Perichondritis is an inflammation of the skin of the cartilage (medical term perichondrium). In the majority of cases, inflammation of the cartilage on the auricle develops as part of the disease. In addition, perichondritis also occurs in other areas of the body, for example, the larynx or the nasal cartilage.
What is perichondritis?
Basically, inflammatory processes develop on the skin of the cartilage in the course of perichondritis. The most common of these is inflammation of the auricle. However, perichondritis can also develop in other cartilage-containing areas. The nose and the larynx are affected. Perichondritis is usually accompanied by pain emanating from the inflamed areas on the cartilage. The skin of the cartilage, known as the perichondrium, is particularly affected. When perichondritis occurs in the ear, in most cases the external auditory canal is also involved in the disease. The cause is primarily bacterial pathogens that penetrate the skin. The point of attack for the bacteria are small injured areas on the skin. It is also possible that perichondritis occurs in connection with systemic diseases. So-called recurrent perichondritis was first described in 1923 by a specialist in internal medicine, von Jaksch. In the meantime, the disease is considered to be one of the autoimmune diseases.
Causes
In the majority of cases, the causes of perichondritis are due to bacterial infections. These are usually staphylococci or pseudomonas. The pathogens often enter the human organism through the skin. Particularly frequently, affected patients become infected with the bacteria via skin injuries. Possible sites are, for example, injured areas on the pinna of the ear. Some pathogens also enter the skin via mosquito bites. In addition, perichondritis develops in some cases following surgery. Individuals also often become infected with perichondritis when piercing their ears. The risk of contracting the disease is greatly increased if the hygienic conditions during piercing are not satisfactory. In addition, the bacterial germs may enter the body through micro-injuries in the pinna. If a so-called othaematoma is present and injured, perichondritis is also possible. Sometimes mycobacteria are responsible for the causative infection.
Symptoms, complaints, and signs
Perichondritis is associated with various complaints for affected patients. The diseased areas of the cartilage usually swell. In most cases, the corresponding areas redden. In addition, the affected persons suffer from more or less severe pain radiating from the inflammation of the cartilaginous membrane. Moreover, when perichondritis occurs on the auricle, the inflammatory processes announce themselves with changes in the relief of the concha. However, perichondritis does not usually extend to the earlobe. If perichondritis is not adequately treated, the focus of inflammation spreads into the neighboring areas. In the worst case, the inflammation progresses to the point where necrosis develops on the cartilage, which is septic in nature, for example. The earlobe is predominantly not affected by perichondritis because it does not have any cartilage tissue. This at the same time facilitates the differential diagnosis, because in erysipelas the earlobe is usually affected by the inflammation. The necrosis that is possible in perichondritis in many cases implies changes in the shape of the auricle. In some diseased individuals, a so-called cauliflower ear develops.
Diagnosis and course of the disease
Individuals with typical symptoms and signs of perichondritis are advised to visit a physician. As part of the medical history, the attending physician clarifies the individual symptoms with the patient and finds out whether injuries have occurred in the area of the affected cartilage. The physician then inspects the affected areas. At this point, he may already make a tentative diagnosis. Laboratory analyses of the relevant tissue are necessary to unequivocally confirm the diagnosis of perichondritis. First, the doctor takes swabs of the inflamed areas and then has them examined.In this way, the responsible bacterial germs can be identified.
Complications
Ear perichondritis is an inflammation of the cartilage of the ear and adjacent tissues. The earlobe is not affected because it does not contain cartilage. Initially, the disease is usually harmless, but it can lead to significant complications if not treated adequately in a timely manner. In the early stages, blisters form around the infected area and the ear begins to ache; sometimes the earlobe also reddens. If treatment is inadequate, there is a risk that perichondritis will spread to the entire cartilaginous membrane of the auricle and ear canal. A common consequence is tissue death (necrosis). This can be accompanied by a permanent change in the cartilage of the ear and lead to the so-called cauliflower ear, which is otherwise only seen in martial artists. In severe cases, it may be necessary to amputate the ear completely or partially. If the patient does not want to live with the visual and usually also acoustic impairment, the ear can be replaced with an ear prosthesis. The surgical intervention is accompanied by the general surgical risks. Diabetics and people with weakened immune systems are at particularly high risk of developing severe perichondritis. Cosmetic procedures on the ear, such as piercings or tattoos, also carry an increased risk because of often inadequate hygiene.
When should you go to the doctor?
If there is redness or painful swelling of the pinna, an appointment with a doctor is recommended. Perichondritis is not a serious condition, but if left untreated, it can lead to the development of cartilage necrosis and other complications. Affected individuals are best to consult a physician at the first sign of inflammation. External redness is a clear warning sign and a reason for a prompt visit to the doctor. A bacterial disease should be treated at an early stage so that the pathogens cannot reach the auricle in the first place. Then an oral antibiotic treatment is often still possible, by which the pathogens can be destroyed. Advanced diseases require intravenous antibiotic therapy. If necrosis has already occurred, surgical intervention is necessary. Perichondritis is treated by the general practitioner or the otolaryngologist. Advanced diseases are treated as inpatient by a surgeon and other specialists. As part of follow-up care, a few control examinations are usually sufficient, by which the degree of recovery is assessed and, if necessary, the medication is adjusted.
Treatment and therapy
Perichondritis is treatable by various means and methods. If the disease is still in a relatively early stage, antibiotics are usually used. These are administered to patients by the oral route. If the inflammation in perichondritis is already more advanced, the antibiotics are usually injected into the veins. This improves the effectiveness of the drugs. Active ingredients such as ciprofloxacin or levofloxacin have proven particularly effective. This is because they are able to penetrate the cartilage. However, if necroses have developed on the cartilage, surgical removal of the corresponding areas is necessary. In this way, the destruction of the auricle can be contained. Concomitantly, the use of medical irrigation of the diseased areas is recommended to accelerate the healing process.
Outlook and prognosis
In most cases, the further course of perichondritis depends very much on when the disease is recognized and how quickly it is also treated. A self-healing of this disease can not occur thereby as a rule, so that the affected person is always dependent on medical treatment by a doctor in this case. Therefore, a doctor should be contacted at the first symptoms and signs. If the disease is not treated, the inflammation usually spreads to other regions of the body and can significantly reduce the quality of life of the affected person. Treatment then also proves to be relatively difficult. If the disease is correctly recognized and treated by a doctor right at the beginning, it can usually be well limited and cured with the help of antibiotics. This also does not lead to further complications or other complaints.However, even after a complete cure, perichondritis may re-infect. If the disease is not treated, the auricle can be completely and irreversibly destroyed. In most cases, the disease itself does not reduce the life expectancy of the affected person.
Prevention
Perichondritis cannot always be prevented. However, the risk of inflammation is reduced if, for example, meticulous attention is paid to hygienic standards when piercing piercings.
Aftercare
In most cases, the person affected by perichondritis has only a few and also only limited options for aftercare. First and foremost, the affected person should see a doctor at an early stage so that complications or other complaints do not arise in the further course. The sooner a doctor is consulted, the better the further course of the disease usually is. The treatment of perichondritis is usually done by taking various medications, mainly antibiotics are used. Regular intake with a correct dosage should always be observed, and antibiotics should also not be taken together with alcohol. In case of questions or in case of side effects, a doctor should be consulted first in case of perichondritis in order to avoid complications. Regular check-ups by a doctor are also very important. If the disease is treated by surgery, the affected person should take it easy after the procedure, especially protecting the affected region. This can prevent infections and inflammations.
What you can do yourself
In the case of perichondritis, it is usually sufficient to take the prescribed medication and inform the doctor of any side effects. The patient does not need to take any further measures, as the inflammation will subside on its own within a few days. Only in the case of complications or a late diagnosis are further self-help measures useful. For example, in the case of severe inflammation in the area of the ear, it is essential to contact the emergency medical service. If the hearing ability deteriorates massively, a hospital visit is indicated. If perichondritis was diagnosed late, necroses may have already formed. These must be surgically removed. After surgical intervention, patients should take it easy and otherwise follow the physician’s recommendations regarding wound care. Irrigation with agents such as Rivanol have a supportive effect and can be supplemented with natural preparations in consultation with the doctor. If inflammation occurs again, there may be a serious condition that needs to be diagnosed first. The patient should contact the ear specialist or consult an internist. A complaint diary serves as a guide for the physician, who can make a diagnosis based on the information about the symptoms and their severity.
