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Perichondritis of the Ear

by Bradley W. Kesser, MD

Perichondritis of the ear can be a diffuse inflammatory, but not necessarily infectious, process resulting in diffuse swelling, redness, and pain of the pinna, or an abscess between the cartilage and the perichondrium.

Causes of perichondritis include

  • Trauma

  • Insect bites

  • Ear piercings through the cartilage

  • Systemic inflammatory conditions such as granulomatosis with polyangiitis (formerly Wegener granulomatosis)

  • Incision of superficial infections of the pinna

Because the cartilage’s blood supply is provided by the perichondrium, separation of the perichondrium from both sides of the cartilage may lead to avascular necrosis and a deformed pinna (called cauliflower ear). Septic necrosis may also ensue, often with infection by gram-negative bacilli.

Symptoms include redness, pain, and swelling. The course of perichondritis can be indolent, recurrent, long-term, and destructive.

Treatment

  • Antibiotics, typically a fluoroquinolone, sometimes with an aminoglycoside plus a semisynthetic penicillin

  • For an abscess, incision and drainage

Patients with diffuse inflammation of the entire pinna are given empiric antibiotics (eg, fluoroquinolones, which have good cartilage penetration) and often a systemic corticosteroid for its anti-inflammatory effects. Any foreign material (eg, ring, splinter) should be removed. If the etiology is not clearly infectious (eg, an infected piercing), patients should be evaluated for an inflammatory disorder (see Overview of Vasculitis).

Perichondrial abscesses are incised, and a drain is left in place for 24 to 72 h. Systemic antibiotics are initiated with a fluoroquinolone or an aminoglycoside plus a semisynthetic penicillin. Subsequent antibiotic choice is guided by culture and sensitivity. Warm compresses may help. It is important to ensure that the perichondrium is reapproximated to the cartilage to maintain the blood supply to the cartilage and prevent necrosis. Reapproximation is ensured by inserting 1 or 2 mattress sutures through the entire thickness of the pinna, preferably through dental rolls on both sides of the pinna.

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