Auricular perichondritis: Difference between revisions
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[[File:Slide2COR.jpg|thumb|Ear anatomy]] | [[File:Slide2COR.jpg|thumb|Ear anatomy]] | ||
*An infection of the connective tissue of the ear that covers the auricle or pinna | *An infection of the connective tissue of the ear that covers the auricle or pinna | ||
**Misnomer as the cartilage is almost always involved with abscess formation and cavitation | **Misnomer as the cartilage is almost always involved with abscess formation and cavitation | ||
**Typically does not involve the lobule since this contains no cartilage | |||
*May be a devastating disease if improperly treated | *May be a devastating disease if improperly treated | ||
** | **Can lead to liquefying chondritis | ||
*Most common causes include minor trauma, burns, and ear piercing | *Most common causes include minor trauma, burns, and ear piercing | ||
** | **Growing incidence may be related rising popularity of high chondral ear piercings | ||
**May be a presenting symptom of | **May be a presenting symptom of immunosuppression | ||
***[[HIV]], [[diabetes]], Non-Hodgkin's [[lymphoma]], or relapsing polychondritis | ***[[HIV]], [[diabetes]], Non-Hodgkin's [[lymphoma]], or relapsing polychondritis | ||
*The most common microorganism responsible for perichondritis is Pseudomonas | *The most common microorganism responsible for perichondritis is Pseudomonas aeruginosa | ||
**One study identified [[Pseudomonas]] as the causative organism in 95% of cases | **One study identified [[Pseudomonas]] as the causative organism in 95% of cases | ||
**Co-infection with [[E. coli]] in half of cases | **Co-infection with [[E. coli]] in half of cases | ||
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==Disposition== | ==Disposition== | ||
*May discharge home for outpatient treatment | *May discharge home for outpatient treatment if mild | ||
* | *Consider specialist evaluation and hospital admission if abscess or necrosis are suspected | ||
==See Also== | ==See Also== | ||
Latest revision as of 17:48, 17 October 2021
Background
- An infection of the connective tissue of the ear that covers the auricle or pinna
- Misnomer as the cartilage is almost always involved with abscess formation and cavitation
- Typically does not involve the lobule since this contains no cartilage
- May be a devastating disease if improperly treated
- Can lead to liquefying chondritis
- Most common causes include minor trauma, burns, and ear piercing
- The most common microorganism responsible for perichondritis is Pseudomonas aeruginosa
- One study identified Pseudomonas as the causative organism in 95% of cases
- Co-infection with E. coli in half of cases
- Staph Aureus in 7% of patients
Clinical Features
- Initially presents with dull pain, progresses to severe otalgia
- Purulent discharge
- Erythema, swelling, tenderness of the auricle without notable fluctuance
- No involvement of the lobule which distinguishes it from otitis externa
Differential Diagnosis
Ear Diagnoses
External
- Auricular hematoma
- Auricular perichondritis
- Cholesteatoma
- Contact dermatitis
- Ear foreign body
- Herpes zoster oticus (Ramsay Hunt syndrome)
- Malignant otitis externa
- Otitis externa
- Otomycosis
- Tympanic membrane rupture
Internal
- Acute otitis media
- Chronic otitis media
- Mastoiditis
Inner/vestibular
Evaluation
- Diagnosis is made clinically by thorough physical exam
- Exam should include evaluation of mastoid process, temporal bone, facial bones, orbital bones, and middle ear
Management
- Antipseudomonal antibiotic therapy
- Ciprofloxacin 750mg q12 hours for 7 days
- 2nd line: Add Clindamycin 450mg q6 hours for 7 days
- Consider incision and drainage by ENT
Disposition
- May discharge home for outpatient treatment if mild
- Consider specialist evaluation and hospital admission if abscess or necrosis are suspected