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Chondritis, Perichondritis, and Cellulitis of the Auricle

  • Spectrum of disease from mild superficial skin infection to chondritis.

  • Cellulitis is an infection of the skin of the auricle.

  • Perichondritis and chondritis are infections of the auricular perichondrium and cartilage, respectively.

  • Bacterial infections typically result from blunt or penetrating trauma, or extension of infectious otitis externa (OE).

  • Superficial infections commonly related to Staphylococcus and Streptococcus.

  • Deeper infections often involve Pseudomonas.

Etiology

  • Trauma—most common cause

  • Blunt trauma (assault, wrestling) resulting in hematoma and secondary infection

  • Penetrating trauma—bites, knives, foreign, body, firearms

  • Ear piercing—transcartilagenous piercings

  • Iatrogenic—otologic surgery

  • Extension of OE

  • Extension of subperiosteal abscess

  • Rule out:

    1. Relapsing perichondritis—autoimmune condition that involves the cartilage and spares the lobule from inflammation

    2. Cutaneous lymphoma

    3. Gouty tophus

Physical Examination

  • Pain and erythema common in cellulitis, perichondritis, and chondritis.

  • Induration and edema typical for chondritis and perichondritis.

  • Induration usually not seen with cellulitis.

  • Hematoma with or without abscess formation—fluctuation present with abscess.

  • Cartilage deformity (“cauliflower ear”) in chronic or recurrent infections and in advanced or untreated cases.

  • Fever, chills, and elevated white blood cell count can be seen.

Diagnosis and Pathogens

  • Diagnosis made on clinical grounds

  • Cellulitis of the auricle typically due to Staphylococcus spp

  • Pseudomonas spp most common cause of perichondritis and chondritis

    1. Most commonly cultured organism from auricular abscess

  • Incision and drainage with culture when possible

  • Other rare bacteria—Escherichia coli and Proteus spp

  • Erysipelas caused by beta-hemolytic Streptococcus

    1. Auricle typically erythematous, indurated, and painful

    2. Infection typically follows a well-demarcated border

Treatment

  • Mild infections

    1. Oral anti-staphylococcal and anti-streptococcal antibiotics

  • Severe infection or immunocompromised patient

    1. IV anti-staphylococcal, anti-streptococcal, and anti-pseudomonal antibiotics

  • Perichondritis or chondritis

    1. Involvement of cartilage with inflammation or abscess can result in cosmetic deformity (cauliflower ear)

    2. Goal of treatment: rapid diagnosis and initiation of therapy, maximize aesthetic outcome

    3. No abscess—oral antibiotics with anti-pseudomonal coverage (fluoroquinolone)

    4. Abscess—incision and drainage with cartilage debridement as needed

    5. Antibiotic therapy for 2 to 4 weeks

    6. Placement of bolsters as needed

Viral Processes of the Auricle

Herpes Zoster

Etiology

  • Thought to occur following viral reactivation within ganglion nerve cells

  • Can result following insult due to direct trauma, dental work, or upper respiratory infection (URI)

  • Most commonly seen in the elderly and immunocompromised

Signs and Symptoms

  • Often includes prodrome of otalgia which precedes vesicular eruption.

  • Vesicles in the external auditory canal (EAC) and conchal bowl.

  • May included tinnitus, hearing loss, vertigo, decreased lacrimation (associated ganglion).

  • Facial paralysis with Herpes Zoster Oticus is known as Ramsay Hunt Syndrome.

  • Other cranial neuropathies (V, IX, X, XI, XII) can be seen.

Diagnosis and Pathogens

  • Tzanck smear to look for multinucleated giant cells at the base of ruptured vesicle

    1. Differential diagnosis includes: herpes ...

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