Auricular perichondritis is a bacterial infection of the overlying skin and perichondrium of the ear, by definition sparing the auricular cartilage. It may be an extension of OE. Causative organisms include P aeruginosa, S aureus, and S pyogenes. Predisposing factors include surgery, ear piercing, burns, frostbite, insect bites, and contact sports. Clinical findings include a swollen, tender, erythematous, and warm auricle, which may involve the ear lobule, and often a fever; the TM is unaffected. Infectious perichondritis may be confused with relapsing polychondritis, an autoimmune condition involving the cartilage of the ears, nose, and trachea.
Management and Disposition
Institute oral antibiotics with Pseudomonas coverage and follow up in 48 hours; however, hospitalization is often required for parenteral antibiotics in children and immunocompromised or diabetic patients. Topical antibiotic otic drops should be used if OE is present.
P aeruginosa is the most common bacteria causing auricular perichondritis.
Ear piercing is the most common activity resulting in auricular perichondritis.
Fluctuance and auricular deformity suggest auricular chondritis, a frequent complication of perichondritis.
Consult ENT for abscess drainage to limit permanent ear disfigurement.
Perichondritis. Swollen and erythematous pinna, excluding the earlobe with no concomitant otitis externa, mastoiditis, or furuncle. (Photo contributor: Lawrence B. Stack, MD.)
Perichondritis. Erythema, swelling, and tenderness seen in the pinna with multiple ear piercings. (Photo contributor: Lawrence B. Stack, MD.)
Auricular Chondritis. Deformity of the auricular cartilage is seen. Ear piercing caused the initial insult to this pinna. (Photo contributor: Lawrence B. Stack, MD.)
Relapsing Polychondritis. Erythema of the right pinna that spares the lobe. A month prior, the left pinna was involved and was treated as infectious perichondritis. (Photo contributor: Lawrence B. Stack, MD.)