“High” ear piercing and the rising incidence of perichondritis of the pinna

Ear piercing is common, and multiple piercing of the ear has become increasingly fashionable. Often this involves “high” piercing, which requires puncture through the cartilage of the upper third of the pinna. Infection at this site results in auricular perichondritis. Soft tissue infection is a recognised complication at any site, but the subperiosteal abscess associated with perichondritis often leads to loss of cartilage and to an unsightly deformity known as “cauliflower ear,” which has a poor chance of good reconstruction fig 1 (left). Cauliflower ear is more likely to occur with transcartilagenous ear piercings. The usual infective agent in auricular perichondritis is Pseudomonas aeruginosa, to which antibiotic resistance seems to be increasing.1 The vast majority of piercings are performed by non-medical practitioners, such as jewellers, hairdressers, or tattooists. These practitioners and their customers may not fully appreciate the implications of cartilage damage resulting from high piercing. We present three cases in which auricular perichondritis and abscess formation was associated with high piercing. Despite prompt intervention, including drainage under general anaesthetic, cosmetic deformity proved difficult to avoid.