Basics
Description
Inflammation and/or infection of the pinna
Etiology
- Mechanism:
- Cartilage of the external ear is easily damaged due to:
- Lack of overlying subcutaneous tissue
- Relative avascularity
- Exposed position
- Chondritis:
- Most commonly a secondary complication of otic trauma and burns
- Onset is often insidious and may be delayed until apparent healing has occurred.
- Improper management may cause disfiguration of the pinna secondary to cartilage avascular necrosis:
- Ranges from being a shriveled, cauliflower-like ear to complete loss of the external ear and possible stenosis of the auditory meatus.
- Causes:
- Common causes of chondritis include:
- Chemical or thermal burns
- Frostbite
- Hematoma formation
- Trauma
- Human/insect bites
- Deep abrasions
- External otitis
- High piercing of the ear lobe especially with poor technique, hygiene, and aftercare.
- Bacteria involved:
- Pseudomonas aeruginosa
- Staphylococcus
- Proteus
Diagnosis
Signs and Symptoms
- Initially a dull pain that increases in severity
- Fever
- Chills
History
Physical Exam
- Pinna:
- Painful
- Exquisite tenderness
- Erythematous
- Warmth
- Loss of contours caused by edema often with sparing of the lobule.
- Increase of the auriculocephalic angle
- Fluctuant areas develop with eventual breakdown and suppuration.
Essential Workup
Clinical diagnosis:
- Typical physical findings in combination with aforementioned causes
Diagnosis Tests & Interpretation
Lab
Only if systemic signs of infection:
- CBC
- Blood cultures
- Local cultures for chondritis and abscess drainage
Differential Diagnosis
- Allergic reaction
- Mastoiditis
- Dermatitis
- Hematoma
Treatment
Ed Treatment/Procedures
General postinjury preventive measures:
- Prevention of chondritis is of utmost importance:
- Difficult management and disfiguring potential
- Avoid pressure to the injured ear.
- Minimize active d ©bridement of eschars and crusts.
- Gentle washing twice daily with antibacterial soap and water followed by complete drying and application of topical antibiotics
- Keep hair away from the ear.
- Oral antibiotics for minor cases of early ear-lobe inflammation
- Parenteral antibiotics and early surgical drainage for patients with chondritis
Medication
- Ciprofloxacin: 500 mg PO BID (adult)
- Cephalexin: 500 mg (peds: 50 mg/kg/d) PO QID
- Dicloxacillin: 500 mg (peds: 25 mg/kg/d) PO QID
- IV antibiotics for severe infection
- Apply topical antibiotics when there is a break in skin barrier.
Follow-Up
Disposition
Admission Criteria
- Edema, erythema, and significant ear tenderness
- Toxic patient with fever and chills
- Immunocompromised patient
Discharge Criteria
Stable patient without systemic signs with close ear, nose, and throat (ENT) follow-up
Issues for Referral
ENT consult:
- For chondritis, abscess, and necrosis of the involved cartilage
- Early surgical drainage for chondritis and abscess
Pearls and Pitfalls
Aggressive early management may prevent gross ear deformity:
- Antibiotic regimen should cover for Pseudomonas.
Additional Reading
- Fisher CG, Kacica MA, Bennett NM. Risk factors for cartilage infections of the ear. Am J Prev Med. 2005;29(3):204-209.
- Guss J, Ruckenstein MJ. Infections of the external ear. In: Cummings CW, Flint PW, Haughey BH, et al., eds. Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, PA: Mosby Elsevier; 2010: chapter 137.
- Rowshan HH, Keith K, Baur D, et al. Pseudomonas aeruginosa infection of the auricular cartilage caused by "high ear piercing": A case report and review of the literature. J Oral Maxillofac Surg. 2008;66(3):543-546.
- Van Wijk MP, Kummer JA, Kon M. Ear piercing techniques and their effect on cartilage, a histologic study. J Plast Reconstr Aesthet Surg. 2008;61(suppl 1):S104-S109.
Codes
ICD9
- 380.03 Chondritis of pinna
- 380.10 Infective otitis externa, unspecified
ICD10
- H60.00 Abscess of external ear, unspecified ear
- H61.033 Chondritis of external ear, bilateral
- H61.039 Chondritis of external ear, unspecified ear
- H60.03 Abscess of external ear, bilateral
- H60.01 Abscess of right external ear
- H60.02 Abscess of left external ear
- H60.0 Abscess of external ear
- H61.031 Chondritis of right external ear
- H61.032 Chondritis of left external ear
- H61.03 Chondritis of external ear
SNOMED
- 34129005 Perichondritis of pinna
- 232215000 Abscess of pinna (disorder)