What is the recommended treatment for an infected pinna?

Treatment of Infected Pinna

Topical fluoroquinolone ear drops (such as ciprofloxacin 0.2% or ofloxacin 0.3%) are the first-line treatment for infected pinna, with cure rates of 77-96%. 1

Diagnosis and Assessment

An infected pinna typically presents with:

• Tenderness of the pinna that is often intense and disproportionate to visual inspection
• Erythema and edema of the pinna
• Possible cellulitis extending to adjacent skin
• May be associated with ear canal inflammation in cases of otitis externa

Treatment Algorithm

First-Line Treatment

• Topical fluoroquinolone ear drops 1
  • Ciprofloxacin 0.2% or ofloxacin 0.3%
  • Adults and children ≥13 years: 10 drops once daily for 7 days
  • Children 6 months to 13 years: 5 drops once daily for 7 days
  • Complete the full 7-day course even if symptoms improve earlier

Administration Technique

• Clean the ear canal of any debris or discharge before administering drops
• Tilt the patient's head and "pump" the tragus several times after instilling drops to aid medication delivery 1
• For adherent discharge, use cotton-tipped swab with hydrogen peroxide (safe with tympanostomy tubes) 2

Pain Management

• Acetaminophen or NSAIDs for immediate pain relief until the infection is controlled
• Pain typically improves within 48 hours of starting treatment 1

Special Considerations

For Pseudomonas Infections

• Pseudomonas aeruginosa is a common causative organism in pinna perichondritis, especially with piercing-related infections 3
• Ensure the selected antibiotic has anti-pseudomonal activity

For Severe or Complicated Infections

If any of the following are present, systemic antibiotics are indicated 2:

• Cellulitis extending beyond the pinna to adjacent skin
• High fever (≥38.5°C/101.3°F)
• Severe pain or systemic symptoms
• Immunocompromised state
• Failure to respond to topical therapy after 72 hours

Systemic Antibiotic Options

For cellulitis of the pinna with systemic signs of infection 2:

• Clindamycin: 600-900 mg every 6 hours IV (adults); 10-13 mg/kg every 8 hours IV (children)
• Cefazolin: 1 g every 8 hours IV (adults); 33 mg/kg/dose (children)

Monitoring and Follow-up

• Reassess after 72 hours of therapy to evaluate response 1

• If no improvement is seen after 72 hours, reevaluate and consider:

  • Obtaining cultures
  • Changing antibiotic therapy
  • Referral to an otolaryngologist

• If the patient fails to respond after 7 days, refer to an otolaryngologist for:

  • Microscopic examination
  • Culture of ear drainage
  • Evaluation for possible complications or alternative diagnoses 1

Prevention of Recurrence

• Avoid excessive moisture in the ear canal
• Dry ears thoroughly after water exposure
• Consider prophylactic acidifying solutions after water exposure
• Avoid trauma from inappropriate cleaning (don't insert cotton-tipped swabs into ear canal) 1

Important Cautions

• Avoid neomycin-containing products as first-line therapy as they can cause sensitization in 5-15% of patients 1
• Do not use aminoglycoside-containing eardrops due to potential ototoxicity 2
• Using oral antibiotics for uncomplicated cases results in lower cure rates, more systemic side effects, and contributes to antibiotic resistance 1
• Consider rare causes such as monkeypox in patients with auricular perichondritis who have systemic symptoms 4