Overview of Perichondritis of the Ear

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 change.

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

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, such as granulomatosis with polyangiitis and relapsing polychondritis

Diagnosis

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 thorough history to identify any risk factors 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 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

Since piercing the cartilage of the outer ear is a very common practice, it seems to be the most common cause of perichondritis at this time. Perichondritis is caused by the bacterium Staphylococcus aureus.

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

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 set up a follow-up appointment to remove the packing. Over time, the ear will heal on its own without sutures..

Regardless of the presence of pus, your doctor will prescribe antibiotics for you. Augmentin or Keflex are common antibiotics prescribed to treat perichondritis. 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.

Preventing Perichondritis

Sometimes perichondritis cannot be prevented, such as in the case of accidental injury. However, piercing the cartilage in your ear, particularly in the upper part of your ear, puts you at 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 earlobe, 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.

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Article Sources
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  1. Merck Manual. Perichondritis. August 2019.

  2. Merck Manual. Relapsing polychondritis. April 2018.

  3. Yahalom S, Eliashar R. Perichondritis: a complication of piercing auricular cartilage. Postgrad Med J. 2003;79(927):29. doi:10.1136/pmj.79.927.29

  4. Borgia F, Giuffrida R, Guarneri F, Cannavò SP. Relapsing polychondritis: an updated review. Biomedicines. 2018;6(3). doi:10.3390/biomedicines6030084

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