What is the recommended treatment for ear cartilage infection?

Treatment of Ear Cartilage Infection (Perichondritis)

Start fluoroquinolone antibiotics immediately for any suspected ear cartilage infection, as Pseudomonas aeruginosa causes 69% of culture-positive cases and delays in treatment lead to permanent cartilage destruction and auricular deformity. 1

Recognizing Perichondritis

The hallmark clinical presentation is painful swelling, warmth, and redness of the cartilaginous ear that characteristically spares the earlobe. 1 This distribution distinguishes perichondritis from simple skin cellulitis, which typically involves the entire ear including the lobe.

• Test for acute tenderness when deflecting the auricular cartilage—this indicates deeper perichondrial infection requiring systemic antibiotics rather than just superficial skin infection 1
• Perichondritis most commonly occurs after trauma (including ear piercing), surgery, or auricular lacerations, with highest risk during warm weather months 2

First-Line Antibiotic Treatment

Prescribe oral fluoroquinolone antibiotics (ciprofloxacin or levofloxacin) as initial therapy because Pseudomonas aeruginosa is the predominant pathogen. 1, 3

• Ciprofloxacin has demonstrated 95% improvement or cure rates in chronic ear infections with Pseudomonas and other resistant organisms 4
• Oral fluoroquinolones allow outpatient management of what previously required prolonged hospitalization with intravenous antibiotics 3
• Continue antibiotics for a full course (typically 10-14 days minimum) even if symptoms improve earlier 3

When Antibiotics Alone Are Insufficient

If abscess formation occurs despite antibiotic therapy, surgical drainage becomes necessary:

• Use tubal drainage technique rather than wide excision, as drainage tubes maintained for 2-4 weeks allow new cartilage formation while preserving cosmetic appearance 5
• The older excision technique results in marked deformity, repeated debridement, and protracted treatment and should be abandoned 5
• Drainage tubes should remain in place for 2-4 weeks to maintain perichondrial elevation and ensure homogeneous cartilage regeneration 5
• Wide cartilage and subcutaneous tissue debridement with preservation of the helical rim minimizes resulting auricular deformity when surgery is required 6

Critical Monitoring and Follow-Up

• Re-examine within 48-72 hours to ensure response to antibiotics and absence of abscess formation 1
• Watch for worsening pain, increasing swelling, or fluctuance indicating abscess development requiring drainage 1
• Once abscess forms, good cosmetic preservation becomes difficult even with optimal surgical management 2

Essential Pitfalls to Avoid

• Never delay starting fluoroquinolone antibiotics while waiting for culture results—empiric coverage of Pseudomonas is critical to prevent cartilage necrosis 1, 3
• Do not use antibiotics that lack Pseudomonas coverage (such as amoxicillin, cephalexin, or macrolides), as this leads to treatment failure and permanent deformity 1
• Avoid local anesthesia with epinephrine if any surgical intervention becomes necessary, as this compromises the already tenuous blood supply to auricular cartilage 1
• Do not confuse perichondritis with relapsing polychondritis, which requires steroid treatment rather than antibiotics 5

Special Considerations for Post-Traumatic Cases

For perichondritis developing after auricular laceration repair:

• The infection risk is highest in the first month after injury, particularly during warm weather 2
• If the original wound involved cartilage, ensure intercartilage sutures were placed in addition to skin sutures, as inadequate cartilage approximation increases infection risk 2
• All auricular lacerations should have been cleaned and repaired within 12-24 hours to minimize infection risk 2