Cartilage is the thick tissue that creates the shape of the nose and the outer ear. All cartilage has a thin layer of tissue around it called the perichondrium. This covering helps provide nutrients to the cartilage.

The most common type of bacteria that causes perichondritis infection is Pseudomonas aeruginosa.

Perichondritis is usually caused by an injury to the ear due to:

• Ear surgery
• Ear piercing (especially piercing of the cartilage)
• Contact sports
• Trauma to the side of the head
  

Ear piercing through the cartilage is probably the major risk factor today. Surgery, burns, and acupuncture also increase the risk for infection.

Perichondritis can lead to chondritis, which is an infection of the cartilage itself. This can cause severe damage to the ear structure.

A painful, swollen, red ear is the most common symptom. At first, the infection will look like a skin infection, but it quickly worsens and involves the perichondrium.

The redness usually surrounds an area of injury, such as a cut or scrape. There may also be fever. In more severe cases, fluid will drain from the wound.

Diagnosis is based on the medical history and examination of the ear. If there is a history of trauma to the ear and the ear is red and very tender, then perichondritis is diagnosed. There may be a change in the normal shape of the ear. The ear may look swollen.

Treatment consists of antibiotics, either by mouth or directly into the bloodstream through an intravenous (IV) line. Antibiotics can be given for 10 days to several weeks. If there is a trapped collection of pus, you may need surgery. The surgery is done to drain this fluid and remove any dead skin and cartilage.

How well a person does depends on how quickly the infection is diagnosed and treated. If antibiotics are taken early, full recovery is expected. If the infection involves the ear cartilage, more involved treatment is needed.

If the infection spreads to the ear cartilage, part of the ear tissue may die and need to be surgically removed. If this occurs, plastic surgery may be needed to restore the ear to its normal shape.

If you have any trauma to your ear (a scratch, blow, or piercing) and then develop pain and redness over the stiff part of the outer ear, contact your health care provider. You may need to take antibiotics.

Avoid piercing your ear through the cartilage. Piercing the ear lobe is a better option. The popularity of cartilage piercing has led to a significant increase in the number of perichondritis and chondritis infections.

Haddad J, Dodhia SN. Externalotitis (otitis externa). In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 657.

Naples JG, Brant JA, Ruckenstein MJ. Infections of the external ear. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 138.

Updated by: Jatin M. Vyas, MD, PhD, Associate Professor in Medicine, Harvard Medical School; Associate in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.