Perichondritis

Overview

Perichondritis is inflammation, usually from infection, of the perichondrium, the layer of connective tissue that surrounds and nourishes the cartilage of the outer ear. Because the cartilage depends on this layer for its blood supply, an untreated infection can damage the cartilage and lead to deformity.

It most often follows trauma to the ear, such as a piercing through the upper cartilage, a cut, surgery, or a burn. Prompt treatment is important to clear the infection and protect the shape of the ear.

Symptoms

Symptoms typically affect the firm, cartilage-containing part of the outer ear:

• Redness, swelling, and warmth of the outer ear
• Pain and tenderness, sometimes severe
• Swelling that spares the earlobe, which has no cartilage
• A change in the ear's shape as swelling increases
• Fever or pus in more advanced infection

A key feature is that the redness and swelling involve the upper, cartilage parts of the ear but usually not the soft earlobe. Worsening pain, spreading redness, or fever signal a more serious infection.

Causes

Perichondritis is usually caused by bacteria entering the tissue around the ear cartilage after the protective skin barrier is broken. Common triggers include:

• High ear piercing: Piercings through the upper cartilage are a leading cause.
• Injury: Cuts, scrapes, burns, or blunt trauma to the ear.
• Surgery or procedures involving the outer ear.
• Untreated ear hematoma (as in cauliflower ear) or severe outer ear infections that spread.

A common bacterium called Pseudomonas is frequently involved, which influences the choice of antibiotics.

Risk Factors

• Cartilage (high) ear piercings
• Recent ear injury, burn, or surgery
• An untreated collection of blood in the ear
• Diabetes or a weakened immune system
• Repeated or severe outer ear infections

Diagnosis

Perichondritis is usually diagnosed by examination. A doctor looks for redness, swelling, warmth, and tenderness of the cartilage part of the ear, with sparing of the lobe, and asks about recent piercing, injury, or surgery. Additional steps may include:

• Swabs or cultures: If pus is present, to identify the bacteria and guide antibiotics.
• Assessment for a hematoma or abscess: Which may need drainage.

Treatment

Prompt treatment is important to clear the infection and protect the cartilage.

• Antibiotics: Chosen to cover the likely bacteria, including Pseudomonas; mild cases may be treated with oral antibiotics, while more severe infections may need intravenous antibiotics.
• Drainage: Any abscess or collection of pus or blood is drained to relieve pressure and aid healing.
• Removing the source: A cartilage piercing in the affected area is usually removed.
• Follow-up: Close monitoring ensures the infection resolves and the cartilage is preserved.

With timely care, most people recover well. Delayed treatment increases the risk of cartilage damage and a deformed ear.

Prevention

• Have piercings done by reputable professionals using sterile technique
• Be cautious with high cartilage piercings, which carry more risk than lobe piercings
• Keep new piercings and any ear wounds clean and follow aftercare instructions
• Treat ear injuries and blood collections promptly
• Seek care early at the first signs of a red, swollen, painful ear

When to See a Doctor

See a doctor promptly if the cartilage part of your outer ear becomes red, swollen, warm, and painful, especially after a piercing, injury, or surgery. Early antibiotic treatment helps prevent damage to the cartilage.

Seek urgent care if you have spreading redness, severe pain, pus, or fever, as these indicate a more serious infection that may need stronger treatment or drainage.

Related Topics

Frequently Asked Questions

References

1. MedlinePlus, U.S. National Library of Medicine. Ear infections and injuries.
2. American Academy of Otolaryngology–Head and Neck Surgery.
3. Mayo Clinic. Ear infection and cartilage problems.
4. Centers for Disease Control and Prevention (CDC).