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

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

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