That ear looks like it hurts. It actually hurts like hell, as exclaimed by the teenager who possesses this awful condition.
Every now-and-then, a patient presents with a horribly painful ear, previously pierced for an earring. Infection is a rare complication of piercings, less likely with the ear lobe which is mostly skin and fatty tissue. Yet folks often pierce the upper part of the ear, right through the cartilage. The cartilage is the framework that gives your outer ear (the auricle) its shape. Unlike a dog or rabbit, the cartilage in a human is thicker and stiffer; the reason human ears don’t droop or flop about. Ye once that area is infected, it’s a hugely painful ordeal, with redness and swelling and the misery that comes with it. In a bizarre twist of fate, I’ve seen an earring embed deep into the ear--on its own, with no help by its owner—where it’s buried beneath the skin and is no longer visible. Sometimes the post on the other side of the ear with its clasp or backing-device also gets buried.
In these cases, the earring must be removed. Infection of the auricle can progress quite rapidly and needs immediate attention.
Case in point: the ear of the young lady above happened literally overnight. She went to bed late one Friday evening, happy as a clam, ear as normal as can be with the exception of multiple earrings, one of which was placed through the auricular cartilage a year or two in the past. She woke up the following morning in excruciating pain, the upper 2/3 of her ear red and painful with early signs of swelling. It being a Saturday, I was about to enjoy my morning cup of coffee with a dash of vodka, when I was called by her mother, asking me for guidance, whether she should go to the ER. A trip to the ER indeed was advisable, but when she described how the earring was no longer visible, that it hadn’t fallen out since the post was still visible on the other side, I knew it had to be removed. Otherwise, the cellulitis (skin infection) would spread, an abscess could occur and she’d need to be admitted to the hospital for iv antibiotics and surgery.
Since the vodka was not consumed, and its mention was merely a bad joke, I met them in the office. I numbed the overlying skin with an injection of lidocaine as she screamed and cursed her mom, then prepped and draped the ear, incised the skin over the site where the head of the darned earring out to be, found it, grasped it with a hemostat while pulling hard on the clasp on the other side of the ear, which ignited even louder, blood-curdling screams and a few sacrilegious words. But lo-and-behold, the backing was released off the post and I got the darned offender out!
I placed her on antibiotics and asked her mom to call if she got worse.
The auricle serves a useful purpose besides being an appendage to adorn lovely ornaments. One function is to funnel sound down towards the eardrum (tympanic membrane or TM). It also protects the TM and the delicate inner ear structures deep to it from blunt-force trauma, such as a fall or blow to the side of the head. The cartilage is bendable and can thus distribute forces outward and away from the inner ear.
Perichondritis is what this patient had, which typically occurs from some trauma to the ear, such as piercings. The perichondrium is the tough lining-tissue of the cartilage and provides the blood supply to the cartilage. Anything that disrupts it, such as trauma or an infection, will prevent blood flow to the cartilage and risks infection of that cartilage. This can lead to the dreaded cauliflower ear, where the cartilage gets badly deformed. An abscess also can occur between the perichondrium and cartilage, which requires incision and drainage, much in the same way we treat an auricular hematoma, another cause of cauliflower ear.
Of course, if the offending foreign body is present (such as an earring), it must be removed. That an earring later becomes embedded under the skin, even years after placement, is baffling to me. I’ve also seen this with nose piercings, where even the opposite post and backing device are both embedded, completely buried underneath the nostril lining, years after the nose stud was placed.
Weird stuff. But much of medicine deals in weirdness, which makes the job interesting, sometimes. The young patient above recovered quite well, healed completely and--as far as I know--has not re-pierced that part of her ear. That day, I returned home to my morning Joe—whether I added the vodka I will not tell.
©Randall
S. Fong, M.D.
For more topics on medicine, health and the weirdness of life in general, check out the rest of the blog site at randallfong.blogspot.com
Comments
Post a Comment