Case 2 Ear

Case 2: A 50 year old male patient complained of right earache of 2 days duration. The pain was especially severe on chewing food and during speech. There was also marked edema of the right side of the face. On examination, pressure on the tragus was painful; and there was a small red swelling arising from the anterior external auditory meatal wall. Rinne test was positive in the right ear. The patient gave a history of 2 previous similar attacks in the same ear during the last six months but less severe.

CASE 2
Diagnosis & reasons	Recurrent furunculosis of the right external auditory canal (pain in the ear with movements of the temporomandibular joint or pressure on the tragus, edema of the face and a small red swelling in the anterior wall of the external auditory canal)
Explain the following manifestations	Severe pain on chewing food: movements of the temporomandibular joint lead to movements of the cartilaginous external auditory canal that is lined by skin containing hair follicles from which the furuncle arises. Edema of the right side of the face: extension of the inflammatory edema to the face in severe cases Rinne positive: means normal hearing and NO conductive hearing loss because when air conduction is better than bone conduction it is called Rinne positive Previous similar attacks: recurrence the most probable cause is Diabetes mellitus
Further examination &/or investigations	Otoscopic examination of the tympanic membrane if possible Blood glucose analysis to discover diabetes
Treatment	Antibiotics Analgesics Never incise or excise for fear of perichondritis Local antibiotic or glycerine icthyol ointment Proper control of diabetes if discovered