Pinna Abscess Management
Primary Treatment: Immediate Surgical Drainage
Incision and drainage is mandatory for pinna abscess and must be performed promptly—antibiotics alone are insufficient and will lead to treatment failure. 1
Surgical Technique
- Perform incision and drainage under local anesthesia with complete evacuation of purulent material and curettage of diseased cartilage. 1
- For large abscesses, use multiple counter incisions rather than a single long incision to prevent step-off deformity and delayed healing. 2
- A cruciate incision over the most dependent part of the swelling with flap elevation allows thorough drainage and scraping of the undersurface with a Rosen's knife. 3
- Apply firm pressure dressing for 3 days post-drainage—this is critical to prevent recurrence and maintain cartilage contour. 1
Timing of Intervention
- Emergency drainage (within hours) is required if the patient has fever, sepsis, or systemic signs of infection. 2
- Emergency drainage is also indicated for immunocompromised patients, diabetics with poor glycemic control, or those with extensive cellulitis. 2
- Without these risk factors, drainage should still occur within 24 hours. 2
Antibiotic Therapy
Antibiotics are NOT routinely indicated after adequate surgical drainage in immunocompetent patients without systemic infection. 4
When Antibiotics ARE Indicated:
- Presence of fever or systemic signs of infection 2
- Surrounding soft tissue infection or extensive cellulitis 2
- Immunocompromised or diabetic patients 2
- Incomplete source control after drainage 5
Antibiotic Selection for Pinna Abscess:
- Pinna perichondritis and abscess are most commonly caused by Pseudomonas aeruginosa, particularly when associated with cartilage piercing. 6
- Anti-pseudomonal coverage is essential—ciprofloxacin 750 mg every 12 hours for 2 weeks is the appropriate first-line choice. 7
- For polymicrobial infections or when Pseudomonas is not suspected, use empiric broad-spectrum coverage against Gram-positive, Gram-negative, and anaerobic organisms. 5
Post-Operative Management
- Wound packing after drainage is controversial and may be painful without adding benefit—not routinely recommended. 2
- Maintain pressure dressing for 3 days to prevent reaccumulation and preserve cartilage architecture. 3, 1
- Routine imaging after drainage is not required unless there is treatment failure or recurrence. 2
Critical Pitfalls to Avoid
- Failure to provide anti-pseudomonal coverage in pinna infections leads to persistent infection and long-term cosmetic defects including cauliflower ear deformity. 6
- Incomplete drainage is the primary cause of recurrence—ensure all loculations are opened and diseased cartilage is curetted. 1
- Never delay drainage waiting for imaging or culture results—clinical diagnosis is sufficient. 1
- Uncontrolled diabetes significantly increases risk of complications and must be simultaneously managed. 1
Expected Outcomes and Complications
- With prompt surgical intervention and appropriate antibiotic coverage, recovery is typically uneventful with minimal complications. 1
- Potential complications include perichondrial reaction requiring analgesics and antibiotics (occurs in approximately 13% of cases), temporary thickening at the incision site (resolves in 4-5 months), and cauliflower ear deformity if treatment is delayed or inadequate. 3, 7
- Recurrence rate approaches zero with proper technique including complete drainage, curettage, and adequate pressure dressing. 3