Advanced Practice - 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
● 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
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
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.