Auricular Chondritis and Ear Piercing

ABSTRACT & COMMENTARY

Synopsis: Pseudomonas infections of the ear cartilages may result from ear piercing. A survey of cosmetic shops, earring kiosks, and tattoo and body-piercing parlors revealed that many of these businesses used piercing methods that could predispose one to these kinds of infection.

Source: More DR, et al. Ear-piercing techniques as a cause of auricular chondritis. Pediatr Emerg Care 1999;15:189-192.

Two cases of auricular chondritis caused by Pseudomonas aeruginosa that occurred after ear piercing prompted a survey of 14 businesses that provided ear piercing. The cosmetic shops and earring kiosks used hand-powered earring "guns," while the tattoo parlors used sterile needles and forceps. The shops and kiosks used benzalkonium chloride, while the tattoo parlors used only iodine-based solutions as ear preparations prior to piercing. The shops and kiosks used a combination of videos, demonstrations, and direct supervision to train employees but did not have a defined training period. The tattoo parlors require completion of an apprenticeship training period of various times. All businesses pierced both the ear lobes and cartilaginous parts of the ear. At all of the businesses, minimal aftercare instructions were given, usually concerning maintenance of ear-hole patency. More and colleagues believe that cosmetic shops and earring kiosks employ piercing methods that could predispose to auricular chondritis, including poor training of employees and use of benzalkonium chloride for skin preparation.

Comment by Eugene D. Shapiro, MD, FAAP

Piercing body parts to insert rings and other jewelry has been in vogue for some time. This article illustrates some of the risks associated with piercing the cartilage of the ear. Because the cartilage is relatively avascular, if the wound becomes infected (the great majority of the time it is with P. aeruginosa), the infections often are more serious than those that occur after piercing of the lobe of the ear; in these cases, the infections required one or more surgical procedures in addition to intravenously administered antimicrobial therapy to ensure adequate treatment. More et al did a survey of both ear- and body-piercing enterprises in their area and found a number of deficiencies in the procedures of most places. Notably, training, especially for ear piercing, often was minimal, and procedures to minimize the risk of infection (e.g., cleaning both of the skin and of the gun used to pierce ears) often were less than optimal.

There are other potential risks associated with body piercing. For example, both hepatitis B and HIV infection may be transmitted by improperly sterilized instruments. Allergic reactions to the jewelry that is inserted can occur (particularly if it is not either stainless steel or 24-karat gold). Even the common, more "minor" infections (usually caused by Staphylococcus aureus or occasionally by group A streptococci) associated with the widely accepted piercing of the ear lobe may turn nasty if the bacteria happens to be a toxin-producing strain (which may even result in fatal toxic-shock syndrome). Pediatricians should inform patients of the risks associated with body piercing (especially when cartilage is pierced) and should investigate which places in their own area can be recommended for piercing ear lobes (or, perhaps, do it in the office themselves). (Dr. Shapiro is Professor of Pediatrics [Infectious Disease] and Epidemiology and Public Health at the Yale University School of Medicine.)

True statements about infections associated with ear piercing include all of the following except:

a. They are frequently caused by Pseudomonas aeruginosa when the ear cartilage is pierced.

b. Risks are restricted to bacterial infections.

c. They may be a result of inadequate skin preparation.

d. They may be more serious when the auricular cartilage rather than the ear lobe is pierced.