What is Perichondritis of the Ear?

Auricular Perichondritis

Woman with ear pain.
Woman with ear pain. IAN HOOTON/SCIENCE PHOTO LIBRARY/Getty Images

Perichondritis is an infection of the perichondrium, which is the tissue that surrounds and nourishes the cartilage which makes up the outer part of your ear. It is similar to chondritis, which is an infection of the cartilage of your ear. Without proper and prompt treatment, perichondritis can cause a permanent cosmetic changes of your ear like cauliflower ear. Common causes usually involve trauma to the tissue and include:

  • ear piercing — especially high up on the cartilage portion of the ear
  • surgical trauma
  • sports injury or other blunt trauma
  • insect bites
  • burns
  • cuts or lacerations of any kind on the ear
  • poorly treated otitis externa (swimmer's ear)
  • autoimmune disease — granulomatosis with polyangiitis & relapsing polychondritis

Diagnosing Perichondritis

The diagnosis of perichondritis is uncomplicated and based on the history of trauma to the ear and the appearance of the area infected. In its beginning stages, perichondritis looks similar to cellulitis. Your doctor will take a through history to identify an risk factor listed above and examine your ear. Even though it may likely hurt a little, your doctor will likely squeeze on your ear to see if there is any "give", or fluctuance, as this can indicate an abscess (pus) or chondritis. If you have had multiple cases of perichondritis, your doctor will refer you to a rheumatologist to determine if you have an autoimmune disease.

Symptoms Related to Perichondritis

Since piercing the cartilage of the outer ear is a common trend, it seems to be the most common cause of perichondritis at this time. Perichondritis is usually caused by pseudomonas aeruginosis, but can also be caused by other bacteria including streptococcus aureus and streptococcus pyogenes.

Perichondritis may be manifested by the following common symptoms:

  • redness
  • swelling
  • pain
  • pus or other fluid discharge (in severe cases)
  • fever (in severe cases)
  • deformation of the ear structure (in severe cases)

If you are experiencing relapsing perichondritis, you may experience other less common symptoms including:

Treatment for Perichondritis

Treatment for your perichondritis will be based on your physical examination. If your doctor suspects an abscess, a small incision will be made to drain the pus. Your doctor will then pack the area that was drained with antibiotic coated gauze, or ribbon. If packing is used, your doctor will setup a follow-up appointment to place a couple sutures to close the wound. If no packing is used, then your doctor will place the sutures immediately after draining the pus.

Regardless of the presence of pus, your doctor will prescribe antibiotics for you. Levaquin (levofloxacin) is a common fluoroquinolone antibiotic to treat perichondritis. However you may also be prescribed a second antibiotic like tobramycin for extended coverage and more aggressive treatment if warranted.

Depending on the severity of the infection, antibiotics are prescribed to be taken orally or given intravenously.

Autoimmune perichondritis is treated using steroid medication such as prednisone to repress the immune response and stop it from attacking the cartilage of the ear (and other parts of the body). After starting treatment, your doctor will also refer you to a rheumatologist for further follow-up in relation to your autoimmune disease.

If the perichondritis is serious enough that you have developed cauliflower ear, plastic surgery may be an option for you. Plastic surgery is typically performed in a same day surgery clinic, and may not always be covered by your insurance.

It is best to have any plastic surgery pre-authorized before having the surgery performed. After removing the damaged parts of the ear, the plastic surgeon can reconstruct the removed portion in order to cosmetically restore the removed portions of your ear

Preventing Perichondritis

Sometimes perichondritis cannot be prevented, such as in the case of accidental injury. However, piercing the cartilage in your ear, which is typically piercing in the upper part of your ear, puts you at a significantly greater risk of developing perichondritis. You can also increase your risk of developing perichondritis by having multiple piercings in close proximity in your upper ear. By keeping your ear piercings in your ear lobe, you can greatly reduce your risk of having any complications related to your ear piercings. Prognosis of perichondritis is good if treated promptly; a full recovery is typically expected.

Sources:

Brant, JA & Ruckenstein, MJ. (2015). Cummings Otolaryngology: Infections of the External Ear. 6th ed. 137, 2115-2122.e2

Diagnosis and management of foreign bodies of the outer ear. Uptodate website. Updated January 13, 2017. Accessed July 24, 2017.

Medline Plus Medical Encyclopedia. Perichondritis. https://medlineplus.gov/ency/article/001253.htm. Accessed July 24, 2017.

Perichondritis. Merck Manual website. http://www.merckmanuals.com/home/ear,-nose,-and-throat-disorders/outer-ear-disorders/perichondritis. Accessed July 24, 2017.

Relapsing Polychondritis. Medscape website. http://emedicine.medscape.com/article/331475-overview. Updated Jun 21, 2016. Accessed July 24, 2017.

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