Skip to main content

Perichondritis: inspect the lobule

Abstract

Case presentation

This is a brief report of a 57-year-old Caucasian female presented with a 4-day history of worsening left ear pain. Her symptoms began with left otalgia and otorrhea which progressed to helical erythema, prompting a visit to the emergency department. She was noted to have erythema of the left auricle and swelling of the left auditory meatus. Our otolaryngology service observed erythema of the auricle with sparing of the lobule.

Diagnosis

The diagnosis to be otitis externa with perichondritis was established, and we recommended otic ciprofloxacin-hydrocortisone, IV vancomycin, and ciprofloxacin. The patient had marked improvement and was discharged on an oral and otic fluoroquinolone. In this case, the diagnosis of perichondritis was made by a classic physical examination finding: erythema and edema with sparing of the fatty lobule. This key finding helps to distinguish perichondritis from otitis externa.

Case presentation

A 57-year-old Caucasian female presented with a 4-day history of worsening left ear pain. Her symptoms began with left otalgia and otorrhea which progressed to helical erythema, prompting a visit to the emergency department (ED). The ED physician noted erythema of her left auricle and swelling of the left auditory meatus. The tympanic membrane was not visualized due to stenosis of the external auditory canal (EAC). The patient was initiated on intravenous (IV) levofloxacin and otic ofloxacin. Our otolaryngology service observed erythema of the auricle with sparing of the lobule (Fig. 1). We amended the diagnosis to be otitis externa with perichondritis and recommended otic ciprofloxacin-hydrocortisone, IV vancomycin, and ciprofloxacin. The patient had marked improvement and was discharged on an oral and otic fluoroquinolone. This clinical image was approved by the IRB at the Philadelphia College of Osteopathic Medicine.

Fig. 1
figure1

Classic picture of otitis externa with perichondritis, evidenced by erythema of the auricle with sparing of the lobule

Diagnosis

Otitis externa with perichondritis

Perichondritis is inflammation of the ear cartilaginous framework, often sparing the fatty lobule. When the cartilage becomes involved, including abscess formation and cartilage cavitation, the term chondritis is used [1]. Chondritis and perichondritis may result from trauma or direct extension from otitis externa. Common infectious etiologies include P. aeruginosa, S. aureus, E. coli, and Proteus species, with P. aeruginosa being the most common [2, 3]. If bilateral or recurrent episodes occur, workup for relapsing polychondritis should be entertained [1, 4].

Perichondritis is a clinical diagnosis made via physical examination [1, 2]. The classic finding of perichondritis is erythema and edema with sparing of the fatty lobule, which lacks any cartilaginous structure [1]. This key exam finding helps to distinguish perichondritis from otitis externa. Management of perichondritis depends on the etiology. Antibiotic therapy is the mainstay treatment with anti-pseudomonal coverage with consideration of surgical incision and drainage if abscess or hematoma is present to prevent long-term deformity [5].

Availability of data and materials

Not applicable

References

  1. 1.

    Pattanaik S. Effective, simple treatment for perichondritis and pinna haematoma. J Laryngol Otol. 2009;123(11):1246–9. https://doi.org/10.1017/S0022215109005635.

    CAS  Article  Google Scholar 

  2. 2.

    Prasad HK, Sreedharan S, Prasad HS, Meyyappan MH, Harsha KS. Perichondritis of the auricle and its management. J Laryngol Otol. 2007;121(6):530–4. https://doi.org/10.1017/S0022215107005877.

    Article  Google Scholar 

  3. 3.

    Yahalom S, Eliashar R. Perichondritis: a complication of piercing auricular cartilage. Postgrad Med J. 2003;79(927):29. https://doi.org/10.1136/pmj.79.927.29.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  4. 4.

    Cristina OL, Sarv M, Claudia M. Relapsing polychondritis - presenting as a recurrent auricular perichondritis-case report. Glob J Oto. 2017;8(3):555736. https://doi.org/10.19080/GJO.2017.08.555736.

    Article  Google Scholar 

  5. 5.

    Noel SB, Scallan P, Meadors MC, Meek TJ Jr, Pankey GA. Treatment of Pseudomonas aeruginosa auricular perichondritis with oral ciprofloxacin. J Dermatol Surg Oncol. 1989;15(6):633–7. https://doi.org/10.1111/j.1524-4725.1989.tb03602.x.

    CAS  Article  PubMed  Google Scholar 

Download references

Acknowledgements

Not applicable

Funding

None

Author information

Affiliations

Authors

Contributions

All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jason E. Cohn.

Ethics declarations

Ethics approval and consent to participate

Not applicable

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Bress, E., Cohn, J.E. Perichondritis: inspect the lobule. Int J Emerg Med 13, 51 (2020). https://doi.org/10.1186/s12245-020-00310-z

Download citation

Keywords

  • Perichondritis
  • Auricle
  • Pinna
  • Ear
  • Otitis externa