Perichondritis - Boxer’s Ear / Cauliflower Ear

👂 Perichondritis of Ear

Definition of Perichondritis

Perichondritis is an infection or inflammation involving the perichondrium of the auricular cartilage, leading to accumulation of pus between the Perichondrium and the cartilage.

This eventually compromises blood supply to the cartilage and may result in cartilage necrosis.

A classic history is that of a young female presenting after high ear piercing through the cartilage.

Why is the auricular cartilage susceptible to Perichondritis?

Etiology of Perichondritis

The two major causes are:

1- Trauma - Most Common Cause

Examples

• Ear piercing through cartilage
• Lacerations of auricle

⭐ High cartilage piercing is a common modern cause.

2- Spread of Infection

Infection may spread from Skin (Erysipelas) or Subcutaneous Tissue (Cellulitis) of External Auditory canal/ Pinna may spread deeply.

What are the Risk Factors of Perichondritis?

Microbiology of Perichondritis

• Pseudomonas aeruginosa
• Staphylococcus aureus
• Streptococcus species
• Proteus
• Enterococcus
• Escherichia coli

What is the most common organism causing perichondritis?

What is the Pathogenesis of Perichondritis?

Cauliflower Ear

The characteristic deformity resulting from untreated perichondritis is Cauliflower Ear.

Also known as:

• Boxer’s Ear
• Pugilistic Ear

Histopathology of Perichondritis

Typical histological changes include:

• Hyperplasia of dermis
• Thickening of subcutaneous tissue
• Polymorphonuclear leukocyte infiltration
• Thickening of perichondrium
• Cartilage destruction by phagocytes

Clinical Features of Perichondritis

Symptoms of Perichondritis

History

Usually there is a history of:

• Ear piercing
• Trauma
• Surgery
• Burn injury

Local Symptoms

• Painful pinna
• Warm sensation over ear
• Progressive dull aching pain
• Swelling of pinna
• Forward displacement of pinna
• Pinna deformity
• Cauliflower ear

Examination Findings of Perichondritis

Inspection

• Redness
• Swelling
• Edema
• Loss of normal contour

⭐ Lobule is spared

Why is the lobule spared in perichondritis?

• Thickened skin
• Erythema
• Necrosis
• Purulent discharge
• Discharging sinuses
• Cauliflower deformity

Palpation

Findings include:

• Marked tenderness
• Fluctuation (if abscess present)
• Purulent discharge

What is the Classification of Perichondritis?

Investigations of Perichondritis

Perichondritis is primarily a Clinical diagnosis.

1- Pus Culture & Sensitivity

Indicated when:

• No response to antibiotics
• Recurrent disease

2- Renal Function Test (RFT)

What is the importance of performing renal function tests in a case of Perichondritis?

What is the differential diagnosis of Perichondritis?

Treatment of Perichondritis

1- Early Perichondritis

Can often be managed as an outpatient.

• Oral antibiotics
• Local toileting
• Debridement if required
• Close follow-up

What is the Drug of Choice for Antibiotic for Perichondritis? Why?

2- Severe Infection

If no improvement within 24–36 hours, start IV Antibiotics.

3- Management of Abscess

If fluctuant abscess is present, perform Incision and drainage.

4- Perichondritis Following Burns

Treatment includes Iontophoresis.

What is Iontophoresis?

5- Resistant Cases

In cases resistant to antibiotic therapy, Low Dose Radiation may be used in selected cases.

If persistent Pain, Suppuration & Inflammation is present despite treatment, Surgical Management is done.

• Aggressive debridement
• Removal of necrotic cartilage
• Excision of involved skin
• Total chondrectomy (if required)

What are some preventative measures taken for Perichondritis?

Complications of Perichondritis

• Subperichondrial Abscess
• Cartilage Necrosis
• Cauliflower Ear
• Streptococcal Septicemia
• Subacute Bacterial Endocarditis
• Necrotizing Fasciitis of Neck

Viva Pearls

• Perichondritis commonly follows cartilage piercing.
• Pseudomonas aeruginosa is the most common causative organism.
• Ciprofloxacin is the drug of choice.
• Lobule is characteristically spared.
• Untreated disease can lead to cauliflower ear.
• Cauliflower ear is also known as boxer’s ear or pugilistic ear.
• Abscess forms between cartilage and perichondrium.
• Diabetes and immunosuppression increase risk.
• Early treatment prevents permanent deformity.