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Perichondritis of the auricle and external auditory canal: causes, symptoms, diagnosis, treatment
Last reviewed: 20.11.2021
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By perichondritis means acute inflammation of the perichondrium, which extends 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 docked with timely and adequate treatment. Further development of the process leads to purulent inflammation. In far-reaching cases with especially virulent pathogens, the inflammatory process can spread to the cartilage, with its purulent melting and sequestration. Usually, these phenomena are observed when the empyema is formed and the belated autopsy.
Causes of perichondritis of the auricle and external auditory canal
As an etiological factor, a polymicrobial association may act, but more often it is a Pseudomonas aeruginosa. Contributing factors may be a trauma to the auricle with the formation of a hematoma, an insect bite with infection at combs of the bite site, a burn or abrasion of the auricle, complication of any skin disease, surgical interventions in the auricle or in the behind-the-ear region. Often the cause of perichondritis of the auricle may be a furuncle of the external auditory canal, herpetic eruptions on it, influenza, tuberculosis.
Symptoms of perichondritis of the auricle and external auditory canal
The disease begins with the appearance of burning and rapidly growing pain in SD, reaching a significant intensity. Touching the auricle causes severe pain. The pain is accompanied first by islet, then by the widespread flushing of the skin, swelling and infiltration of the auricle. At the same time, the auricle increases, its contours and relief obliterate natural forms and smooth out. Inflammatory process is distributed to the ear lobe.
In the places of the most pronounced hyperemia between the perichondrium and the cartilage, purulent foci appear, giving the surface of the auricle a tuberous appearance. These foci merge into a common purulent cavity, when opened, under pressure, pus greenish-blue (with Pseudomonas aeruginosa), often with an admixture of blood, is released, especially when the disease occurs against the background of the herpetic process.
Timely complex treatment leads to a rapid recovery, but with the formation of empyema and purulent melting of cartilage there are scarring deformities of the auricle, leading to its disfigurement.
The general condition of the patient suffers significantly (fever to 38-39 ° C, weakness, weakness, insomnia due to severe pulsating pain, loss of appetite, sometimes chills). Pain can spread to the ear-temporal, occipital and cervical region, do not subside when prescribing analgesics.
Diagnosis in typical cases of difficulties does not cause and relies on the presence of prying factors, pain syndrome, islet with blurred edges of hyperemia, acquiring a humpy nature. It should be differentiated from erysipelas and festering hematoma.
Treatment begins with the appointment of broad-spectrum antibiotics, including those to which the Pseudomonas aeruginosa (erythromycin, tetracycline, oletetrin) is particularly sensitive in the usual dosage. Together with antibiotics prescribe per os and sulfonamides, to which, due to their rare use in recent years, the sensitivity of microorganisms again increases. Locally - lotions from the Bohr liquid or 70% of ethyl alcohol. Some authors recommend lubricating the affected part of urine with 5% alcohol solution of iodine or 10% solution of silver nitrate. At the same time, physiotherapeutic procedures (UHF, UFO, UHF, laser therapy) are prescribed.
When empyema is formed, it is opened, pus is removed, the cavity is washed with solutions of antibiotics, curettage of the cartilage surface is made to remove necrotic tissues. The incision is made parallel to the contour of the auricle, or the method of the final opening is used according to Howard, in which small square plates are cut from the skin and perichondrium on three sides and raised, separating them from the cartilage. The use of this method prevents the formation of scar deformations of the auricle. The cavity of the abscess is washed 3-4 times a day with a solution of the corresponding antibiotic and drained with rubber strips folded into tubes.
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