External Ear Conditions (Perichondritis)

What is Perichondritis?

Perichondritis is an infection involving the lining (perichondrium) of the cartilage of the pinna. Common causes include injury, insect bites, pierced ears and burns. These infections are more common in patients with diabetes mellitus and weakened immune systems. The most common organism is Pseudomonas aeruginosa although Staphylococcus aureus sometimes can be found. The condition results in inflammation and swelling of the perichondrium.

Symptoms and Signs

Pain, warmth and swelling are the usual complaints. The swelling and erythema are generally limited to the cartilaginous portion of the pinna, leaving the lobule untouched. The pinna is tense, warm and tender to touch. Generally, there is no fluctuation. The cause can sometimes be seen in the form of a puncture wound or burn.

Management

In the early stages, oral antibiotics may suffice. Ciprofloxacin 250 mg bd for 10 days can be prescribed in addition to medication for pain relief. For more severe infections, itravenous antibiotics may be required. Occasionally, the infection is complicated by a collection of pus between the cartilage and the perichondrium (subperichondrial abscess) which requires surgical drainage.

Complications

The cartilage of the pinna derives its nutrients from its perichondrium. When the perichondrium is infected or, worse, separated from the cartilage by pus, the cartilage begins to degenerate. If this process is allowed to progress, the cartilage may shrivel and die, resulting in a "cauliflower ear".