Perichondritis

General: Infection of the connective tissue of the ear that covers auricle and pinna

● Can lead to liquefying chondritis if improperly treating

● Can result in disfigurement (cauliflower ear) or loss of external ear

Etiology:

● Secondary to ear piercings (especially high chondral)

● Trauma and burns.

● Can be secondary to trivial trauma like scratch

● Immunosuppression association: HIV, DM, Cancer

Micro: Pseudomonas most common; E.Coli co-infection in 50% of cases; skin flora

Clinical: Erythema, swelling, tenderness; usually spares lobule; examine the mastoid; can get abscess, cavitation and necrosis

Diagnosis: Clinical

Management: Ciprofloxacin 750 mg BID; use your institution’s antibiotic biogram to determine pseudomonas susceptibility in considering admission for IV antibiotics

● Consider fluoroquinolones in pediatric population as multiple reviews have failed to demonstrate musculoskeletal adverse events

Discharge Instructions: Early ENT follow up and strong return precautions regarding worsening symptoms as resistance to oral antibiotics is increasing

References:

Caruso, Andria M., Macario Camacho Jr, and Scott Brietzke. “Recurrent auricular perichondritis in a child as the initial manifestation of insulin-dependent diabetes mellitus: A case report.” ENT: Ear, Nose & Throat Journal 93.2 (2014).

Noel, Stella Boustany, et al. “Treatment of Pseudomonas aeruginosa auricular perichondritis with oral ciprofloxacin.” The Journal of dermatologic surgery and oncology. 15.6 (1989):

Forsythe, Clinton T., and Michael E. Ernst. “Do fluoroquinolones commonly cause arthropathy in children?.” Canadian journal of emergency medicine 9.6 (2007): 459-462.