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Perichondritis of the ear: causes, symptoms, treatments

Perichondritis is a serious ear condition that shouldn’t be overlooked. Learn about its causes, symptoms, and treatment options. If you're experiencing ear pain or swelling, visit a healthcare provider.

Key takeaways

  • Perichondritis is a bacterial infection of the lining of your outer ear, known as the perichondrium.
  • The perichondrium covers the cartilage, the stiff-yet-flexible tissue which gives your ear its shape and delivers the blood and nutrients that keep cartilage healthy.
  • A cut, burn, scrape or puncture injury can allow bacteria to reach the perichondrium and cause the infection.
  • Upper ear piercings (not ear lobe piercings) and contact sports are often the sources of injuries that lead to perichondritis.
  • If perichondritis isn’t treated quickly, blood flow to the ear cartilage can be cut off, resulting in scarring (cauliflower ear) or tissue death.
  • Perichondritis is generally treated with antibiotics, but in some cases, minor surgery is needed to drain the infection.
  • If it is treated quickly, perichondritis can start to clear up within 2–3 days.
  • You should always see a doctor if you suspect perichondritis; it should not be treated with home remedies or left to heal on its own.

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What is perichondritis?

Perichondritis is an infection in the lining of your outer ear, called the perichondrium. This condition — sometimes known as auricular perichondritis — only occurs in the upper part of the ear, as opposed to the earlobe, due to the layered anatomy of your ear.

Think of the cartilage as the middle layer: this is the firm but flexible tissue that gives your ears their shape. On top of the cartilage is the perichondrium, a layer of connective tissue that carries blood and nutrients to the cartilage to keep it healthy. Your skin is the final, outer layer

Earlobes are a bit different; there’s no cartilage or perichondrium covering them. So, perichondritis doesn’t happen in the earlobes because there is no perichondrium in that part of the ear. 

What is chondritis?

Chondritis, like perichondritis, is also an infection, but it only affects the cartilage, not the lining surrounding it. When it occurs specifically in the ear, doctors may refer to it asauricular chondritis” (auricular means “outer ear”), to differentiate it from chondritis in other parts of the body.

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Causes of perichondritis

Perichondritis causes all trace back to an ear injury that lets in bacteria. Different types of bacteria can cause perichondritis, but cuts, scratches, punctures or burns make it possible for the bacteria to invade your ear. Some common sources of injuries that lead to perichondritis include:

  • Upper ear piercings
  • Contact sports
  • Head trauma
  • Acupuncture
  • Insect bites

Symptoms of perichondritis

Common auricular perichondritis symptoms include:

  • Swelling
  • Redness
  • Tenderness
  • Itchiness
  • Heat

In some cases of perichondritis, abscesses can also develop. These are pockets of pus that form under the skin and sometimes drain fluid.

Treatment of perichondritis

Perichondritis treatment will depend on the kind of bacteria causing the infection as well as the severity of the infection, but it typically includes taking an antibiotic. Your doctor will examine you and perform tests to determine the right course of action. 

For perichondritis, antibiotics are the most common treatment. They might be in pill form or administered through an IV. Your doctor will choose the appropriate antibiotic to fight the kind of bacteria causing your infection, and it might be a medication such as fluoroquinolone (ciprofloxacin) or amoxicillin. When you’re prescribed antibiotics, it’s important to follow the dose instructions carefully and use the whole supply you’re giveneven if you’re starting to feel better before you run out. 

If you develop an abscess due to perichondritis, drainage might be needed. For this, a doctor would numb the ear area, make a small incision and drain the pus from the abscess. If needed, some stitches might be placed to help the ear heal well. 

Perichondritis surgery is quite rare1. However, it is sometimes a last resort, especially in persistent cases or in cases where the perichondritis has led to tissue death (necrosis) and scarring. When dead tissue is replaced by scar tissue, it can lead to cauliflower ear. Surgery can help reconstruct the ear for a more normal appearance.

For an infection like perichondritis, home remedy is not recommended. Bacterial infections need to be treated with antibiotics, and as soon as possible to prevent the infection from getting worse.
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Diagnosis of perichondritis: similar conditions

Many health conditions have similar symptoms that can be hard to tell apart. Doctors have to consider all of the possibilities and rule them out to land on the right answer — this is called differential diagnosis”. In the case of perichondritis, differential diagnosis conditions2 can include:

  • Auricular hematoma (cauliflower ear)
  • Cellulitis (a different kind of bacterial infection)
  • Eczema (a skin disease)
  • Psoriasis (a skin disease)
  • Hemangioma (a non-cancerous tumor caused by irregular blood vessel growth)
  • Skin cancer
  • Sunburn

Let’s take a closer look at the differences between perichondritis and other conditions that often look like it.

Perichondritis is an infection specific to the perichondrium (the tissue lining the cartilage in the upper parts of the outer ear), while cellulitis is a bacterial infection that can affect the entire outer ear

Perichondritis is an infection of the perichondrium tissue layer, while chondritis is an infection of the cartilage underneath the perichondrium.

The key difference between these two infections is their location. Otitis externa is located in the ear canal, while perichondritis is in the upper part of the outer ear.

Perichondritis can cause swelling and redness that looks similar to auricular hematoma. However, auricular hematoma is a collection of blood that builds up after an injury that tears the perichondrium apart from the cartilage. Both conditions can cause tissue damage that leads to cauliflower ear.

Complications of perichondritis

The potential complications of perichondritis are the reason why it’s so important to get it treated fast. If left untreated, the infection can cut off the flow of blood and nutrients that keep the ear cartilage healthy. Without that, the tissue can die. Dead tissue may become deformed due to scar tissue (cauliflower ear) or need to be surgically removed. Ear deformity can lead to hearing problems such as conductive hearing loss

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Perichondritis in children

Pediatric perichondritis generally has the same symptoms and complications as in adults. However, your child might also have a fever in addition to a sore, red and swollen ear. If you notice these symptoms, see a doctor as soon as possible to prevent tissue damage that could affect their health and hearing. 

Preventing perichondritis

While it’s not 100 percent possible to prevent perichondritis — it can happen due to accidental scrapes and injuries — there are things you can avoid or protect yourself from. When playing contact sports, wear ear protection. It’s also safer to avoid puncturing of the upper ear, either through acupuncture or piercings. 

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FAQs about perichondritis

No. Perichondritis should not be left to heal on its own. As a bacterial infection, it needs to be treated with antibiotics to prevent tissue damage. 

Perichondritis is not an overly common disease, but some doctors have seen an increase in cases along with the growing popularity of upper ear piercings

No, perichondritis is not contagious. It is caused by bacteria getting into a wound on the ear, and cannot spread from person to person.

Perichondritis is not an autoimmune disease. However, it is associated with a rare autoimmune condition called relapsing polychondritis that causes inflammation of cartilage in the ears, nose and throat.

If see a doctor and get treatment promptly, perichondritis can start to clear up within two or three days. If you have an abscess, your doctor may place a drain in your ear; it will need to stay in place for a couple of days before being removed

Even after the infection clears up, your ear might still have some healing to do that can lead to your ear feeling a bit odd. It’s normal to feel some discomfort for as long as a month after developing perichondritis. Resist any urges to scratch the ear to avoid causing any new damage.

Sources

1 Forozidou E, Poutoglidis A, Tsetsos N, Kilmpasanis A, Fyrmpas G. Surgery as a Last Resort for Persistent Auricular Perichondritis. Ear Nose Throat J. 2024 Feb;103(2):81-83. doi: 10.1177/01455613211038343. Epub 2021 Aug 10. PMID: 34375535.

2 Khan N, Saleh HM, Hohman MH, et al. Pinna Perichondritis. [Updated 2024 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK572081/.

Dr. Tom Tedeschi

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Dr. Thomas Tedeschi, Au.D.

Chief Audiology Officer, Miracle-Ear

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