Perichondritis (Ear Cartilage Infection)

What is perichondritis?

The cartilage of the outer ear (pinna or auricle) has no blood vessels of its own. It gets oxygen and nutrients from the overlying perichondrium. When the perichondrium becomes infected and swollen, pus can collect between it and the cartilage. Cut off from its blood supply, the cartilage can die (chondritis) and shrink, leaving a crumpled ear.

The earlobe has no cartilage, which is why perichondritis spares it. That is the key clue that separates it from simple skin cellulitis of the ear, which can involve the lobe.

Symptoms

• Ear pain and tenderness, often severe
• Redness, warmth and swelling of the upper ear, sparing the lobe
• A shiny, tense or bumpy outer ear
• Pus or fluid from a piercing or wound
• A soft swelling if an abscess has formed
• Fever and feeling unwell in more severe cases

Symptoms usually appear a few days to a few weeks after a piercing or injury.

Causes and risk factors

• Cartilage piercings: especially "high" piercings through the helix, industrial bars, and piercings made with a piercing gun, which crush tissue
• Trauma, such as a blow to the ear in contact sports
• Burns and frostbite
• Ear surgery or acupuncture
• Insect bites and scratching
• Untreated swimmer's ear that spreads outward
• Diabetes and a weakened immune system

Pseudomonas aeruginosa thrives in moist environments, which is why piercings exposed to water, hair products and sweat are at risk.

Perichondritis vs other ear problems

Diagnosis

Diagnosis is based on the appearance of the ear and history. A swab of any pus is sent for culture to guide antibiotic choice. An ultrasound can show whether there is an abscess. Blood tests are only needed for severe infection.

Treatment

Antibiotics

Because Pseudomonas is the usual cause, doctors choose antibiotics that cover it. In adults, oral ciprofloxacin or another fluoroquinolone is commonly used, sometimes with antibiotic drops. Children and severe infections may need other choices or intravenous antibiotics in the hospital. Treatment usually lasts 10 to 14 days.

Remove the jewelry

The piercing jewelry is usually removed, especially if an abscess is present, to allow drainage and prevent the infection being trapped.

Drainage and surgery

An abscess must be opened and drained, and dead cartilage removed. A pressure dressing or stitched bolster then keeps the perichondrium pressed against the cartilage to stop fluid reaccumulating. This is done by an ENT surgeon.

Supportive care

• Pain relief: acetaminophen (paracetamol) or ibuprofen, following the label dose
• Warm compresses for comfort, unless the doctor advises otherwise
• Keep the ear clean and avoid pressure on it while sleeping

Complications

• Abscess formation
• Cartilage death leading to a permanent cauliflower-like deformity
• Spread of infection to the face or, rarely, deeper tissues

Starting antibiotics early greatly reduces these risks. Reconstructing a badly deformed ear is difficult and may need plastic surgery.

Prevention

• Choose earlobe rather than cartilage piercings if possible.
• Use a reputable, licensed piercer who uses a sterile hollow needle, not a gun, for cartilage.
• Clean a new piercing with sterile saline twice daily and avoid touching or twisting it.
• Avoid swimming pools, hot tubs and lakes until the piercing has healed (cartilage piercings can take 6 to 12 months).
• Wear protective headgear in contact sports.
• Get any red, painful ear seen early.

Frequently asked questions

What causes perichondritis?

Perichondritis is usually caused by bacteria, most often Pseudomonas aeruginosa and sometimes Staphylococcus aureus, entering through a break in the skin of the outer ear. The most common trigger is a cartilage piercing. Others include injuries, burns, insect bites, ear surgery and spreading swimmer's ear.

How do I know if my cartilage piercing is infected?

Mild redness and soreness are common in the first days. Signs of infection include increasing pain, swelling, warmth and redness spreading across the upper ear, yellow or green pus and fever. If the upper ear is red, hot and swollen while the lobe looks normal, see a doctor within 24 hours.

How is perichondritis treated?

It is treated with antibiotics that cover Pseudomonas, often ciprofloxacin for adults, for about 10 to 14 days. The piercing jewelry is usually removed. If an abscess has formed, an ENT surgeon drains it and places a pressure dressing. Severe infections need hospital treatment with intravenous antibiotics.

Can perichondritis go away on its own?

It should not be left to clear on its own. Common skin antibiotics such as cephalexin often do not cover Pseudomonas, and untreated infection can destroy the ear cartilage within days, leaving a permanent deformity. Early medical treatment gives the best chance of a full recovery.

Can I keep my piercing after perichondritis?

Often the jewelry needs to be removed so the infection can drain and heal. Whether you can re-pierce later depends on how the ear healed. Many doctors advise against re-piercing the same cartilage, especially after an abscess or any cartilage damage.