Abscess of the outer ear is a purulent-necrotic process affecting one or more hair follicles, sebaceous gland and adjacent soft tissues of the membranous-cartilaginous part of the auditory canal or auricle. It is manifested by hyperemia, swelling of the skin, pain of varying intensity in the abscess area, symptoms of general intoxication. The diagnosis is established on the basis of examination, otoscopy data and laboratory tests. Conservative therapy with the use of antibiotics and antiseptics is prescribed. In the absence of an effect, surgical opening of the abscess is performed.
H60.0 Abscess of the outer ear
An abscess of the outer ear occurs when an infection enters the deep layers of the skin, subcutaneous tissue of the auricle or auditory canal. According to the frequency of occurrence, the disease ranks third among the entire pathology of the outer ear. Abscess of the external auditory canal, suppuration of the atheroma behind the ear are more often detected, and purulent inflammation of the lobe is less common. People of any age get sick. The incidence rate is slightly higher in the age group from 10 to 19 years, as well as among elderly people suffering from diabetes mellitus, another chronic pathology that weakens the immune system. In ICD 10, the abscess, furuncle and carbuncle of the outer ear are combined into one group.
Causes of outer ear abscess
The causative agents of the disease are bacteria. Most often, the direct cause of the appearance of an abscess is Staphylococcus aureus and Pseudomonas aeruginosa, less often streptococci and other representatives of gram–positive coccal microflora. Staphylococcus aureus inhabits the skin and mucous membranes of most people, Pseudomonas aeruginosa lives in water and air everywhere. Being conditionally pathogenic, these microorganisms usually provoke the development of the disease in the presence of the following risk factors:
- Injuries of the outer ear. The formation of a limited suppuration in the external ear canal leads to traumatization of its walls. Damage occurs with improper toilet of the ears – the use of objects that can violate the integrity of the skin. An abscess complicates any mechanical, physical or chemical injury to the auricle. It is often a consequence of piercing.
- Immunodeficiency conditions. Pathology often occurs in patients with immune disorders. An abscess of the outer ear develops in HIV-infected persons, patients with tuberculosis and other severe chronic diseases, with a decrease in local immunity, for example, after irradiation of the head or neck.
Local suppuration of the outer ear often appears, recurs against the background of diabetes mellitus and other endocrine pathology, chronic suppuration from the ear. A prerequisite for the onset of the disease is sometimes a long stay in the hospital. Nosocomial abscess is more severe. Hospital strains of coccoid flora, Pseudomonas aeruginosa are often resistant to antibiotics. Multiple boils are formed with hypovitaminosis.
The pathological process is localized in the areas of the ear where hairs are present: in the fibrous-cartilaginous part of the auditory canal, on the auricle. Infectious agents are introduced through damage to the skin of the outer ear into the hair follicle, sebaceous gland. An inflammatory reaction develops, neutrophils rush to the place of accumulation of bacteria. An infiltrate is formed. The inflammation sometimes spreads to the soft tissues of the face and neck, the mastoid process. Salivary glands and lymph nodes are often involved in the pathological process.
In the area of inflammatory infiltrate, necrosis and melting of tissues occur under the action of enzymes secreted by neutrophils. A purulent cavity is formed, surrounded by a pyogenic capsule. Later, the abscess is spontaneously emptied, purulent exudate is separated. A cavity is formed, which is then filled with granulations. The abscess heals through scarring. After the healing of a small boil, no traces remain.
Symptoms of outer ear abscess
At the initial stage of the disease, redness of the skin, swelling and compaction of tissues at the site of the formation of an abscess are observed. The patient is concerned about itching of the ear, then pain joins. The severity of the pain syndrome depends on the localization of the pathological process. With limited suppuration of the area of the external auditory canal, the pain is intense, pulsating in nature. The symptom increases at night, when chewing, radiates into the temporal region, teeth and neck. When an abscess of the auricle is formed, pain is felt only when the infiltrate is palpated.
A large abscess partially blocks the auditory canal, causing a feeling of stuffy ear, hearing loss. There are symptoms of general intoxication – the body temperature rises to subfebrile and febrile values. The parotid lymph nodes are enlarged. Young children with this disease behave restlessly, pulling their hands to the sick ear. Infants have disturbed sleep, lack of appetite. An abscess of the posterior wall of the ear canal provokes coughing attacks and vomiting in a sick child. After opening the abscess, pus is released from the wound in a moderate amount, the patient’s condition improves significantly.
The abscess of the outer ear is able to resolve spontaneously by self-opening and emptying on the 3-7 day of the disease. In case of violations of the functions of local or systemic immune protection, the suppurative process often spreads further along the walls of the auditory canal, acquires a protracted course. Acute or chronic diffuse external otitis is formed. Through the Santorini cracks, the infection enters the parotid salivary gland and causes its inflammation.
As a result of the transition of the pathological process to the ear cartilage, chondritis occurs, the auricle is deformed. Less often, limited suppuration in the area of the auditory canal causes the appearance of otitis media, myringitis. In immunocompromised individuals, hematogenic spread of infection occurs, mastoiditis, sepsis and otogenic intracranial complications develop, which can be fatal. Mortality of patients with limited suppuration of the outer ear is 0.04%.
Diagnostics of outer ear abscess
Diagnostic search for suspected abscess of the outer ear is carried out by an otorhinolaryngologist. When suppuration is localized near the mouth of the auditory canal, on the earlobe or in the behind-the-ear region, the formation is visualized with the naked eye. There is pronounced hyperemia of the skin, visible swelling. Palpation of the auricle causes pain. Regional lymph nodes are enlarged. For the final confirmation of the diagnosis , the following are carried out:
- Otoscopy. It is the main research method used to detect an abscess in the auditory canal. During otoscopy, a painful formation is determined, partially blocking the auditory canal. There is a purulent yellowish-white plug on the top of the boil. After emptying the abscess, a crater-shaped depression remains. Otoscopy makes it possible to differentiate limited external otitis with diffuse, to exclude the pathology of the middle ear.
- Laboratory tests. Blood glucose determination and HIV infection testing is performed to clarify the immune status of the patient, to detect diabetes mellitus. If necessary, seeding of the discharge from the ear for microflora and sensitivity to antibacterial drugs is carried out.
Prolonged, recurrent course of local purulent-inflammatory process requires differential diagnosis of abscess with oncological disease of the outer ear. To exclude neoplasms, dermatoscopy, biopsy, followed by cytological examination of pathological material are performed. Such patients need additional advice from an oncologist. In unclear cases, radiation techniques are used – radiography, CT of the temporal bones.
Treatment of an abscess of the outer ear
In most cases, patients with a local suppurative process of the outer ear receive outpatient conservative treatment. Children and elderly people with severe immunodeficiency and other concomitant pathology, pronounced clinical manifestations, as well as patients with mastoiditis and other serious complications requiring surgical intervention are subject to hospitalization in the department of otorhinolaryngology.
Pharmacological therapy includes the use of antibacterial drugs, corticosteroid hormones and local antiseptics. Treatment with antibiotics begins from the first day. Preference is given to local medicines in the form of ointments, solutions. Combined drugs are more often used. The use of systemic antibiotics is indicated with pronounced local manifestations with a tendency to the spread of purulent pathology, significant general intoxication.
Until the results of the microflora sensitivity test are obtained, antibiotics are prescribed empirically. Broad–spectrum drugs are used – protected aminopenicillins, macrolides, with the ineffectiveness of the treatment – fluoroquinolones. To accelerate the maturation of the abscess, UFOs, UHF and other physiotherapy procedures are additionally used. At the same time, drug correction of the existing chronic pathology, a decrease in blood glucose levels is carried out.
Effective conservative therapy leads to the resorption of pathological formation at the stage of infiltration. If this does not happen, the abscess is subject to surgical treatment. Other indications for surgery are the large size of the abscess, a high risk of complications. During the manipulation, the abscess is opened. The resulting cavity is washed with antiseptics, drainage is installed.
Prognosis and prevention
The abscess of the outer ear proceeds mainly favorably. In some patients, the reverse development of the boil occurs at the stage of infiltration. The prognosis worsens significantly when signs of severe complications appear. Preventive measures are aimed at timely treatment of chronic otitis media, correction of endocrine disorders and immune system functions. To prevent the formation of boils, traumatization of the ears should be avoided, and the piercing areas should be treated with antiseptics in a timely manner.