Perichondritis: Definition, Causes, Symptoms, Diagnosis and Treatment

It is the inflammation of the perichondrium, a layer of connective tissue that surrounds the cartilage.

Perichondritis can be a devastating disease, and if improperly treated, the infection can worsen and develop into a watery chondritis resulting in deformation and / or loss of the outer ear.

A rare form is laryngeal perichondritis (perichondritis laryngitis). It develops suddenly due to injury, virulent or compromised organisms, and it also affects the cartilage of the larynx. This can lead to deformation and stenosis .

Symptoms

The most common symptoms are:

  • Pain in the ear.
  • Inflammation of the ear
  • Redness of the ear.
  • In some cases fever and discharge from the wound.

Causes

Several causes of perichondritis were identified, and a study of 85 patients suggested the most common causes, including minor trauma, burns, and ear piercing.

In particular, cartilage damage is not a necessary prerequisite; Infection can occur if the overlying meatus skin is subject to even trivial trauma, such as a scratch from an infected nail.

In a significant percentage of cases, no major cause can be identified.

However, several authors postulate that an increasing incidence of perichondritis may be associated with the increasing popularity of high chondral perforation, which causes removal of the perichondrium and microfracture of the avascular cartilage while directly introducing infection.

Perichondritis has been shown to be the initial symptom of several disease processes marked by immunosuppression, including HIV-associated non-Hodkin lymphoma, relapsing polychondritis, and, not infrequently, diabetes.

The most common organism responsible for perichondritis is Pseudomonas aeruginosa, a gram-negative rod with intrinsic mechanisms of resistance to antibiotics.

In a retrospective analysis of 61 patients with perichondritis, Pseudomonas was identified in 95% of cases.

Coinfection with E. Coli was identified in half of the cases, and Staph Aureus in 7% of the patients. Due to the variable antibiotic sensitivities of these causative organisms, the culture swab is recommended in all cases.

Diagnosis

The diagnosis of perichondritis is clinical by physical examination. Patients initially experience dull pain, gradually turning into severe earache with a purulent discharge.

Early cases are marked by erythema, swelling, and tenderness of the atrium without noticeable fluctuation. The lobe is not affected, which helps distinguish perichondritis from external otitis.

A nest of infection can be identified within the upper fossa, although it will often be absent. The complete clinical examination should exclude sensitivity or fluctuating mastoid process of the temporal bone, as well as facial, orbital, or middle ear involvement.

Treatment

Treatment of perichondritis includes therapy with antibiotics with anti-pseudomonal activity and consideration of incision and drainage by ENT specialists in the case of fluctuation to remove necrotic cartilage.

Generally, adequate outpatient antibiotic coverage would dictate oral therapy with ciprofloxacin or another fluoroquinolone, however, the overall susceptibility to Pseudomonas has steadily decreased from 86% in 1994 to 76% in 2000, a result that has been significantly correlated with the increased use of fluoroquinolones.

However, local antibiograms demonstrating susceptibilities to antibiotics should guide empirical therapy.

As high failure rates of oral antibiotic treatment have been documented, some patients may require intravenous antibiotic treatment or treatment in a controlled setting to ensure improvement of symptoms.

In fact, as any injury involving the pinna can have drastic and alarming cosmetic complications, some authors routinely recommend hospital admission for urgent specialist evaluation and parenteral therapy, particularly in pediatric patients.