What Is Perichondritis?

Perichondritis is an infection of the outer ear cartilage. The most common cause of perichondritis is ear piercing. Infection usually develops about four weeks after the piercing. The ear grows red, is painful, and swells as the infection worsens. The majority of cases result from poorly trained professionals and unsanitary piercing equipment.

Treatment of the inflammation requires antibiotics. If antibiotics are not effective, the ear may fill with fluid, and the fluid must be drained to avoid further damage. Surgery may have to be performed to remove dead or decaying parts of the ear. Serious complications, such as human immunodeficiency virus (HIV), can occur from using unsterilized equipment.

Quick treatment with antibiotics can stop permanent damage. The more severe cases that require surgery can leave the ear with a “cauliflower deformity.” Trauma to the ear may be permanent and beyond the scope of plastic surgery.

Causes of Perihondritis

Perichondritis is often related to unqualified piercing professionals. Even those who are qualified may be lax about sterilization of needles between procedures.

Other causes include:

  • staphylococcus aureus infection
  • pseudomonas aeruginosa infection
  • bacteria transmitted by reusing ear-piercing guns
  • failure to keep piercing area clean

Risk Factors

People with certain risk factors should either avoid or carefully consider before getting their ears pierced. Risk factors include:

  • history of developing infections easily
  • diabetes
  • taking a corticosteroid medication
  • higher piercings of the upper cartilage are more likely to become infected
  • sensitivity to nickel

Symptoms of Perichondritis

Perichondritis symptoms typically begin about four weeks after the piercing. The ear becomes inflamed by the infection. Touching or hitting the ear can become extremely painful as the infection progresses.

Other symptoms include:

  • swelling
  • redness
  • tenderness
  • fever

How Is Perichondritis Diagnosed?

The diagnosis of perichondritis is made by clinical observation. Doctors must decide if the infection is caused by perichondritis or cellulitis (skin infection). 

Skin infections are more common in the earlobe. Unlike the outer ear, the lobe of the ear contains no cartilage. Perichondritis is an infection of the cartilage, while an earlobe infection is cellulitis. 

The inflammation of the ear is the best indicator of perichondritis. The area will be red and painful to touch. As it worsens, swelling will become apparent, and you may develop a fever.

Treatment Methods

The first course of treatment for early perichondritis is the use of antibiotics. Doctors will prescribe a course of antibiotics that may include:

  • ciprofloxacin: antibiotic prescribed only for those age 18 and older to prevent damage to developing cartilage
  • flouroquinolone: antibiotic chosen if ciprofloxacin fails or cannot be prescribed

Later perichondritis requires antibiotics and treatment of the infected area. These treatments include:

  • drainage: the ear is drained of fluid from the infection
  • debridement: the dead tissue of the infection is removed from the ear to improve healing
  • surgery: in extreme cases, a part of the ear must be removed

Long-Term Outlook

Early treatment with antibiotics typically clears the infection so there is no change in the ear’s appearance. Untreated infections may cause the ear to swell with fluid. An abscess may form. Ear abscesses are pockets in the skin filled with dead cells and fluid. Draining the abscess can leave permanent scarring on the ear.

In extreme cases, a deformity known as cauliflower ear may result. The ear becomes misshapen and resembles a head of cauliflower. Once the damage has occurred, reconstruction by plastic surgery becomes problematic.

Complications of Perichondritis

Serious complications can result from unsterilized or reused equipment. They can leave a person with permanent conditions, such as:

  • hepatitis B
  • hepatitis  C
  • human immunodeficiency virus (HIV)

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