Auricular perichondritis
Background
- An infection of the connective tissue of the ear that covers the auricle or pinna
- Typically does not involve the lobule
- Misnomer as the cartilage is almost always involved with abscess formation and cavitation
- May be a devastating disease if improperly treated
- can lead to liquefying chondritis
- Most common causes include minor trauma, burns, and ear piercing
- growing incidence may be related rising popularity of high chondral ear piercings
- May be a presenting symptom of immunosuppresion
- HIV, Diabetes, Non-Hodgkin's lymphoma, or relapsing polychondritis
- The most common microorganism responsible for perichondritis is Pseudomonas Aeruginosa
- One study identified Pseudomonas as the causative organism in 95% of cases
- Co-infection with E. coli in half of cases
- Staph Aureus in 7% of patients
Clinical Features
- Initially presents with dull pain, progresses to severe otalgia
- Purulent discharge
- Erythema, swelling, tenderness of the auricle without notable fluctuance
- No involvement of the lobule which distinguishes it from otitis externa
Differential Diagnosis
Ear Diagnoses
External
- Auricular hematoma
- Auricular perichondritis
- Cholesteatoma
- Contact dermatitis
- Ear foreign body
- Herpes zoster oticus (Ramsay Hunt syndrome)
- Malignant otitis externa
- Otitis externa
- Otomycosis
- Tympanic membrane rupture
Internal
- Acute otitis media
- Chronic otitis media
- Mastoiditis
Inner/vestibular
Evaluation
- Diagnosis is made clinically by thorough physical exam
- Exam should include evaluation of mastoid process, temporal bone, facial bones, orbital bones, and middle ear
Management
- Anti-pseudomonal antibiotic therapy
- Ciprofloxacin 750mg q12 hours for 7 days
- 2nd line: Add Clindamycin 450mg q6 hours for 7 days
- Consider incision and drainage by ENT
Disposition
- May discharge home for outpatient treatment
- consider specialist evaluation and hospital admission if abscess or necrosis are suspected