REBEL Core Cast 92.0 – Perichondritis

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Background

1. Perichondritis may appear to be a simple cellulitis of the ear but, in fact, it represents an infection of the connective tissue of the ear.
2. Misdiagnosis and mistreatment of perichondritis is common and can lead to significant morbidity

Critical Point #1: Perichondritis is an infection of the cartilage and connective tissue of the ear

• Perichondritis often appears as simple cellulitis but, the infection goes much deeper.
• Abscess and cavitation of the cartilage is common

Critical Point #2: Perichondritis can be recognized clinically by erythema, swelling and tenderness of the auricle.

• Over time, this may progress to severe otalgia and purulent discharge
• The lobule is often spared as is the external canal

Critical Point #3: The most common organism in perichondritis is P. aeruginosa and antibiotics should be tailored to cover this organism

• Typical cellulitis treatment with cephalexin, TMP-SMX or doxycycline will not treat this disorder
• Fluoroquinolones (I.e. ciprofloxacin) can be used as first line therapy but some patients will fail this treatment due to increasing resistance and require parenteral antibiotics

References

Noel, Stella Boustany, et al. “Treatment of Pseudomonas aeruginosa auricular perichondritis with oral ciprofloxacin.” The Journal of dermatologic surgery and oncology. 15.6 (1989): 633-637. (PMID: 2723226 )

Kullar, Peter, and Philip D. Yates. “Infections and foreign bodies in ENT.” Surgery (Oxford) 30.11 (2012): 590-596. (PMID: 27057069 )

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). (PMID: 24526489 )

REBEL EM: Perichondritis

Post Peer Reviewed By: Salim R. Rezaie, MD (Twitter: @srrezaie)