Perichondritis is an infection of the connective tissue that covers the cartilage of the outer ear, also called the auricle or pinna. It can cause symptoms such as pain, redness, swelling, tenderness, and fever.
This infection is usually triggered by trauma to the ear cartilage, such as sports injuries or piercings, but it can also develop after burns or untreated infections in the middle or outer ear.
Treatment for perichondritis is typically provided by a dermatologist or general practitioner and involves antibiotics in cream or pill form to eliminate the bacteria, or surgery in more severe cases.
Main symptoms
The main symptoms of perichondritis include:
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Severe pain in the outer ear
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Redness and swelling in the affected area
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Warmth around the ear
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Pus drainage when an abscess is present
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Fever
These symptoms usually affect the upper part of the outer ear, near the site of trauma, and do not involve the earlobe.
In some cases, the buildup of pus between the perichondrium and the cartilage can block blood flow to the cartilage, leading to tissue death (necrosis). This can cause a deformity known as “cauliflower ear.”
It is important to see a dermatologist or general practitioner as soon as symptoms of perichondritis appear so that the condition can be properly diagnosed and treated to avoid complications.
How a diagnosis is confirmed
A diagnosis of perichondritis is made by a dermatologist or general practitioner based on a physical examination, a review of symptoms, and a history of any ear trauma.
Additional tests are usually not needed. However, if the swelling is extensive or an abscess is present, the doctor may order blood tests such as a complete blood count (CBC), coagulation factors, electrolytes, urea, and C-reactive protein (CRP).
In some cases, the doctor may collect a pus sample from the abscess for laboratory analysis to identify the type of bacteria causing the infection and determine the most effective antibiotic treatment.
Possible causes
Perichondritis occurs when bacteria infect the perichondrium, which is the tissue that surrounds the ear cartilage. This infection leads to inflammation and the typical symptoms of the condition.
The main causes of ear perichondritis include:
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Ear piercings
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Acupuncture
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Insect bites
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Burns
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Scratches or small cuts on the ear
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Trauma to the outer ear from sports or accidents
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Auricular hematoma
Although less common, perichondritis can also develop from untreated middle or outer ear infections that spread to the auricle or cartilage, or from surgical trauma such as after otoplasty (cosmetic ear surgery).
The bacteria most commonly responsible for perichondritis are Staphylococcus aureus and Pseudomonas aeruginosa.
Treatment options
Treatment for perichondritis should always be guided by a dermatologist or general practitioner. The main approaches include:
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Antibiotics in cream or pill form, usually from the fluoroquinolone class, such as ciprofloxacin or levofloxacin
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Intravenous antibiotics in more severe cases
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Pain relievers to ease discomfort
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Corticosteroids to reduce inflammation
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Warm compresses applied to the affected area
In children, other types of antibiotics may be prescribed, as fluoroquinolones can sometimes cause side effects like tendon rupture.
If an abscess forms in the auricle, the doctor may perform a minor surgical procedure to drain the pus and remove any necrotic tissue or cartilage. A small drain may be left in place for 2 to 3 days and should only be removed by the doctor.
In some cases, the doctor may place sutures to reattach the perichondrium to the cartilage to restore blood flow and prevent complications.
Possible complications
The main complication of perichondritis is ear deformity, known as “cauliflower ear,” which usually occurs when the infection is not treated promptly.
In more severe cases, the infection can spread into the bloodstream and cause bacteremia, requiring hospitalization and intravenous antibiotic treatment.