Generality
Perichondritis is an inflammation of the connective tissue layer ( perichondrium ) that coats and nourishes most of our body's cartilage .
Usually, when we talk about perichondritis, the reference is to the inflammatory process that involves the cartilaginous components of the auricle .
The perichondritis of the external part of the ear is often secondary to an inflammation of the surrounding tissues (eg otitis, trauma, dermatitis, etc.) and, if neglected, can become complicated in chondrite and / or result in deforming scars.
Perichondritis therapy essentially uses drugs aimed at resolving the underlying cause.
What's this
Pericondrite: what is it?
Perichondritis is an inflammatory process that affects the perichondrium, that is the layer of dense fibrous connective tissue that covers the cartilages and provides them with nourishment.
Generally, when the term " perichondritis " is used, the reference is to the inflammation of the perichondrium of the outer part of the ear (auricle).
What does Pericondrio mean?
- The perichondrium is a layer of compact fibrous connective tissue, rich in collagen, blood vessels and nerve endings.
- The perichondrium surrounds, as a sort of armor, most of the cartilaginous structures of the body, with the exception of the articular surfaces.
- The nutritional exchanges of cartilage cells depend on perichondrium. The cartilaginous tissue is, in fact, devoid of blood vessels.
Causes and Risk Factors
What are the causes of Pericondrite?
Usually, perichondritis is an inflammation secondary to an inflammatory process originating from the surrounding tissues. In turn, inflammation can spread and involve the underlying cartilage ( chondrite ).
The most common form of perichondritis is that of the outer ear . Given the particular position, in fact, the perichondrium of the auricle is susceptible to dermatosis, trauma, insect bites, infections and burns that can induce and / or maintain inflammation.
Perchondritis of the external ear: what is it caused by?
The perichondritis of the external ear is mainly caused by:
- Traumas ;
- Otitis externa ;
- Eczema and other dermatoses (eg contact dermatitis due to prolonged use of topical products, herpes zoster oticus, psoriasis, etc.);
- Boils inside the auricle ;
- Insect bites ;
- Infections (note: the main infectious agents called into question are Staphylococcus aureus and Pseudomonas aeruginosa );
- Incisions or perforations of the cartilage of the pavilion (secondary, for example, to piercing);
- Otoplastics and middle ear surgery ;
- Burns ;
- Superinfection of an otohematoma .
Particularly at risk of developing perichondritis are people with systemic inflammatory diseases or a weakened immune system .
The inflammation of the perichondrium of the external ear is found above all in association with the following pathologies:
- Granulomatosis with polyangiitis (vasculitis formerly known as Wegener's granulomatosis);
- Recurrent polycondritis ;
- Diabetes .
Perichondritis of the larynx
Inflammation of the laryngeal perichondrium manifests itself as a complication of acute laryngitis. This form of perichondritis occurs during infectious diseases (especially typhoid and tuberculosis) or as a result of lesions affecting the larynx.
Symptoms and Complications
Pericondrite: how does it manifest itself?
In general, the perichondritis manifests itself with hyperemia, pain and swelling of the part involved. Subsequently, fever and pus formation can occur between the cartilage and the layer of connective tissue (ie the perichondrium).
If the collection of purulent material reduces or interrupts the supply of blood and nutrients to the cartilage, the separation of the perichondrium on both sides from the cartilaginous tissue can occur. This phenomenon can lead to avascular necrosis, that is to the destruction and deformation of the area affected by the perichondritis, within a few weeks.
Perchondritis of the external ear
The perichondritis of the external ear usually begins with:
- Diffuse swelling (note: the swelling of the ear can cancel out the reliefs);
- Very intense and persistent pain in the ear and periauricular tissues;
- Redness ;
- Fever (often high).
In some cases, the inflammation manifests itself with a purulent abscess, which tends to form between the perichondrium and the underlying cartilage.
If it is not properly treated, the perichondritis may evolve into avascular necrosis, which results in the deformation of the cartilaginous skeleton of the auricle; this condition is known, in common parlance, also as " cauliflower ear ".
Possible complications of Perichondritis
- Inflammation of the perichondrium can develop into a chondrite (inflammation of the cartilage), complicating the clinical picture.
- Perichondritis can be destructive: cartilaginous necrosis can deform the part involved in the pathological process.
- The inflammation of the perichondrium can also recur and last for a long time .
Diagnosis
Pericondrite: which exams are needed?
The diagnosis of perichondritis is mainly based on the objective examination (inspection, palpation and otorhinolaryngology evaluation). In fact, a doctor's visit is usually sufficient to recognize the inflammation of the perichondrium.
To establish the presence of an infection, it is possible that a culture test is performed on the secretions or on the materials taken from the perichondritis site, for the correct identification of the pathogen and the most effective drug for its eradication.
If the etiology is not infectious, patients must undergo a rheumatological evaluation to ascertain the presence of vasculitis or other pathologies.
Treatment and Remedies
Perichondritis should never be underestimated, as inflammation can spread and damage surrounding structures.
In the case of the external ear, for example, the inflammation of the perichondrium could have important scarring results, such as the closure of the ear canal or the deformations of the auricle. It is not excluded, therefore, that the perichondritis can compromise the hearing.
Drug therapy of Perichondritis
If the perichondritis is sustained by an infection, the doctor can prescribe an oral therapy based on antibiotics, chosen based on the severity of the disease and the bacteria involved in it. The treatment should be established as early as possible, to avoid the evolution of phlogosis in cartilaginous necrosis; this event requires a surgical treatment with removal of necrotic tissues and correction of scarring. Therefore, patients with diffuse inflammation of the entire auricle could be treated initially with antibiotics on an empirical basis (eg fluoroquinolones). The choice of antibiotic will be modified, then, depending on the outcome of the culture test and the antibiogram.
To relieve inflammation of the perichondrium, systemic corticosteroids may also be indicated. Analgesics are useful, however, for pain relief.
Other therapeutic options
Depending on the cause, the inflammation of the perichondrium can include various therapeutic measures. For example, if there are any foreign bodies, such as earrings, piercings or splinters, the doctor can remove them and advise the application of hot packs to try to resolve any abscesses.
Perichondritis: can surgery be needed?
The treatment of perichondritis may include surgery, should it be necessary to:
- Drain any purulent material : in the presence of a pericondrial abscess (collection of pus), the doctor can make an incision to help the pus escape, allowing the blood to flow back to the cartilage. For the next 24-72 hours, a small drainage tube is kept in place;
- Preventing or resolving the deforming outcomes of the complications : in order to allow for the correct healing of the perichondritis, it is possible for the doctor to perform a suture from the perichondrium to the cartilage. This operation is also performed to avoid any deformity of the auricle.
