Intended for healthcare professionals

Clinical Review Lesson of the week

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

BMJ 2001; 322 doi: (Published 14 April 2001) Cite this as: BMJ 2001;322:906
  1. Junaid Hanif, specialist registrara (,
  2. Adam Frosh, consultant surgeonb,
  3. C Marnane, senior house officerc,
  4. K Ghufoor, specialist registrard,
  5. R Rivron, consultant surgeonc,
  6. G Sandhu, specialist registrard
  1. a Ear, Nose, and Throat Department, University Hospital of Wales, Cardiff CF14 4XW
  2. b Ear, Nose, and Throat Department, Lister Hospital, Stevenage SG1 4AB
  3. cRoyal National Nose, Throat and Ear Hospital, London WC1X 8EE
  4. dEar, Nose, and Throat Department, Royal Glamorgan Hospital, Ynysmaerdy CF75 8XR
  1. Correspondence to: J Hanif
  • Accepted 27 November 2000

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.


Left: “Cauliflower ear” after auricular perichondritis. Centre: Subperichondrial abscess after “high” transcartilaginous ear piercing. Right: Multiple chronic inflammatory lesions of auricle at sites of previous piercings

Case reports

Case 1—A 16 year old man presented to an accident and emergency department with a painful and swollen left pinna, two days after high, …

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