What is Pinna Perichondritis?
Pinna perichondritis is a condition where the protective layer around the ear’s cartilage, known as the perichondrium, becomes inflamed. This is usually mistaken for pinna cellulitis, which is a skin infection, but it’s actually a more severe condition. Ear injuries, like a piercing through the cartilage, are the most common causes and can lead to infection if not done in a sterile environment.
When this infection is ignored, an abscess can form, causing damage to the layer between the skin and cartilage. This can disrupt the blood supply to the cartilage, leading to cartilage death and potentially change the shape of the ear. This also causes inflammation due to blood collecting in the spaces within the ear. If left unchecked, it can lead to a severe tissue infection or spread to other parts of the body. It can also cause a “cauliflower ear” deformity, which is when the ear becomes lumpy and enlarged as a result of fibrous tissue (scar-like tissue) forming on the ear.
Let’s take a closer look at the ear’s structure. The external part of your ear, known as the auricle or pinna, is made up of a flexible type of cartilage that is protected by the dense perichondrium layer. These layers contain elastic fibers, helping to maintain the shape and integrity of your ear. It also plays a role in providing oxygen and nutrients to the ear cartilage, which doesn’t have a direct blood supply. The skin of your ear, which tightly sticks to the perichondrium, contains small hairs, sweat glands, and oil glands.
Knowing all of this, it’s clear how important keeping this complex structure, particularly the perichondrium, healthy is – an inflammation or infection here can cause serious complications like deformation of the ear or formation of an abscess. This underscores the importance of proper care, especially when getting a piercing.
What Causes Pinna Perichondritis?
Pinna perichondritis, or inflammation of the cartilage in the outer ear, can be caused by various factors, but the most common one is damage caused by ear piercing, especially through the cartilage. The recent trend of piercing through the cartilage of the ear has been linked to an increase in perichondritis cases. Piercings through the cartilage, are more likely to get infected and form abscesses than piercing through the fleshy lobe of the ear. The risk of infection increases if the new piercing is exposed to freshwater or hot tubs.
Other less common causes can include untreated ear infections that spread to the cartilage of the outer ear, injuries caused by medical treatments, conditions that weaken the immune system, and minor injuries such as scratching, insect bites, or acupuncture. However, in many cases, the exact cause cannot be identified.
The bacteria Pseudomonas aeruginosa is most commonly found in cases of pinna perichondritis. This bacteria tends to infect damaged cartilage. In fact, it’s responsible for almost all infections related to ear piercings and is often linked to abscesses in the ear. Other bacteria that can cause this condition are Staphylococcus aureus, Escherichia coli, and Proteus species. Staphylococcus is the most common type of bacteria when an abscess does not form. Fungal infections have also been reported occasionally, particularly in cases where antibiotics are used to prevent infection during ear surgery.
Viruses like herpes zoster and monkeypox, which cause blister-like skin lesions, could also lead to perichondritis by providing an entry point for bacteria. Other less common causes include infection due to a retained ear wick, used to treat outer ear infection, and recurrent infections of a birth defect involving the sinus tract in the ear.
Risk Factors and Frequency for Pinna Perichondritis
Pinna perichondritis, a condition involving inflammation around the cartilage of the ear, is not very common. While it’s hard to know exactly how often it happens, cases in England seemed to double between 1990 and 1998. This trend is thought to be linked with the growing popularity of cartilage ear piercings among young people. Research from 2015 found that women are more than seven times more likely than men to experience complications from these kinds of piercings. It seems this is due to more women getting their ears pierced rather than any difference in how men and women’s bodies react to piercings. The average age of patients developing complications from such ear piercings is 19 years.
Another study showed that waiting more than 5 days to get treatment greatly increased the chances of needing to be hospitalized. The type of infection also made a difference. For example, infections caused by a bacterium called Pseudomonas aeruginosa were more likely to lead to hospitalization than infections caused by another bacterium known as Staphylococcus aureus. In fact, Pseudomonas aeruginosa was responsible for 87% of the cases in the study. And the site of the piercing mattered too. Those who had piercings in the scapha part of the ear (the flat area near the top) were left with long-term ear deformities in 100% of cases. This compared to a 43% occurrence of deformities in patients with piercings on the helix (the curved rim of the ear).
Signs and Symptoms of Pinna Perichondritis
Pinna perichondritis, an infection of the outer ear, is diagnosed based on symptoms and physical examination. People with this condition usually have intense pain, swelling, and redness in the external ear. In severe cases, there might be pus discharge. If the infection spreads, they could also experience fever and swollen neck glands. Any recent ear or face injury, such as from piercings, wounds, or insect bites, could also indicate pinna perichondritis. Symptoms like hearing loss, ear discharge, or nerve irregularities might suggest different conditions like otitis externa, otitis media, or mastoiditis. Also, any existing health issues like diabetes or immunosuppression that can increase the risk of infections should also be taken into account.
During a physical examination, the healthcare professional will conduct a thorough ear inspection, touching, and otoscopy. Pinna perichondritis usually causes a red, swollen, hot, and sensitive outer ear. The exam could reveal the presence of a soft tissue infection or tissue death. There will be notable sensitivity when the ear is touched. The doctor will also examine the mastoid process and areas in front of and behind the ear for tenderness.
- Perichondritis and chondritis: Typically, these conditions do not affect the earlobe which sets them apart from pinna cellulitis, a skin infection that usually involves the whole ear. They are caused by different types of microorganisms.
- Pinna cellulitis: Any areas affected by this should be marked during the examination to track the response to treatment.
If there are symptoms like fever or redness extending beyond the outer ear, these can indicate the infection has spread. A careful ear examination should be done, starting with the unaffected ear. If there’s debris, discharge, redness, or swelling in the external ear canal, this could suggest otitis externa, which is mainly treated with cleaning the ear canal, topical antibiotics, and keeping the ear dry. The eardrum should also be checked for any fluid or perforation that might indicate a middle ear issue. A nerve function assessment and lymph node evaluation should also be done if needed.
If a patient comes in exhibiting signs of inflammation in the nose, joints, breathing passages, and both outer ears, the condition known as relapsing polychondritis could be suspected. This autoimmune disorder is usually treated with oral steroids.
Testing for Pinna Perichondritis
If you have a mild ear infection in the outer part of your ear (also known as pinna perichondritis), your doctor typically does not need to order blood tests. However, if your ear shows significant swelling or redness, or if there’s an area filled with pus (abscess) or dead tissue (necrosis), then you will need some blood tests. These can include a complete blood count, basic metabolic panel (or complete, depending on your symptoms), C-reactive protein, blood cultures, and coagulation profile. Your doctor will use these tests to check for signs of a severe body-wide infection, also known as sepsis, especially if you are feeling very unwell.
In addition to pulling blood tests, your doctor will also take swabs from the infected part of your ear and any pus if present. These samples will be sent to a laboratory to identify the exact bacteria causing the infection, which will help tailor your treatment. However, you typically don’t need any imaging tests like X-rays or CT scans unless your doctor suspects severe conditions that can affect the brain, such as malignant otitis externa.
Treatment Options for Pinna Perichondritis
If you have an infection in the outer part of your ear (a condition called pinna perichondritis), the first line of treatment usually involves antibiotics. If the infection hasn’t created an abscess (a pocket of pus), oral antibiotics can often effectively treat it. One example of such an antibiotic is Levofloxacin, which can fight off the staphylococcus and pseudomonas bacteria. On the other hand, if an abscess has formed, both antibiotics and surgical drainage would be necessary. This process is similar to dealing with an auricular hematoma, a swelling of the ear due to blood accumulation.
Remember, when an abscess is present, there’s a higher possibility that a type of bacteria called pseudomonas is involved, and in such cases, hospital stay for the administration of intravenous antibiotics might be needed. The antibiotic of choice can vary, but often includes fluoroquinolones (despite their potential side effects), cephalosporins, or aminoglycosides. Fluoroquinolones, were historically avoided in children due to worries about joint pain and rupture of tendons. But, a 2011 study showed that these side effects are quite rare and resolve after stopping the antibiotic. There were also no disturbances in growth detected, making short-term use of fluoroquinolones safe for children.
If you’re dealing with this condition, it’s important to know that it can be quite painful. So, ensuring you have adequate pain relief is crucial.
When it comes to draining the abscess, it can be done in a way that causes minimal scarring and cosmetic impact. This is usually achieved by making a curved cut along the inner part of the outer ear. Once the pus has been drained, pressure needs to be applied to the site to prevent any reaccumulation of fluid. This is similar to the management of auricular hematoma.
In some cases, absorbable stitches may be used to keep the skin tightly held against the remaining cartilage in the ear. This can help keep the infection from coming back. Sometimes, plastic supports like cotton dental rolls or clothing buttons can be used to maintain pressure on the ear.
If the infection of the pinna is caused by other conditions, such as external ear infection (otitis externa), herpes zoster oticus, or relapsing polychondritis, it’s important to treat the main cause of the condition.
Despite all appropriate treatment, some patients may develop ear deformity. If this occurs, reconstructive surgery can be considered, but it’s typically postponed for 6 to 12 months after the infection has cleared. The type of reconstruction will depend on how the ear looks after healing, and it’s usually performed by unfurling and suturing the native cartilage into place. If needed, a graft (transplant) from the opposite ear’s cartilage or even from a rib (costal cartilage) may be used to restore the ear’s shape. Severe deformities might require replacing most, if not all, of the ear cartilage.
What else can Pinna Perichondritis be?
Doctors should know that there are many different conditions that can result in pain, and inflammation of the outer ear, also known as the pinna. When trying to identify the cause of these symptoms, they might consider:
- Abscess on the ear
- Infection of the tissue of the ear (cellulitis)
- Blood clot in the ear (hematoma)
- Skin conditions that affect the ear like eczema, psoriasis, and allergic reactions
- Acute skin infection (erysipelas)
- Abnormal growth of blood vessels (hemangioma)
- Shingles in the ear (herpes zoster oticus)
- Leprosy
- Lymphoma, a type of cancer
- Monkeypox, a viral disease
- Outer ear infection (otitis externa)
- Repeated inflammation of cartilage (relapsing polychondritis)
- Skin cancer
- Sunburn
A thorough check-up and proper tests can help identify the exact condition and develop the right treatment plan.
What to expect with Pinna Perichondritis
If you have pinna perichondritis, which is an infection of the outer part of the ear, the symptoms should start to get better in 2 to 3 days with proper treatment and antibiotics. However, it’s not uncommon for pain and discomfort to stick around for a month or even longer. Depending on how severe your infection is and how much it has damaged the cartilage – the firm, bouncy tissue that shapes your ear – you might see a noticeable change in the appearance of your ear.
On a brighter note, a systematic review – a study where scientists pool results from several studies to get a bigger picture – conducted by Sosin et al in 2015 reveals that the presence of an abscess (a pocket of pus) at the time of diagnosis doesn’t significantly change outcomes. This means that even if your diagnosis comes with the inconvenient and often painful addition of an abscess, your recovery process shouldn’t be significantly different.
Possible Complications When Diagnosed with Pinna Perichondritis
If left untreated, perichondritis can lead to serious outcomes such as the decay of cartilage, slight changes to physical appearance, or creating a condition known as ‘cauliflower ear’. Specifically, infection in the scapha area of the ear increases the risks of an ear deformity compared to infection in the helix area. This is particularly true if the infection remains untreated for more than five days. At times, the infection can spread further into the cartilage structure, in which case, the treatment remains the same as perichondritis. To note, the infection could progress beyond the ear (or pinna), resulting in a body-wide illness due to toxic shock syndrome or endocarditis. This would necessitate the use of IV antibiotics and a stay in the hospital.
Main Risks:
- Decay of cartilage
- Minor visual alterations
- ‘Cauliflower ear’
- Higher deformity risk with Scapha perichondritis
- Risk rises with untreated infection beyond 5 days
- Potential infection spread in the cartilage
- Possible spread beyond the ear leading to systemic illness
- Requirement for a hospital stay and use of IV antibiotics.
Preventing Pinna Perichondritis
If you’re considering getting a part of your ear known as the pinna (the visible part of your ear) pierced, it’s important to know that this type of piercing is more prone to infection compared to traditional earlobe piercings. Therefore, medical professionals discourage getting this type of piercing, especially at walk-in kiosks that may not follow strict cleanliness standards.
If you notice symptoms like pain, swelling, or redness at the piercing site, it’s crucial to get medical help right away. Waiting too long to get these symptoms checked out could cause permanent changes in the shape of your ear. So, if you experience inflammation or infection of the pinna and you have been putting off getting medical attention, you need to be prepared for the possible impact this could have.
