--- title: "Perichondritis - Boxer’s Ear / Cauliflower Ear" description: "ENT notes on Perichondritis of the ear including causes, pathogenesis, clinical features, investigations, treatment, complications." source: "The ENT Resident" author: "Dr. Mausumi Das" canonical_url: "https://www.theentresident.com/ent-notes-lectures/perichondritis-pinna-boxer-cauliflower-ear" categories: ["Otology"] video: "https://www.youtube.com/watch?v=DTp972Y87Iw" image: "https://media.theentresident.com/og-images/perichondritis-pinna-boxer-cauliflower-ear.png" --- # Perichondritis - Boxer’s Ear / Cauliflower Ear ENT notes on Perichondritis of the ear including causes, pathogenesis, clinical features, investigations, treatment, complications. Watch the full video lecture on YouTube: https://www.youtube.com/watch?v=DTp972Y87Iw ## 👂 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. --- ## About This Note This free ENT note on Perichondritis - Boxer’s Ear / Cauliflower Ear was written by Dr. Mausumi Das and is paired with a corresponding video lecture. 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