External Ear Chondritis/Abscess

By admin On Dec 13, 2023

Ovid: 5-Minute Sports Medicine Consult, The

Arturo J. Aguilar

Basics

Description

Inflammation and infection of the pinna
Commonly a complication of otic trauma, burns, or neighboring infection
It may present as a complication of draining a periauricular hematoma (cauliflower ear) in sports such as wrestling and rugby.
Occasionally, chondritis may be a complication of untreated or resistant otitis externa in swimmers.
Cartilage of the external ear is easily damaged and at risk for infection owing to:
- Lack of overlying subcutaneous tissue
- Relative avascularity
- Exposed position

Etiology

Common causes of chondritis include:
- Chemical or thermal burns
- Otitis externa
- Deep abrasions
- Frostbite
- High piercing of the earlobe
- Human bites
- Iatrogenic from incision and drainage treatment of hematoma
- Mastoid surgery
Bacteria involved:
- Pseudomonas aeruginosa
- Staphylococcus spp.
- Proteus spp.

Diagnosis

Typical physical findings in combination with preceding causes

Physical Exam

Initially a dull pain that increases in severity
Pinna:
- Painful
- Exquisite tenderness
- Erythematous
- Warmth
- Loss of contours caused by edema often with sparing of the lobule
Increase in the auriculocephalic angle
Fluctuant areas develop with eventual breakdown and suppuration.
Entire ear involvement if untreated: Disfigurement can occur.
Fever/chills

Diagnostic Tests & Interpretation

Lab

CBC with differential for systemic symptoms
Wound culture for signs of localized infection
Blood culture if systemic signs of infection

Differential Diagnosis

Periauricular hematoma: “Cauliflower ear”
Malignant otitis externa

P.153

Treatment

Acute treatment
General postinjury preventive measures:
- Prevention of chondritis is of the utmost importance.
  - Difficult management and disfiguring potential
  - Avoid pressure to the injured ear
  - Minimize active débridement of eschars and crusts
- Gentle washing twice daily with antibacterial soap and water followed by complete drying and application of topical antibiotics
- Keep hair away from the ear.
Complications: Disfiguration of the pinna:
- Occurs without proper treatment
- Ranges from being shriveled, cauliflower-like ear to complete loss of the external ear and possible stenosis of the auditory meatus
ENT consult:
- For treatment of chondritis, abscess, and necrosis of the involved cartilage
- Early surgical drainage
- Aggressive early management may prevent gross ear deformity.

Medication

Oral antibiotics for minor cases of early ear lobe inflammation:
- Ciprofloxacin preferred (<18 yrs old)
- 1st-generation cephalosporin or dicloxacillin
- IV antibiotics for severe infection
- Apply topical antibiotics when break in skin barrier.
Medications:
- Ciprofloxacin: 500 mg PO t.i.d. (adult)
- Cephalexin: 500 mg (children: 50 mg/kg/day) PO q.i.d.
- Dicloxacillin: 500 mg (children: 25 mg/kg/day) PO q.i.d.

In-Patient Considerations

Admission Criteria

Parenteral antibiotics and early surgical drainage for patients with complicated chondritis
Toxic patient with fever and chills
Immunocompromised patient
Unreliable patient or caretaker

Additional Reading

Bentrem DJ, Bill TJ, Himel HN, et al. Chondritis of the ear: a late sequela of deep partial thickness burns of the face. J Emerg Med. 1996;14:469–471.

Leybell I, Regan L. Drainage, auricular hematoma: treatment and medication. Emedicine. 2008. Medscape. 7 Sept. 2009 http://emedicine.medscape.com/article/82793-overview

Osguthorpe D, Nielsen D. Otitis externa: review and clinical update. Am Fam Phys. 2006;74:1510–1516.

Staley R, Fitzgibbon JJ, Anderson C. Auricular infections caused by high ear piercing in adolescents. Pediatrics. 1997;99:610–611.

Codes

ICD9

380.03 Chondritis of pinna
380.10 Infective otitis externa, unspecified
380.11 Acute infection of pinna