Perichondritis

• Causes, incidence, and risk factors

  Cartilage is the thick tissue that creates the shape of the nose and the outer ear. All cartilage has a thin layer of tissue around it called the perichondrium. This covering helps provide nutrients to the cartilage.

  The most common bacteria that causes perichondritis infection is Pseudomonas aeruginosa.

  Perichondritis is usually caused by injury to the ear due to ear surgery, ear piercing (especially piercing of the cartilage), or contact sports. Ear piercing through the cartilage is probably the most significant risk factor today. Surgery, burns, and acupuncture also increase the risk of infection.

  Perichondritis can cause severe damage to the ear structure if it becomes chondritis -- infection of the cartilage itself.

• Symptoms

  A painful, red ear is the most common symptom. At first the infection will look like a skin infection (cellulitis), but it quickly worsens and involves the perichondrium.

  The redness usually surrounds an area of injury, such as a cut or scrape. There may also be fever, and -- in more severe cases -- fluid draining from the wound.

• Signs and tests

  Perichondritis is diagnosed based on the person's medical history and by looking at the ear. If there is a history of trauma to the ear and the ear is red and very tender, then perichondritis is diagnosed. There may be a change in the normal shape of the ear.

• Treatment

  Treatment consists of antibiotics, either by mouth or directly into the blood stream through an intravenous line (IV). If there is a trapped collection of pus, surgery may be necessary to drain this fluid and remove any dead skin and cartilage.

• Expectations (prognosis)

  What happens depends on how quickly the infection is diagnosed and treated. If antibiotics are taken early on, full recovery is expected. In more advanced cases, when the infection involves the ear cartilage (chondritis), part of the ear may die and need to be surgically removed. If so, plastic surgery may be needed to restore the ear to its normal shape.

• Complications

  If not treated early enough, the infection can spread to the ear cartilage. This would require removal of the damaged part and possibly cosmetic surgery to restore it to a normal shape.

• Calling your health care provider

  If you suffer any trauma to your ear (a scratch, blow, or piercing) and then develop pain and redness over the stiff part of the outer ear, contact your health care provider. You may need to take antibiotics.

• Prevention

  The best way to prevent this infection is to avoid piercing your ear through the cartilage (as opposed to the ear lobe). The popularity of cartilage piercing has led to a significant increase in the number of perichondritis and chondritis cases.

• References

  Ruckenstein MJ. Infections of the external ear. In: Cummings CW, Flint PW, Haughey BH, Robbins KT, Thomas JR, eds. Otolaryngology: Head & Neck Surgery. 4th ed. Philadelphia, Pa: Mosby Elsevier; 2005: chap 132.

Review Date: 9/28/2008

Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Jatin M. Vyas, MD, PhD, Instructor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.