Perichondritis: Symptoms, Types, Causes and Treatment

Perichondritis is a serious infection involving the cartilage of the ear, most often affecting the outer ear (auricle or pinna). While not exceedingly common, it can lead to significant complications, including long-term deformity, if not recognized and treated promptly. In this article, we'll explore the key symptoms, various types, common causes, and current treatment modalities for perichondritis. Whether you are a healthcare professional, someone at risk, or simply interested in learning more, this guide will provide an in-depth, evidence-based overview.

Symptoms of Perichondritis

Perichondritis can present subtly at first, but symptoms often worsen if the infection is not addressed. Early recognition is crucial to prevent complications such as cartilage destruction or permanent deformity. Below is a concise summary of the main symptoms typically associated with perichondritis.

Main Symptom	Description	Additional Notes	Source(s)
Pain	Dull ache, increased with touch or movement	Pain may intensify over time	1, 3, 5
Swelling	Localized, can be severe	May lead to focal necrosis	3, 5, 8
Redness	Erythema over helix/antihelix	Often warm to the touch	2, 3, 5
Warmth	Skin feels hot compared to surrounding areas	Often accompanies redness and swelling	2, 5
Tenderness	Sensitive on palpation	Key sign in acute cases	1, 3, 5
Ear Deformity	Loss of normal shape, "cauliflower ear"	Usually a late complication	4, 6, 9
Systemic Signs	Fever, malaise (less common)	Variable; can be mild or absent	1, 5

Table 1: Key Symptoms

Recognizing Early and Advanced Symptoms

The classic symptoms of perichondritis are pain, redness, swelling, and warmth over the outer ear, especially the helix and antihelix—the curved rim and inner ridge of the ear, respectively. Early in the infection, patients might notice a dull ache, which can rapidly escalate to severe pain. Swelling is usually localized but can become extensive and even lead to necrosis of the ear tissue if left untreated 3, 5.

Warmth and erythema (redness) are also prominent, often making the ear appear distinctly different from the surrounding skin. The area may feel hot and look shiny or taut. Tenderness is a key feature; even gentle palpation can elicit significant discomfort 2, 5.

Systemic and Late Manifestations

While systemic symptoms such as fever are less common, they may accompany more severe or advanced infections 1, 5. Untreated or poorly managed perichondritis can progress to cartilage destruction, resulting in deformity of the ear, sometimes referred to as "cauliflower ear"—a term more familiar from sports medicine but highly relevant in infectious contexts 4, 6, 9. In rare cases, there may also be associated lymphadenopathy (swollen lymph nodes) near the ear 3.

Types of Perichondritis

Perichondritis is not a uniform disease; it can manifest in several forms depending on the severity, underlying cause, and presence of complications. Understanding these types is essential for effective diagnosis and management.

Type	Distinguishing Feature	Clinical Implication	Source(s)
Acute	Rapid onset, intense symptoms	Requires prompt intervention	1, 4, 5
Chronic	Slow progression, less severe signs	Risk of recurrent deformity	8, 9
Abscess Formation	Pus collection, fluctuant swelling	May need surgical drainage	6, 11
Necrotizing	Tissue death, severe pain	High risk of ear loss, deformity	3, 6, 9
Relapsing	Recurrent episodes, often autoimmune	May affect other cartilages	2, 3

Table 2: Types of Perichondritis

Acute Versus Chronic Perichondritis

Acute perichondritis is characterized by a sudden onset of symptoms—pain, redness, swelling, and warmth—over hours to days. This form is most frequently seen after trauma, surgery, or ear piercing, and carries the highest risk of rapid progression to abscess or necrosis if not treated 1, 4, 5.

Chronic perichondritis develops more slowly and may not be as painful. It is often the result of inadequately treated acute infection or ongoing low-grade trauma. Chronic cases can be insidious, with subtle swelling and mild erythema, but over time, these can still lead to significant deformity 8, 9.

Abscess, Necrotizing, and Relapsing Forms

Perichondrial abscess occurs when pus accumulates between the perichondrium and cartilage, producing a fluctuant (movable) swelling. This typically requires surgical intervention to prevent cartilage destruction 6, 11.

Necrotizing perichondritis is a severe complication in which tissue death (necrosis) occurs due to overwhelming infection, often with highly virulent bacteria or in immunocompromised individuals. This form carries a high risk of loss of ear structure 3, 6, 9.

Relapsing perichondritis is an autoimmune condition in which episodes of inflammation recur, not always due to infection. It may involve other cartilages in the body, such as the nose and respiratory tract, and requires a different approach to diagnosis and management 2, 3.

Causes of Perichondritis

The underlying causes of perichondritis are diverse, ranging from direct trauma to infection by specific organisms. Identifying the precipitating factor is crucial for targeted treatment and prevention of recurrence.

Cause	Example/Trigger	Typical Organism(s)	Source(s)
Trauma	Piercing, surgery, blunt injury	Pseudomonas, Staph aureus	4, 6, 7
Infection	Post-injury, burns, frostbite	Pseudomonas aeruginosa	6, 7, 8
Autoimmune	Relapsing polychondritis	Non-infectious	2, 3
Iatrogenic	Ear syringing, acupuncture	Pseudomonas, mixed flora	3, 6, 8
Other	Radiation, burns	Pseudomonas, Proteus	6, 11

Table 3: Causes of Perichondritis

Traumatic and Infectious Triggers

The most common cause of perichondritis is trauma to the ear cartilage. This includes high ear piercings (through the cartilage, not just the lobe), accidental lacerations, surgical procedures, and even minor injuries such as those from ear syringing 4, 6, 7. The exposed cartilage is particularly susceptible to infection, especially when hygiene is compromised.

Infections following burns, frostbite, or other skin injuries can also trigger perichondritis, particularly when the integrity of the skin overlying the cartilage is breached 6, 11.

Key Microorganisms

Pseudomonas aeruginosa is the most frequently isolated organism in perichondritis, especially in cases related to trauma or piercing. This bacterium is notorious for its resistance to many antibiotics and its ability to thrive in moist environments, making it a common culprit in auricular infections 4, 6, 7, 8. Staphylococcus aureus and, less commonly, Proteus species may also be found 6, 11.

Autoimmune and Iatrogenic Causes

Relapsing polychondritis is a rare autoimmune disorder that can mimic infectious perichondritis but usually involves recurrent, non-infectious inflammation of multiple cartilages (ear, nose, trachea) 2, 3.

Iatrogenic causes include medical interventions such as ear syringing or acupuncture, which can inadvertently introduce bacteria into the perichondrium 3, 6, 8.

Other Contributing Factors

Burns, radiation exposure, or chronic skin conditions can predispose individuals to perichondritis by damaging the protective skin barrier and providing a portal of entry for bacteria 6, 11.

Treatment of Perichondritis

Effective treatment of perichondritis hinges on early recognition, appropriate antibiotic therapy, and timely surgical intervention when necessary. Delays or inadequate treatment can lead to irreversible cartilage destruction and cosmetic deformity.

Treatment	When Used	Outcome/Complication Risk	Source(s)
Oral Antibiotics	Early, mild cases	High success if organism covered	4, 7, 10
IV Antibiotics	Severe or unresponsive cases	Prevents progression, deformity	3, 4, 6
Surgical Drainage	Abscess or severe swelling present	Needed to prevent cartilage loss	6, 8, 11
Debridement	Necrosis or failed medical therapy	May lead to residual deformity	4, 6, 9
Tubal Drainage	Persistent infections	Preserves ear shape, less scarring	11
Adjunctive Care	Pain control, anti-inflammatories	Supports recovery, symptom relief	8

Table 4: Treatment Approaches

Medical Management: Antibiotics

Antibiotics are the cornerstone of treatment. Because Pseudomonas aeruginosa is the most common organism, antibiotics with anti-pseudomonal activity (such as ciprofloxacin) are recommended, especially in post-trauma or piercing cases 4, 7, 8, 10. Early, mild infections may respond to oral antibiotics, but more severe cases typically require intravenous therapy 4, 6.

Unfortunately, many patients are initially prescribed antibiotics that do not cover Pseudomonas, leading to persistent infection and increased risk of deformity 7. Culture and sensitivity testing of ear discharge or tissue is important to guide antibiotic choice 8.

Surgical Management

When an abscess forms (fluctuant swelling or visible pus), incision and drainage is required to remove the infected material and prevent cartilage loss 6, 8, 11. In severe or necrotizing cases, surgical debridement—removal of dead tissue—may be necessary, but this carries a risk of ear deformity 4, 6, 9.

Tubal drainage is a specialized technique in which a tube is placed to continually drain pus and deliver local antibiotics, shown to preserve ear structure better than excision in persistent or severe cases 11.

Adjunctive and Supportive Measures

Supportive care—including pain management and anti-inflammatory medications—can help relieve symptoms and promote recovery 8. In select cases (for example, autoimmune causes), corticosteroids or other immunosuppressive therapy may be indicated, but only after infection has been excluded 2, 3.

Preventing Complications

Early, appropriate therapy is vital to avoid complications such as "cauliflower ear," chronic pain, or hearing changes. Patients should be educated about the risks of high cartilage piercings and about seeking prompt care for any ear trauma or infection 6, 7, 8.

Conclusion

Perichondritis is a potentially serious infection of the ear cartilage that can lead to significant long-term consequences if not managed promptly and adequately. Here's a brief summary of the essential points:

• Symptoms include pain, redness, swelling, warmth, and tenderness of the ear, with risk of deformity in advanced cases (1, 3, 5, 4, 6, 9).
• Types range from acute and chronic forms to abscess, necrotizing, and relapsing perichondritis (1, 4, 5, 8, 9, 6, 11, 2, 3).
• Causes are most often trauma (especially piercings), with Pseudomonas aeruginosa as the principal pathogen; autoimmune and iatrogenic factors are less common but important (4, 6, 7, 2, 3, 8, 11).
• Treatment requires prompt, targeted antibiotics (preferably anti-pseudomonal), surgical intervention when necessary, and careful prevention to avoid deformity (4, 7, 10, 3, 6, 8, 11, 9).

Key Takeaways:

• Early recognition and treatment are vital to prevent complications.
• Pseudomonas aeruginosa is the most common causative organism.
• High ear piercings are a significant risk factor.
• Inadequate or delayed therapy increases the risk of permanent ear deformity.
• Both medical and surgical therapies may be needed, depending on severity.

By understanding the symptoms, types, causes, and treatments of perichondritis, individuals and healthcare providers can work together to ensure prompt diagnosis, effective therapy, and preservation of ear function and appearance.