Ear reconstruction after auricular chondritis secondary to ear piercing

[Complications of cosmetic piercings and tattoos in the head and neck region]

Piercings and tattoos have gained popularity across all cultural environments during the past century, and one in ten Europeans are now pierced. While tattoos are often restricted to the rest of the body, piercings are common at facial sites such as ears, nose, lips, and tongue. Complications following piercings are not uncommon. Infections can rapidly spread across the auricular cartilage and require antibiotic and often surgical treatment. Mild trauma (i.e., piercing the earlobe) can lead to excessive scar formation due to fibroblast proliferation. Keloids have a particularly high rate of recurrence and are therefore difficult to treat. Due to recent developments in the field of permanent makeup, tattooing techniques are also increasingly applied in the head and neck region. Here, complications such as infection or allergic reactions can occur. Topical medication or laser procedures are the usual therapeutic options.

National outbreak of Pseudomonas aeruginosa associated with an aftercare solution following piercings, July to September 2016, England

We report a national Pseudomonas aeruginosa outbreak from a common source following piercings between July and September 2016 in England. The multi-agency outbreak investigation included active case finding, microbiological testing of environmental samples and case specimens including Variable Number Tandem Repeat (VNTR) typing and a retrospective cohort study. Overall, 162 outbreak cases (29 confirmed, 14 probable and 119 possible) and 14 non-outbreak cases were identified; all confirmed cases had ear piercings (93% cartilage). Outbreak cases were predominantly female (95%) and had a median age of 18 years (interquartile range: 13-56 years). Nineteen outbreak cases required surgery under general anaesthetic The same outbreak VNTR type (11,3,5,3,3,3,6,4,7) was isolated from bottles of an aftercare solution from a single manufacturer and in specimens from confirmed cases who attended eight different piercing studios supplied with this product. In the cohort study, use of aftercare solution was associated with becoming a case (aOR: 4.60, 95% confidence interval: 1.65-12.90). Environmental, microbiological and epidemiological investigations confirmed that contamination during production of aftercare solution was the source of this national outbreak; highlighting challenges in the regulation of a cosmetic products used in the piercing industry and that guidance on piercing aftercare may need to be reviewed.

Trends and complications of ear piercing among selected Nigerian population

Background:

The reported health and socioeconomic consequences of ear piercing, especially in modern day society, underscore the need to further research into this subject. In this study, we determine the trends and complications of ear piercing among selected Nigerian population.

Aim and Objectives:

The aim and objective of this study was to draw attention to the trends and complications of ear piercing with a view to prevent its associated complications.

Methodology:

It is a descriptive cross-sectional study carried out between February and May 2015 among selected Nigerian population from two of its six geo-political zones. A self-administered semi-structured questionnaire which had been pretested was used to collect data from 458 respondents who consented using multistage sampling technique.

Results:

Of 480 respondents enumerated, 458 completed the questionnaires and gave their biodata. The male:female ratio was 1:6.2. Their ages ranged from 18 to 75 years with a mean of 35.56 ± 10.16. About 35.4% of the respondents were within the age group of 31–40 years. Majority of the respondents, i.e.,79.3% practiced ear piercing on their children. Most of them (86.8%) preferred single piercing. Ear piercing was performed within the 1^st week of birth in 37.2% of the respondents. Large percentage (93.2%) of the respondents will not encourage ear piercing in male children. Nearly 20.5% of the respondents observed complications.

Conclusion:

Ear piercing remained a common practice in Nigeria, with respondents preferring it on females. Majority of the piercings are done in childhood and by untrained personnel. Keloid formation was the notable complication observed by the respondents. There is a need to increase awareness about the hazards of ear piercings and to enact laws that regulate ear piercings particularly in children which is hereby stretched.

Transcartilaginous ear piercing and infectious complications: a systematic review and critical analysis of outcomes

OBJECTIVES/HYPOTHESIS

The purpose of this systematic review was to critically analyze infectious complications and treatment following transcartilaginous ear piercing.

DATA SOURCES

MEDLINE Pubmed database.

REVIEW METHODS

A MEDLINE PubMed database search using free text, including "ear chondritis," "ear perichondritis," "ear cartilage piercing," and "auricle piercing," yielded 483 titles. Based on set inclusion and exclusion criteria, the titles, abstracts, and full text articles were reviewed for inclusion and underwent data extraction. Pooled outcomes are reported.

RESULTS

A total of 29 articles met inclusion criteria, including 66 patients. The mean age of the patients was 18.7 ± 7.6 years (range: 11-49), 87.5% female. Ear deformity was more likely to occur following postpiercing perichondritis of the scapha 100% versus the helix 43% (P = 0.003). Mean duration of symptoms prior to patients seeking medical attention was 6.1 ± 4.1 days. Greater than 5 days of symptoms prior to seeking treatment was significantly more likely to result in hospitalization. Pseudomonas aeruginosa accounted for 87.2% infections. Of the patients with Pseudomonas, 92.3% were hospitalized versus 75% of the patients infected with Staphylococcus aureus. Initial oral antibiotics prescribed did not target the cultured bacterium in 53.3% of cases; of these, 87.5% were hospitalized.

CONCLUSIONS

Transcartilaginous postpiercing infection may lead to ear deformity and hospitalization. Patients (customers) and practitioners must be aware of optimal treatment strategies to minimize associated morbidity. Scapha piercing and delay in presentation are associated with poorer outcomes. Pseudomonas is the most common bacterial infection. Initial antibiotic selection must be optimized accordingly.

Post-piercing perichondritis

Piercing has become more and more popular among adolescents. The procedure is generally performed by unqualified professionals and carries its risk. Non-sterilized material or inappropiate hygiene increases the possibility of perichondritis and celulitis. The disease is characterized by erythema of the auricula pinna, unbearable pain and fever. Left untreated, the condition progresses with edema along the auricula and abscess formation that may result in ischemic necrosis and a cauliflower anesthetic deformation. The most common bacteria is Pseudomonas aeruginosa. In cases with abscesses, drainage is necessary along with antibiotic therapy guided by cultures and antibiogram. Aim: The aim of this case report was to review the past 10 years of published papers dealing with anatomical aspects of the auricular pinna, the history of piercing and its most common complications. Methods: A case report of perichondritis after “high” ear piercing that required surgical treatment and that progressed with no esthetic loss. Results: Theoretical and practical experience based on a review and a report of a case that progressed satisfactorily. Conclusions: The increased incidence of perichondritis in adolescents should require more elaborated primary prevention measures.

Ear piercing techniques and their effect on cartilage, a histologic study

BACKGROUND

The popularity of high ear piercing has led to an increased incidence of perichondritis. Damage to the relatively avascular cartilage will make the ear prone to infection. The literature suggests that a piercing gun, mainly used by jewellers to pierce the lobule, may give excessive cartilaginous damage. Therefore some authors favour the piercing needle, as used in piercing studios. But until now, no comparative histological studies have been performed.

PURPOSE OF STUDY

To evaluate the extent of damage to ear cartilage using different piercing techniques.

METHODS

Twenty-two fresh human cadaver ears were pierced using two spring loaded piercing guns (Caflon and Blomdahl), one hand force system (Studex) and a piercing needle (16G i.v. catheter). Extent of damage to the perichondrium and cartilage was quantified using a transverse section along the pin tract and compared between the different methods.

RESULTS

The pattern of injury was similar in all techniques, showing perichondrium stripped from the cartilage around the pin tract, with most damage present on the exit site (mean length of 0.43 mm). Cartilage fractures and loose fragments were present over a mean length of 0.21 mm. No significant difference in the amount of injury between the different techniques was observed.

CONCLUSIONS

In contradiction with assumptions in the literature, all piercing methods give the same extent of damage to cartilage and perichondrium. Each method is expected to have the same risk for perichondritis, thus in the prevention of post-piercing perichondritis focus should be on other factors such as hygiene and after-care.

Risk factors for cartilage infections of the ear

BACKGROUND

Investigation and case-control study to identify risk factors in a large outbreak in 2003 of auricular chondritis associated with piercing.

METHODS

Epidemiologic, environmental, and laboratory (pulsed-field gel electrophoresis) investigation, and case-control study. Telephone interviews were conducted for 15 cases and 61 controls. Odds ratios were determined for risks of infection.

RESULTS

Of 15 confirmed cases, nine (60%) were hospitalized (median duration 4.4 days) and treated with intravenous/oral antibiotics. Cases required surgical treatment and multiple antibiotics. Risk factors for infection included piercing location and the use of a contaminated aftercare solution. Pseudomonas aeruginosa isolates, nine from patients and four from the aftercare solution, were indistinguishable by pulsed-field gel electrophoresis; one from the sink at the facility differed by two bands.

CONCLUSIONS

This study demonstrates the serious consequences of cartilage piercing, identifies specific risk factors for infection, and suggests the importance of implementation and assurance of safe procedures.

Double opposing V-Y hinge flap

A relatively large earlobe hole was closed with triangular flaps on both sides using a V-Y plasty. The design and elevation of this flap are simple and easy. This flap can close relatively large earlobe holes, preventing earlobe deformity.