Perichondritis of the auricle and external auditory canal: causes, symptoms, diagnosis, treatment

Perichondritis is an acute inflammation of the perichondrium, which spreads to the skin of the auricle and the membranous part of the external auditory canal. The disease begins with serous inflammation, which can be quickly stopped with timely and adequate treatment. Further development of the process leads to purulent inflammation. In advanced cases with particularly virulent pathogens, the inflammatory process can spread to the cartilage, causing its purulent melting and sequestration. These phenomena are usually observed with the formation of empyema and its late opening.

Causes of perichondritis of the auricle and external auditory canal

The etiologic factor may be a polymicrobial association, but more often it is Pseudomonas aeruginosa. Contributing factors may be trauma to the auricle with the formation of a hematoma, an insect bite with the introduction of infection when scratching the bite site, a burn or abrasion of the auricle, a complication of any skin disease, surgical interventions on the auricle or in the retroauricular area. Often the cause of perichondritis of the auricle can be a furuncle of the external auditory canal, herpetic rashes on it, flu, tuberculosis.

Symptoms of perichondritis of the auricle and external auditory canal

The disease begins with the appearance of a burning sensation and rapidly increasing pain in the auricle, reaching significant intensity. Touching the auricle causes sharp pain. The pain is accompanied first by insular, then widespread hyperemia of the skin, edema and infiltration of the auricle. In this case, the auricle increases in size, its contours and relief diminish natural forms and are smoothed out. The inflammatory process spreads to the ear lobe.

In places of the most pronounced hyperemia between the perichondrium and cartilage, purulent foci arise, giving the surface of the auricle a bumpy appearance. These foci merge into a common purulent cavity, which, when opened, releases greenish-blue pus under pressure (with Pseudomonas aeruginosa), often with an admixture of blood, especially when the disease occurs against the background of a herpetic process.

Timely complex treatment leads to rapid recovery, however, with the formation of empyema and purulent melting of cartilage, cicatricial deformations of the auricle occur, leading to its disfigurement.

The general condition of the patient suffers significantly (increase in body temperature to 38-39°C, weakness, fatigue, insomnia due to severe pulsating pain, loss of appetite, sometimes chills). The pain can spread to the ear-temporal, occipital and cervical region, and does not subside when analgesics are prescribed.

Diagnostics in typical cases does not cause difficulties and is based on the presence of attendant factors, pain syndrome, insular hyperemia with blurred edges, acquiring a lumpy character. It should be differentiated from erysipelas and suppurating hematoma.

Treatment begins with the prescription of broad-spectrum antibiotics, including those to which Pseudomonas aeruginosa is particularly sensitive (erythromycin, tetracycline, olethetrin) in the usual dosage. Along with antibiotics, sulfonamides are prescribed per os, to which, due to their rare use in recent years, the sensitivity of microorganisms is again increasing. Locally - lotions of Burow's solution or 70% ethyl alcohol. Some authors recommend lubricating the affected part of the UR with a 5% alcohol solution of iodine or a 10% solution of silver nitrate. At the same time, physiotherapeutic procedures are prescribed (UHF, UV, microwave, laser therapy).

When an empyema forms, it is opened, the pus is removed, the cavity is washed with antibiotic solutions, and the cartilage surface is curettaged to remove necrotic tissue. The incision is made parallel to the contour of the auricle, or the Howard method of final opening is used, in which small square plates are cut out of the skin and perichondrium on three sides and lifted, separating them from the cartilage. The use of this method prevents the formation of cicatricial deformations of the auricle. The abscess cavity is washed 3-4 times a day with a solution of the appropriate antibiotic and drained with rubber strips rolled into tubes.

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