Suppurative perichondritis of the auricle: causes, symptoms, diagnosis, treatment, and prevention

Suppurative perichondritis of the auricle is a common complication of ear injury, mostly caused by pseudomonas aeruginosa infection. Due to poor blood circulation in the auricle, infection is prone to spread. Delayed treatment can cause a large area of auricular cartilage infection and necrosis, resulting in auricular deformities.


Causes

Pseudomonas aeruginosa is an aerobic Gram-negative bacillus, is widely present in moist natural environments, mainly in the soil, water, and intestines of few persons, and can also temporarily parasitize the anus, genitals, armpits, and external auditory canal. Under normal circumstances, its growth is inhibited by Gram-positive cocci, generally nonpathogenic. However, the bacterium can quickly reproduce in the burns, ulcers, and moist skin, causing skin infections. Systemic infections usually occur in persons with low immunity, such as patients whose normal microflora being inhibited by antibiotics or glucocorticoids, tumor patients, patients with granulocytopenia caused by various causes, patients with immunodeficiency caused by chronic wasting diseases, frail old adults, and malnourished infants. If a healthy person is immersed in water for a long time, the infection of the bacteria can also occur. The bacteria can also cause nosocomial infections by contamination of hospital bedpans and sheets, and has become one of the main pathogens of nosocomial infections in recent years.

Studies have shown that the pathogenicity of the bacteria is mainly caused by the secreted exotoxin, and the collagenase, elastase, and phospholipase secreted by the bacteria are involved in the disease. A typical strain produces two pigments of blueish green pyocyanin and yellowish green pyoverdin.

Systemic pseudomonas aeruginosa infection can cause sepsis, and patients present with fever, jaundice, splenomegaly, pneumonia, urinary tract infection, and meningitis. Cutaneous pseudomonas aeruginosa infection often occurs in the persistently moist lesion sites, especially on the periumbilical and burned surfaces of infants, as well as in macerated toes, external auditory canal, and auricle.


Signs and Symptoms

This disease occurs mostly after ear surgery, acupuncture treatment, and otitis externa. The initial manifestations are auricular redness, swelling, and pain, accompanied by systemic symptoms such as fever, and then redness and swelling are aggravated, forming abscesses, with intensified pain, with undulation when palpation. Compression of the empyema can lead to chondronecrosis, resulting in auricular deformities.


Diagnosis

On the basis of typical clinical manifestations and results of bacterial culture, diagnose can be provided.


Treatment

Systematic anti-pseudomonas aeruginosa antibiotics are needed. In the early stage, infrared irradiation can be used on the local lesion. Once the abscess is formed, incision and drainage should be immediately performed, and the pus, necrotic cartilage, and granulation tissue should be completely eliminated. Both intraoperative and postoperative sensitive antibiotics should be administered. It is reported that carbenicillin combined with gentamicin can be the first choice for the treatment. Bacterial culture and drug sensitivity test are followed by administration.


Prevention

Adequate disinfection before ear surgery and auriculotherapy should be performed. In the case of trauma in the external auditory canal or auricle, medications sensitive to pseudomonas aeruginosa should be preferred to prevent the occurrence of suppurative perichondritis of the auricle.