Auricular perichondritis, also known as perichondritis of the ear or pinna, is an infection or inflammation of the cartilage-bearing part of the external ear.
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Terminology
The term perichondritis, strictly speaking, refers to inflammation involving the perichondrium. However, a distinction is often not made between perichondritis and chondritis clinically. Some have suggested that perichondritis is a misnomer, as the cartilage itself is almost always involved to some degree 1,2.
Clinical presentation
Acute auricular perichondritis presents as erythema and painful swelling of the auricle that characteristically spares the lobule 3,4.
Pathology
Etiology
The most common bacterial causes of auricular perichondritis are Pseudomonas aeruginosa and Staphylococcus aureus 3.
Inciting factors include surgical manipulation such as Mohs surgery reconstruction using skin from the ear 5, high ear piercing 6,7, and acupuncture 8.
Radiographic features
Perichondritis appears as soft tissue edema and hyperemia around the cartilage of the auricle.
Progression to cartilage involvement (chondritis) appears as thickening and hyperemia of the cartilage itself.
Treatment and prognosis
The treatment involves systemic antibiotics including pseudomonal coverage 3. Refractory cases with abscesses may require incision and drainage 9.
Complications
Perichondritis can lead to chondritis and chondrolysis, resulting in cosmetic deformity of the ear 3.
Differential diagnosis
- relapsing polychondritis: auricular chondritis in this disorder may be clinically indistinguishable from infectious perichondritis based on a single episode but bilateral involvement or recurrence should raise suspicion for this diagnosis
- otitis externa: erythema and swelling is centered in the external auditory canal but can occasionally extend into the auricle
- auricular cellulitis: erythema and swelling involves the auricle including the lobule