomycosis) and circumscribed otitis externa (bacterial infection).

Furuncle or Boil

Furuncles, boils in hair follicles, can occur in various body parts. It commonly occurs on the face.


It is a staphylococcal infection caused by Staphylococcus Aureus bacteria. In general, it needs treatment from a dermatologist. If it occurs in the ear canal, an ENT doctor treats it.


If there is more than one furuncle, the condition is called furunculosis. But, in-ear, most of the time, it is restricted to one. People generally take action before it spreads or worsens due to the pain.


Circumscribed Otitis Externa or Boil in Ear

When a furuncle or boil develops in the ear canal, it is called Otitis Externa Circumscribed. The significant symptom that grabs the patient's attention is ear pain.


It is called Circumscribed Otitis Externa because the infection is restricted to the outer part of the ear canal because the inner part of the ear canal doesn't contain hair or hair follicles. The infection occurs in 25% to 50% of the circumference of the ear canal only, and the pain is confined to that particular area only.


Circumscribed Otitis Externa Causes

Staphylococcus Aureus bacteria causes Circumscribed Otitis Externa. The bacteria causes infection in the hair follicle.


This infection typically occurs in the outer part of the external ear, where hair or hair follicles are present. The absence of hair in the ear canal's inner part does not allow furuncles to occur in the inner part of the ear canal.


Generally, boils are not just confined to the ear canal in many cases. They are observed on the face and other body parts.


This infection occurs mostly in hot and humid climates.


Symptoms

The symptoms of otitis externa circumscribed include:

  1. Intense Localized Ear Pain: Individuals with circumscribed otitis externa experience sharp, intermittent ear pain that can escalate to continuous pain. Touching the affected ear, particularly the specific area in the ear canal where the furuncle is located exacerbates the pain.

  2. Visible boil: In some cases, a small, pointed tip of yellow or white pus may be visible at the peak of the swelling. However, it's important to note that the furuncle or boil might not always be visible, as it could be located inside the ear canal.

  3. Tenderness: When touching the ear pinna or ear canal, there is significant pain and tenderness, helping to identify the affected area.

  4. Swelling: The swelling usually involves only one-quarter of the ear canal's circumference and may manifest as a small, pointed tip of pus at the peak of the swelling. The pus can be white or yellow in colour.

  5. Painful Movement of the Jaw: If the boil is in the ear canal's front wall, jaw movements can become painful due to the proximity of the affected area.

  6. Visible Evidence on the Face: In some cases, careful examination of the face may reveal scar marks from previous furuncles or the presence of a developing boil.


Differentiation Symptom of Circumscribed Otitis Externa - Ear Pain

The pain in circumscribed otitis media helps you easily differentiate circumscribed from diffuse otitis externa.


In diffuse otitis externa, the pain can be throughout the ear canal. Even when you touch the pinna or anywhere near the ear canal, there will be tenderness or pain.


On the contrary, in circumscribed, the pain is only near the boil. The pain you get from touching the ear pinna is primarily due to the skin movement caused near the furuncle or boil in the ear. This helps you to identify or have an idea about the location of the infection, too.


Diagnosis

Diagnosing circumscribed otitis externa involves checking the visible boil in the ear, though it may not always be apparent.


The key distinction is localized tenderness in a specific ear canal area, setting it apart from the diffuse type. The tenderness will be present in one area of the ear canal, not the entire ear canal.


Usually, this infection is not always restricted to the ear. You could mostly see a boil on the face or other body parts.


Those familiar with the disease may recognize it without immediate medical intervention, but consulting a healthcare professional is crucial for accurate diagnosis and tailored treatment.


Furuncle Ear Treatment

Furuncles generally don't just appear in the ear but also mostly on the face or other parts of the body, requiring a dermatologist's visit. For a furuncle in the ear, you have to visit an ENT.


The treatment for furuncle otitis externa involves using antibiotics that target staphylococcal bacteria. Medications such as Amoxicillin or Co-Amoxiclav are commonly prescribed by a doctor and should not be self-administered. The course has to be strictly followed and shouldn't be stopped in the middle, even after the disappearance of the symptoms.


Minor Surgery

In some cases, where it is very painful or if the patient is not responding to the medication within 24 to 48 hours, a minor surgical intervention under general anesthesia may be necessary to drain the pus inside the boil. The cost of such a procedure typically includes anesthesia and medications, ranging from 5000 to 8000 INR.


Can Furuncle be Treated at Home?

While medical intervention is crucial for treating circumscribed otitis externa, some home remedies may provide relief and complement prescribed treatments.


Hot Fomentation

Applying a warm compress to the affected ear can help soothe pain and reduce inflammation.


Antibiotic Cream

Applying an antibiotic cream to the affected area in the ear canal can provide relief. Using antibiotic creams as directed and recommended by a healthcare professional is crucial.


Complications

Complications from circumscribed otitis externa are rare.


One potential complication is the occurrence of multiple boils. If one boil is left untreated, there is a possibility of developing additional boils in the ear canal. This is called ear furunculosis.


Fortunately, due to the pain associated with the condition, individuals typically seek medical attention on time. The likelihood of complications is thereby minimized, as timely intervention prevents the progression of the infection and the formation of additional boils.


Prevention

Preventing Furuncle Otitis Externa involves proactively managing Staphylococcus carrier status and promptly addressing skin infections. Consulting a dermatologist, practising good personal hygiene, and recognizing early signs of skin boils are essential steps in preventing the recurrence of this condition, particularly in hot and humid environments where the risk of infection may be higher.



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