Perichondritis: Symptoms, Causes and Treatment

Perichondritis is the infection of the skin and the underlying tissue that covers the cartilage of the outer ear, the pinna. This condition is also known as pinna perichondritis or auricular chondritis.

Some of the signs and symptoms of perichondritis are:

1. Redness and swelling in the ear
2. Pain in the ear
3. Fever
4. Tenderness 
5. Pus and fluid discharge from the ear in severe cases.
6. Disfigured ear

If the patients are experiencing relapsing perichondritis, they may have some other symptoms like:

1. Vertigo (Having a sensation like an environment around is spinning in a circular motion)
2. Tinnitus (ringing in the ear)
3. Sudden loss of hearing

Perichondritis is a bacterial infection that is caused by Pseudomonas aeruginosa. Perichondritis can also occur due to Staphylococcus aureus and Escherichia coli infection. It develops when the bacteria enter the cartilage of the outer ear. In most cases, it is triggered by external trauma or injury.

Some factors may increase the chances of developing perichondritis. They are:

1. Ear piercing, especially in the area of the upper ear having cartilage
2. Burns
3. Insect bites
4. Sports injury or any blunt trauma caused to the ear.
5. Any kind of cut or laceration on the ear
6. Weak immune system
7. Medical conditions like diabetes (either type 2 or type 1)

Perichondritis can be prevented through the following:

1. Avoid piercing in the ear, especially through the cartilage. If the patient desires to go piercing, then piercing the earlobe is a better option. There has been a significant increase in cases of perichondritis because of the increasing trend of ear cartilage piercing. 
2. Avoid playing games that involve the risk of ear damage or traumatic injury.

The doctor diagnoses perichondritis through the following techniques:

1. Physical examination: The doctor comprehensively evaluates the external ear of the patient. The examination includes inspection and palpation. The lobules are generally spared in perichondritis, which helps the doctor differentiate them from cellulitis. The doctor may also inquire about the history of acupuncture, burns, piercings, graze, and lacerations. In addition, the patients may be asked about other symptoms, including hearing loss or ear discharge. 
2. Blood and urine culture: If the patients have systemic symptoms, such as necrosis or swelling in an extended area, the doctor may advise the patient to undergo blood and urine tests. It will help determine if the infection has spread to other body parts. 
3. Otoscopy: The doctor also carefully examines the ear through otoscopy to determine if the infection has spread to the internal ear. 

Perichondritis Treatment with Surgery

Incision and drainage: The patient should be taken to the clinic or a nearby hospital if the abscess is present. The doctor completely drains the pus from the ear of the patient by using surgical procedures. After the drainage of the pus and fluid from the ear, the incision is dressed using a bandage and surgical tape.

Perichondritis Treatment without Surgery

Antibiotic therapy: It is the main choice of treatment for perichondritis. The antibiotic choice depends upon the severity of the condition and the kind of bacteria that is causing the condition. It also depends upon the presence or absence of abscess formation. The doctor usually prescribes fluoroquinolone in patients with perichondritis in adults. Treatment of perichondritis in children does not include fluoroquinolone antibiotics. It is because, in some recent studies, it has been revealed that fluoroquinolones may cause joint stiffness and tear in tendons if used in children. The regime of antibiotics used in perichondritis can be both oral and injection. The antibiotic may be given to the patient for ten days to several weeks depending upon the condition and recovery of the patient.

1. If the perichondritis is not treated on time, it may lead to complications like cartilage necrosis. It may also result in cauliflower deformity of the ear, a type of cosmetic deformity.
2. The infection can spread beyond the pinna if untreated for a long period. The patient may need intravenous antibiotic administration and hospital admission in such conditions.
3. In some cases, the patient may require plastic surgery.