Management

1. Assess
   • Otoscopy if tolerable: focal tender swelling in outer canal, check tympanic membrane if visible.
   • Check for fever, spreading pinna/facial cellulitis, canal obstruction, discharge, hearing reduction.
   • Ask about diabetes, immunosuppression, recurrent boils, cotton-bud/ear-picking trauma, and swimming.
   • In a 49-year-old, consider checking blood glucose/HbA1c if diabetes is unknown or infection is recurrent/severe.
2. Early, non-fluctuant furuncle
   • Analgesia: paracetamol or an NSAID if safe for the patient.
   • Warm compresses or dry heat several times daily.
   • Keep ear dry: no swimming, no ear buds, cotton tips, scratching, or instrumentation.
   • Topical antibiotic ointment may be used for a superficial localized lesion, but treatment usually requires an oral antistaphylococcal antibiotic, selected according to local resistance patterns, allergy status, renal function, and MRSA risk. Cummings Otolaryngology Head and Neck Surgery states warm compresses, topical antibiotic ointment, and oral antistaphylococcal therapy are used.
3. Pointing or fluctuant abscess
   • Refer to ENT or a trained clinician for incision and drainage under local anesthesia. Do not attempt squeezing or self-incision.
   • Culture pus if drainage is obtained, especially with recurrence, severe infection, treatment failure, or MRSA risk.
   • Continue appropriate antistaphylococcal antibiotic therapy and analgesia. A fluctuant lesion should be drained; early incision before it points is generally of little value, per the Merck Manual guidance.
4. If the canal is very swollen
   • ENT review may be needed for careful aural toilet and placement of an ear wick if topical treatment is required. Avoid forceful irrigation or traumatic cleaning.
5. Review
   • Reassess in 48 to 72 hours, earlier if worsening.
   • Recurrent furunculosis warrants assessment for diabetes, chronic skin disease, nasal staphylococcal carriage, and hygiene/trauma factors.

Urgent ENT/emergency assessment