Perichondritis (pinna)

• perichondritis may be a complication of ear piercing
  • "high" piercing, which requires puncture through the cartilage of the upper third of the pinna may cause auricular perichondritis
    • the subperiosteal abscess which may occur with perichondritis often leads to loss of cartilage and to an unsightly deformity known as "cauliflower ear," which has a poor chance of good reconstruction
    • the usual infective agent in auricular perichondritis is Pseudomonas aeruginosa
• in the early phase of infection, treatment should focus on eradicating Pseudomonas aeruginosa and Staphylococcus aureus
  • antipseudomonal agents such as oral ciprofloxacin or intravenous ticarcillin or carbenicillin are necessary. Ciprofloxacin also has good activity against S aureus
  • NOTE: MHRA has advised that healthcare professionals prescribing fluoroquinolone antibiotics (ciprofloxacin, delafloxacin, levofloxacin, moxifloxacin, ofloxacin) are reminded to be alert to the risk of psychiatric reactions, including depression and psychotic reactions, which may potentially lead to thoughts of suicide or suicide attempts. Healthcare professionals are also reminded to advise patients to be alert to these risks (1).
  • as a result of this warning, consider addition of flucloxacillin 500mg QDS or clindamycin 300mg QDS until ENT assessment.
• keep the patient under close observation
  • failure to respond to treatment requires admission as inpatient to an ear, nose, and throat department. Surgical intervention is required at the earliest sign of an abscess
• lacerations of the pinna can progress to severe chondritis or perichondritis and so must be fully treated by suturing and antibiotics such as Penicillin plus Flucloxacillin, Co-amoxiclav or Erythromycin

Reference:

1. Medicines and Healthcare products Regulatory Agency. Fluoroquinolone antibiotics: suicidal thoughts and behaviour. Published26 September 2023