Perichondritis

What is perichondritis?

Perichondritis is an infection of the tissue covering the cartilage of your outer ear. This part of your ear is called the pinna or auricle. The infection is sometimes called auricular perichondritis or pinna perichondritis.

Perichondritis typically occurs due to some form of ear trauma. This can include injuries, burns and high ear piercings. It causes pain, swelling and redness of your outer ear. Sometimes a buildup of pus (abscess) may form between your ear tissue and cartilage.

Delayed diagnosis and treatment can cause serious complications. If left untreated, an abscess can cut off the blood supply to your cartilage. This can damage your cartilage and lead to tissue death (necrosis). Necrosis can cause a permanent ear deformity called cauliflower ear.

What’s the difference between perichondritis and cellulitis?

Perichondritis and cellulitis are both skin infections that can cause inflammation. But they have different causes and symptoms. Perichondritis typically only affects the upper part of your outer ear. It doesn’t affect your earlobe. Cellulitis can affect your entire outer ear, including the upper part of your ear and your earlobe.

How common is perichondritis?

Perichondritis isn’t a very common skin condition, but researchers don’t know exact numbers. One study in England indicated cases doubled between 1990 and 1998. Researchers noted the increase was likely due to a rise in high ear piercings among adolescents. Other studies have supported this theory. High ear piercings carry a greater risk of infection than earlobe piercings.

What are the symptoms of perichondritis?

The most common symptom of perichondritis is a painful, red and swollen outer ear. The redness typically surrounds a bite, cut, scrape or another injury. Perichondritis tends to affect the upper part of your outer ear but not your earlobe. If you have an abscess, you may experience fluid drainage. Other symptoms of perichondritis may include:

• Fever.
• Tenderness.
• Feeling of warmth on your ear.

What causes perichondritis?

Perichondritis is a bacterial infection. Pseudomonas aeruginosa is the most common type of bacteria that causes the infection. Staphylococcus aureus and Escherichia coli can also cause perichondritis. Perichondritis occurs when bacteria enter the cartilage of your outer ear. This most frequently occurs due to an injury or trauma.

Cartilage is the thick tissue that creates the shape of your outer ear. Cartilage has a thin layer of tissue surrounding it called perichondrium. The perichondrium provides nutrients to your cartilage.

The most common cause of perichondritis is high ear piercings through your cartilage. This type of piercing can damage your cartilage, which allows for the introduction of bacteria. Other causes of perichondritis may include:

• Trauma to the side of your head.
• Contact sports.
• Burns.
• Insect bites.
• Acupuncture.

Less common causes of perichondritis include:

• Ear surgery.
• Untreated ear infections that spread to your cartilage.
• Minor trauma, such as scratching your ear.
• Herpes zoster (shingles) infection.

Perichondritis may affect certain groups of people as well. This includes people who have:

• Inflammatory conditions, such as granulomatosis with polyangiitis.
• Weakened immune systems.
• Conditions like diabetes.

How is perichondritis diagnosed?

Your healthcare provider will perform a physical examination to diagnose perichondritis. They’ll look at and feel your ear. They’ll also ask you about your symptoms.

Your healthcare provider will ask about your medical history, including any recent trauma to your ear. Trauma may include any piercings, burns, cuts or acupuncture procedures.

How is perichondritis treated?

Treatment guidelines for perichondritis typically include the use of antibiotics. The type of antibiotics depends on the severity of your condition and the kind of bacteria causing the infection. A common antibiotic for the treatment of perichondritis is fluoroquinolone. You may take the antibiotic by mouth (orally) or apply it directly onto your skin (topically).

Perichondritis treatment for children may or may not include fluoroquinolone. Some studies have shown the antibiotic causes side effects like joint stiffness and tendon tears in children. But the American Academy of Pediatrics has said the antibiotic is safe for children.

Your healthcare provider will remove any foreign objects from your ear. This includes any high ear piercings and splinters. They may also recommend:

• A corticosteroid taken by mouth.
• Warm compresses.
• Over-the-counter pain relievers.

You may need surgery if you have a buildup of pus (abscess) cutting off the blood supply to your cartilage. Your healthcare provider will make a cut (incision) in the abscess. Then they’ll drain the pus and remove any dead cartilage and skin. The incision will allow blood to reach your cartilage again.

Your healthcare provider may leave a small drain in place for one to three days. To maintain blood supply to your cartilage, your healthcare provider may stitch your tissue to your cartilage.

How can I prevent perichondritis?

The best way to prevent perichondritis is to avoid piercing your high ear cartilage. Your risk of infection is much lower if you pierce your earlobe. Other ways to prevent perichondritis include:

• Don’t get acupuncture on your ears.
• Get ear infections treated promptly.
• Avoid contact sports.
• Try not to scratch your ears too much.

What can I expect if I have perichondritis?

With prompt diagnosis and antibiotic treatment, your symptoms should start to clear within two to three days. Some discomfort may remain for up to one month. But you can expect to make a full recovery.

If you have an abscess, your healthcare provider may have to perform surgery. They may leave in a drain that they’ll have to remove. After surgery, you’ll need to pack and dress your wound to let it heal properly.

If you don’t get treatment, an abscess can cut off the blood supply to your cartilage. This can destroy your cartilage and cause tissue death. This can lead to an ear deformity called cauliflower ear.

Perichondritis can also lead to an infection in your ear cartilage called chondritis. Chondritis can cause severe damage to your ear structure. Part of your ear tissue may die and need to be surgically removed. You may need ear reshaping surgery to restore your ear to its normal shape.

A note from Cleveland Clinic

If you have pain, redness and swelling in the upper part of your outer ear, you may have perichondritis. This bacterial infection is treatable with prompt medical care. See your healthcare provider for quick treatment to avoid complications. You can prevent the condition altogether by not following the popular trend of piercing your high ear cartilage. This part of your ear has a greater risk of infection than the earlobe. So stick with some rings in your lobes.