Management of Pinna Abscess
Immediate incision and drainage is the cornerstone of treatment for pinna abscesses, and must be performed urgently to prevent permanent cartilage destruction and cauliflower ear deformity. 1
Surgical Management
Primary treatment is surgical drainage, not antibiotics alone. The key principles include:
- Perform incision and drainage as soon as the diagnosis is made to prevent progression to perichondritis and permanent cartilage necrosis 1, 2
- Make the incision over the most dependent part of the abscess to ensure complete drainage 3
- Perform deep curettage of the abscess cavity to remove all purulent material and granulation tissue 2
- Consider a cruciate incision technique for better drainage and lower recurrence rates compared to simple linear incision 3
- Apply pressure dressing (buttoning technique) for 3-7 days post-drainage to prevent reaccumulation and ensure cartilage-perichondrium apposition 3, 4
Timing of Intervention
Emergency drainage is mandatory in the following situations: 1
- Patients with systemic signs of infection or sepsis
- Immunocompromised patients
- Diabetic patients
- Presence of diffuse cellulitis extending beyond the pinna
For stable patients without these risk factors, drainage should still be performed within 24 hours to minimize cartilage damage 1
Antibiotic Therapy
Anti-pseudomonal antibiotics are essential for pinna abscesses, as Pseudomonas aeruginosa is the predominant causative organism, especially in piercing-related cases. 5
- Prescribe ciprofloxacin 750 mg twice daily for 2 weeks as first-line therapy 2
- Antibiotics should be given in addition to surgical drainage, not as monotherapy 2, 5
- The common pitfall is prescribing non-pseudomonal antibiotics (such as beta-lactams alone), which leads to treatment failure and permanent deformity 5
- Consider broader coverage if there are signs of severe cellulitis or systemic infection 6
Post-Operative Care
- Wound packing may be necessary for hemostasis but remains controversial - some evidence suggests it adds cost and pain without clear benefit for simple abscesses 7, 8
- Maintain pressure dressing for at least 3 days to prevent seroma/hematoma reaccumulation 3
- Monitor closely for perichondritis development (pain, inflammation, cartilage thickening) which may require extended antibiotic therapy 3
Critical Pitfalls to Avoid
The most devastating complication is cauliflower ear deformity from inadequate or delayed treatment: 2
- Inadequate drainage leads to recurrence rates up to 44% 7, 1
- Failure to use anti-pseudomonal antibiotics results in persistent infection 5
- Delayed intervention allows cartilage necrosis and permanent cosmetic defects 2
- Simple aspiration without surgical drainage has a 96% recurrence rate and should be avoided 4