Auricular perichondritis

Background

Ear anatomy

• An infection of the connective tissue of the ear that covers the auricle or pinna
  • Misnomer as the cartilage is almost always involved with abscess formation and cavitation
  • Typically does not involve the lobule since this contains no cartilage
• 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 immunosuppression
    • 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

Perichondritis of the pinna.

• 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

• Otitis Externa
• Mastoiditis
• Auricular Hematoma
• Herpes zoster oticus
• Malignant otitis externa

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
  • Otic barotrauma

Internal

• Acute otitis media
  • Bullous myringitis
• Chronic otitis media
• Mastoiditis

Inner/vestibular

• Labyrinthitis, vestibular neuritis
• Meniere's disease
• Sudden sensorineural hearing loss

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

• Antipseudomonal 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 if mild
• Consider specialist evaluation and hospital admission if abscess or necrosis are suspected

See Also

• Ear diagnoses