Perichondritis is an infection of the skin and covering that surrounds cartilage, the thick tissue that forms the distinctive shape of the nose or ears. Perichondritis most often affects the external ear.

All cartilage has a thin layer of tissue around it called the perichondrium. This covering helps provide nutrients to the cartilage. The most common bacteria causing perichondritis infection is Pseudomonas aeruginosa.

Perichondritis is usually caused by injury to the ear due to ear surgery, ear piercing (especially piercing of the cartilage), or contact sports. Ear piercing through the cartilage is probably the most significant risk factor today.

Perichondritis may cause severe damage to the ear structure if it progresses to chondritis, a general infection of the cartilage.

A painful, red ear is the most common symptom. At first the infection will look like cellulitis (a skin infection), but it rapidly gets worse and involves the perichondrium.

The redness usually surrounds an area of injury, such as a cut or scrape. There may also be fever, and -- in more severe cases -- fluid draining from the wound.

The diagnosis of perichondritis is usually made by history and physical exam. If there is a history of trauma to the ear and the ear is red and very tender, then the presumed diagnosis is perichondritis. There may be an abnormal change in the shape of the ear.

Treatment consists of antibiotics, either by mouth or directly into the blood stream through an intravenous line (IV). If there is a trapped collection of pus, surgery may be necessary to drain this fluid and remove any dead skin and cartilage.

If the diagnosis is made rapidly and antibiotics are started, full recovery is expected. In more advanced cases, when the infection involves the ear cartilage (chondritis), part of the ear may die and need to be surgically removed. This may result in the need for plastic surgery to restore the ear to its normal shape.

The main complication is extension of the infection into the cartilage of the ear, which would require removal of the damaged part and possibly cosmetic surgery to restore it.

If you suffer any trauma to your ear (a scratch, blow, or piercing) followed by the development of pain and redness over the stiff part of the ear, contact your health care provider for evaluation. You may need antibiotic treatment.

The best way to prevent this infection is to avoid ear piercing through the cartilage (not the ear lobe). Since this practice has become more popular, there has been a significant increase in the number of cases of perichondritis and chondritis.