1. Perichondritis of the external ear
Definition : refers to inflammation involving the perichondrium of the external ear, auricle,
&external auditory canal. However, it is commonly used to describe continuum of conditions of the
external ear from erysipelas(infection of overlying skin) through cellulitis(infection of the soft
tissue)& true perichondritis to chondritis( infection involving the cartilage itself).
Classification
A practical classification might be:
Erysipelas of external ear;
Cellulitis of external ear;
Perichondritis ;
Chondritis;
Aetiology
Perichondritis usually happens secondary to trauma. Such trauma may include laceration, surgery,
frost bite, burns,chemical injury, infection of a haematoma of the pinna, high piercing of the
cartilaginous portion of the auricle for the insertion of earring.
The most common organism pseudomonas aeruginosa, & staphalococcus aureus.
Diagnosis
The diagnosis of perichondritis is clinical & a background of underlying trauma to external ear
should be sought. The lobule contains no cartilage, is spared. Dull pain & sign of inflammation
involving the cartilaginous pinna is enough to diagnosis.
D/D relapsing perichondritis.
Outcomes
If untreated , a subperichondrial abscess may develop , leading to avascular necrosis of the
underlying cartilage, marked deformity of the pinna.
Management options;
Prevention; acute perichondritis should be prevented by careful placement of ear piercing away
from the cartilaginous pinna.
Haematoma of the auricle should be drained promptly.
The meticulous management of the burn injuries to the ears should include the use of prophylactic
antibiotic against Gram-negative bacteria & diligent local care including daily dressing &removal of
eschars & crust.
First line management
The mildest forms are treated with oral & topical antibiotic.

2. If there is any discharge or abscess needs draining, a pus swab should be sent for C/S. Prompt
treatment with broad –spectrum antibiotic possibly I/V.
Subperichondrial abscesses require incision & drainage but only when definite fluctuation is
present, as premature incision may result in further spread of the infection.
Resistant cases
Nonresponse to the above treatment ,accompanied by persistent pain , suppuration need further
intervation.
Dowling ; Advocate aggressive excision of necrosed cartilage including overlying subcutaneous
tissues & skin. However, it is difficult to decide how much cartilage to excise. Repeated debridement
may be needed.
Stevenson advocates a system of continuous drainage & irrigation with antibiotic & steroid solution
as an alternative to preservation of the structure, fenetrated polyethylene tubes are placedin the
subperiosteal tunnels on either side of the cartilage& aminoglycoside /steroid solution to irrigate
these twice daily.
Best clinical practice
Considerd broad-spectum antibiotic ( including anti-pseudomonas) prophylaxis in severely
traumatized or burnt pinna.
Early use of local & systemic antibiotic including antipseudomonas if perichondritis is suspected.
In resistant cases, add effective local antibiotic delivered by irrigation.
Conservative surgery for drainage of abscesses, creation of irrigation & excision of necrotic cartilage
with preservation of the perichondrium wherever possible.