Q. How to treat recurrent MSSA infection on preauricular sinus?

Answered by
Dr. Shyam Kalyan N
and medically reviewed by iCliniq medical review team.
Published on Oct 17, 2019

Hello doctor,

My nephew is 7 years old. For the last three months, he is suffering from a recurring infection of preauricular sinus on his right ear. His right ear has a small hole since birth. But no infection was there since birth. All started three months back. IV and oral antibiotic of Augmentin were not much effective, although he was under antibiotic treatment for one month. Discharge from a pit near the hole on right ear was regular. Earlier it was painful, but after continuous dressing with Betadine and ointments subsides the pain and pit are drier now and frequency of pus discharge has reduced for last 3 to 4 days. We are doing pressure dressing on daily basis twice to thrice. Recent pus culture shows moderate growth of Methicillin-sensitive staphylococcus aureus (MSSA). The report is uploaded here. How to treat MSSA infection on preauricular sinus of 7 years old boy? Treatment with Augmentin was not successful. Whether we should go for surgery or there is an alternative treatment? Please suggest.

Dr. Shyam Kalyan N

Allergy Specialist Otolaryngology (E.N.T)
#

Hi,

Welcome to icliniq.com.

Give him Linezolid as per his weight. It is sensitive in your culture sensitivity report and it is safe in the pediatric population. Once the infection resolves, do a fistulogram study and plan for operation for a permanent cure. It is a developmental anomaly and needs surgery.

Thank you doctor,

As pus culture report is obtained, we are going to visit the doctor. At present, dressings of the pit are being done with Betadine solution and Fucidin cream. Pus discharge from the hole has reduced from daily basis to once in two days. Quantity of discharge is also reduced. The wound on the skin is now somewhat better looking than earlier. We are very confused. Whether an ENT specialist or plastic surgeon would do the surgery? Whether surgery can be done without a full cure of infection as it persists for the last two months?

Dr. Shyam Kalyan N

Allergy Specialist Otolaryngology (E.N.T)
#

Hello,

Welcome back to icliniq.com.

ENT surgeons are better poised to do the surgery than plastic surgeons. That being said, any of the two specialties can do the job well based on the experience they have. The sinus has a tract that extends inside and during the surgery, the tract has to be traced completely and excised fully. If the tract remnant is left inside, then the problems will recur. If the tract is entirely removed then that will be a permanent solution for the boy.

The CT fistulogram finds out the extent of the lesion. A dye is pushed into the sinus and then CT is taken. The complications we are looking at depends on the location of the sinus. If you can send a picture of the area I would be able to tell you. Nextly, we do the surgery when the acute infection has subsided. But in the case of preauricular sinus, some discharge may be there and that does not deter us from operating. But fever, pain, and thick continuous pus should reduce before the operation.

Thank you doctor,

At present, pus is not coming out on its own from the hole. We are doing dressings for three times a day. During the time of dressings, one small drop may be seen once a day.

Dr. Shyam Kalyan N

Allergy Specialist Otolaryngology (E.N.T)
#

Hello,

Welcome back to icliniq.com.

It appears infected still due to the redness (attachment removed to protect patient identity). Does he have any pain? I suggest you start him on a course of antibiotic. The antibiotic should be a sensitive one.

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Dr. Shyam Kalyan N
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Answer: Hi, Welcome to icliniq.com. Let me answer your query in parts. It is a developmental anomaly, a branchial cleft anomaly. Once we remove the whole sinus tract, it does not recur. To see till where it extends one must do a fistulogram scan. When infected we do not do surgery. We do culture sensitivi...  Read Full

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