Pinna perichondritis in a rural setting: a 10-year review of cases and an introduction to the PinCH as a novel technique for improving cosmetic outcomes following pinna abscess

Background: This paper presents a cohort study of pinna perichondritis presentations at a rural hospital over a 10-year period, as well as describing a novel approach to the management of pinna abscesses and suppurative perichondritis to prevent cosmetic deformity. A review of the literature with a focus on piercing-associated perichondritis is also presented. Methods: A retrospective analysis of perichondritis presentations to Dubbo Base Hospital between January 2012 and January 2022 was performed and variables of interest collected including demographics, cause of perichondritis, pre-hospital and inpatient management and organism cultured. Statistical analyses were performed using Fisher’s exact test for categorical variables and student’s t-test for continuous variables. Results: There were 30 cases of perichondritis identified, with a mean age of 35.7 years and 60% were male. Cartilaginous piercing was the most common cause, followed by otitis externa. All cases of piercing-associated pinna abscess grew Pseudomonas aeruginosa (P.aeruginosa) on culture. Indigenous patients had increased rates of P.aeruginosa infection and need for surgical management compared to non-Indigenous patients. Patients were less likely to receive anti-pseudomonal antibiotics in hospital if an abscess was present, despite being more likely to culture P.aeruginosa than other organisms. Older patients were more likely to receive timely and appropriate anti-pseudomonal cover with ciprofloxacin in the community. A novel method of post-drainage primary moulding to minimise cosmetic deformity is described using a finger-cot splint in two patients from this cohort, presented as a case series. Conclusions: This study highlights that in the rural and remote setting cartilaginous piercing is a common risk factor for pinna perichondritis, and P.aeruginosa is frequently implicated in these infections and their subsequent abscess formation. Despite recent recommendations outlining safe use in paediatric patients, ciprofloxacin is not routinely prescribed to patients with this presentation in the community. Our novel method of managing these abscesses is the first of its kind and has been demonstrated to be a cost-effective, readily available and well-tolerated option for the prevention of cosmetic deformity following piercing-associated pinna abscess, with potential application in other causes of pinna collection.