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Perichondritis


Presentation

  • Pseudomonas is common causative agent and when present can be associated with a more advanced clinical presentation and a longer hospitalization.[ 4 ] There may be no evident inciting cause, as in this case presentation.[ncbi.nlm.nih.gov]
  • SAXENA, MD, PHD, and MIKAYLA SPANGLER, PHARM D, BCPS Case Presentation A 26-year-old female presented with complaints of a swollen right pinna for 2 weeks. The swelling progressively worsened over time.[jucm.com]
  • Staphylococcus aureus and Pseudomonas aeruginosa are the most common bacteria. 1 The use of guns for piercing cartilage presents an additional risk of perichondritis.[pmj.bmj.com]
  • Presentation [ edit ] Intense pain in auricle. Auricles become red and thick. Body temperature rises. In serious cases pus appears between the perichondrium and cartillage. Purulent melting of auricular cartilage takes place.[en.wikipedia.org]
  • Pseudomonas aeruginosa was found to be the predominant organism (69% of available isolates) and was associated with a more advanced clinical presentation and longer hospitalization (P 0.008).[ncbi.nlm.nih.gov]
Arthralgia
  • In one meta-analysis of 16,184 pediatric patients given systemic ciprofloxacin, the risk of musculoskeletal adverse events attributed to therapy was 1.6%, half of which were arthralgias which resolved upon drug withdrawal ( Adefurin 2011 ).[rebelem.com]
Otalgia
  • Patients initially experience dull pain, which gradually develops into severe otalgia with a purulent discharge ( Noel 1989 ). Early cases are marked by erythema, swelling, and tenderness of the auricle without notable fluctuance (Chun 2013).[rebelem.com]
Ear Discharge
  • […] even further, providing a good medium for bacteria that could be introduced by the piercing needle or gun.5 Surgery and burns can also cause perichondritis, and there have been rare cases of the infection occurring secondary to furunculosis, chronic ear[jucm.com]
Lesion of the Pinna
  • A comprehensive study on lesions of the pinna. Am J Otolaryngol 2005;26(1):1-6. ( PMID: 15635573 ) Chun, Robert, and Opeyemi Daramola. “Clinical Anatomy for the Pediatrician.” Otolaryngology for the Pediatrician 1 (2013): 3.[rebelem.com]
Ear Deformity
  • Second intention healing process often causes an ear deformity known as “cauliflower” ear1. The destruction of ear cartilage in cases of unfavorable development, associated with a creased and deforming scar, hampers plastic reconstruction success 5.[bjorl.org]
Suggestibility
  • Traditionally, fluoroquinolones have been avoided in pediatric patients due to fears of arthropathy, however recent literature suggests that risk is abundantly low.[rebelem.com]
  • Conclusions Our findings suggest that intravenous antibiotic therapy covering S. aureus is sufficient and appropriate empirical treatment in the majority of patients with non-abscess perichondritis.[springermedizin.de]
Fear
  • Traditionally, fluoroquinolones have been avoided in pediatric patients due to fears of arthropathy, however recent literature suggests that risk is abundantly low.[rebelem.com]

Workup

Pseudomonas
  • Also known as: perichondritis infection, Pseudomonas aeruginosa infection. What is perichondritis? The perichondrium is a thin dense layer of tissue that surrounds cartilage and which provides it with nutrients.[nicklauschildrens.org]
  • The most common microorganism responsible for perichondritis is Pseudomonas Aeruginosa, a gram-negative rod with intrinsic antibiotic resistance mechanisms ( Caruso 2014 ) ( Wu 2011 ).[rebelem.com]
  • The most commonly found pathogen is Pseudomonas aeruginosa, together with Staphylococcus aureus 6.[bjorl.org]
  • Abstract Purpose Pseudomonas aeruginosa is commonly found in suppurative perichondritis, but the significant pathogens in non-abscess perichondritis are unclarified.[springermedizin.de]
  • The common bacterial causative agent is Pseudomonas aeruginosa. Symptoms include redness, pain, fever, swelling of the earlobe and pus accumulation between the cartilage and the layer of connective tissue around it.[malacards.org]

Treatment

  • The human pinna receives less humoral circulation which can lead to treatment failure and progression of the disease.[ 5 ] Treatment however, consists of antibiotics and, if an abscess is present, surgical drainage.[ncbi.nlm.nih.gov]
  • Perichondritis treatment Early treatment is important in order to reduce the chance of the infection spreading to the cartilage which could damage the structure of the ear.[specsavers.co.uk]
  • […] for Perichondritis Treatment for your perichondritis will be based on your physical examination.[verywellhealth.com]
  • Treatment Treatment consists of broad antibiotic coverage, either by mouth or directly into the bloodstream via an intravenous line.[jucm.com]
  • Treatment Treatment consists of antibiotics, either by mouth or directly into the bloodstream through an intravenous (IV) line. If there is a trapped collection of pus, you may need surgery.[account.allinahealth.org]

Prognosis

  • Outlook (Prognosis) How well a person does depends on how quickly the infection is diagnosed and treated. If antibiotics are taken early, full recovery is expected. If the infection involves the ear cartilage, more involved treatment is needed.[account.allinahealth.org]
  • Prognosis of perichondritis is good if treated promptly; a full recovery is typically expected. Thanks for your feedback! Brant, JA & Ruckenstein, MJ. (2015).[verywellhealth.com]

Etiology

  • METHODS: We retrospectively studied 114 patients who were admitted with perichondritis during 1987-2004, including their demographic details, medical history, current illness, etiology, pathogens and treatments.[ncbi.nlm.nih.gov]
  • No inciting etiology was identified in the case presented.[ncbi.nlm.nih.gov]
  • Stell, PM, Morrison, MD: Radiation necrosis of the larynx, etiology and management. Arch Otolaryngol 98: 111 – 113, 1973. Google Scholar Medline 6. Goodrich, WA, Lenz, M: Laryngeal chondronecrosis following roentgen therapy.[journals.sagepub.com]
  • No traumatic etiology was identified.[rebelem.com]

Prevention

  • If so, plastic surgery will be needed to restore the ear to its normal shape.2-4 Prevention The best way to prevent perichondritis is to avoid pierc- ing one’s ear through the cartilage, as opposed to the ear lobe.[jucm.com]
  • After removing the damaged parts of the ear, the plastic surgeon can reconstruct the removed portion in order to cosmetically restore the removed portions of your ear Preventing Perichondritis Sometimes perichondritis cannot be prevented, such as in the[verywellhealth.com]
  • Prevention Avoid piercing your ear through the cartilage. Piercing the ear lobe is a better option. The popularity of cartilage piercing has led to a significant increase in the number of perichondritis and chondritis infections.[account.allinahealth.org]

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