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External Ear Chondritis/Abscess, Emergency Medicine

Basics

Description

- 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.

- 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

- Pinna: - Painful - Exquisite tenderness - Erythematous - Warmth - Loss of contours caused by edema often with sparing of the lobule.

Inflammation and/or infection of the pinna

Etiology

  • Mechanism:Cartilage of the external ear is easily damaged due to:Lack of overlying subcutaneous tissueRelative avascularityExposed positionChondritis:Most commonly a secondary complication of otic trauma and burnsOnset 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 burnsFrostbiteHematoma formationTraumaHuman/insect bitesDeep abrasionsExternal otitisHigh piercing of the ear lobe especially with poor technique, hygiene, and aftercare.Bacteria involved:Pseudomonas aeruginosaStaphylococcusProteus

Diagnosis

Signs and Symptoms

  • Initially a dull pain that increases in severity
  • Fever
  • Chills

History

Physical Exam

  • Pinna:PainfulExquisite tendernessErythematousWarmthLoss 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)