A swab should be taken for culture and sensitivity of any purulent material present.
In cases of recurrent furunculosis, further investigations to exclude an underlying systemic disease such as diabetes or a blood dyscrasia should be considered.
If there is doubt about the differentiationbetween mastoiditis and acute circumscribed otitis externa, mastoid X rays should be obtained.
In acute mastoiditis, X rays will typically show clouding and coalescence of the mastoid air cells.
If the furuncle is obviously pointing, it can be punctured with a large sterile hypodermic needle, bringing relief from pain.
More commonly, however, the patient is seen at an early stage, when incision is of little value. In these cases a wick may be inserted into the lumen of the external canal.
The best wick available today is the Pope Otowick, a small dried plug of compressed Merocel sponge which can be easily inserted into the narrowed canal and which gradually expands once moistened soaked in a solution of aluminum acetate (13 % ), or a mixture of acetic acid (2%) and propylene glycol diacetate (3%) can usually be gently inserted into the canal.
These compounds are hygroscopic and produce relief of pain by reducing the swelling and stabilizing the canal during jaw movements.
Analgesics and a full course of an oral broad spectrum antibiotic are usually indicated.
Penicillin is usually the drug of choice, but amoxycillin and potassium clavulanate acid will be preferred if the causative organism is suspected to be a penicillinase producing strain.