Behavior & Development • Mar 30, 2015

You’re piercing what? Medical complications of cartilage and ear piercing

with earringsIt was almost midnight when 14-year-old Kyla came to the emergency room with her mom and two friends– but they knew that infected ear cartilage could not wait until the morning.  Cartilage infections spread rapidly and can cause permanent disfigurement to the ear.  Her ear didn’t even look too bad– just a little red and sore where she had pierced it five days before. I’ve included a picture of her ear with the piercing studs still in place, and a picture of her ear after the earrings were removed and the piercings cleaned.  We didn’t realize how bad the infection was until the earrings were removed.

IMG_5393Kyla had done everything right– she had her upper ear cartilage pierced at a reputable jewelry store using sterile conditions and gold earrings.  She cleaned the piercings appropriately with antiseptic solution.  But five days later her cartilage piercings became infected, a medical emergency.

Even with meticulous care, cartilage piercings become infected about 30% of the time.  One study followed a more than 450 nurses who pierced their ears.  About 30% of “high” ear piercings, or piercings of the cartilage of the pinna/upper ear, become infected, compared to about 20% of ear lobe piercings.

The good news is that the treatment for infected piercings is simple when caught early. If there is no pus draining and no firm pocket of pus in the ear that needs to be drained (an abscess), infected ear cartilage can be treated with common oral antibiotics.  Most infected ear piercings are caused by a bacteria called Pseudomonas aeruginosa, and so you need an antibiotic that covers this bacteria, such as ciprofloxacin or levofloxacin.  Amoxcillin, Augmentin, and Keflex do not cover pseudomonas infections and are not the right drug to treat infected ear piercings.

If there is pus draining from your pierced cartilage or an abscess in the ear, you may need to be admitted to the hospital for intravenous antibiotics and possible surgical drainage of the infection.  This is a medical emergency– waiting even a few hours can result in permanent loss of ear cartilage and a poor cosmetic outcome.

Other medical complications from high ear piercing/ear cartilage piercing include: allergic reactions to earrings, scarring and pull-through tears of the ear, and two medical conditions called pyogenic granuloma and keloid formation.

Allergic reactions to earrings are common, especially if the earrings are made of nickel.  This is easily treated by removing the earrings and replacing with gold or nylon earrings.  Nylon (plastic) studs are inexpensive and rarely cause allergic reactions.  For about ten dollars you can buy a whole selection of different colors from or most jewelry stores.

Earrings buried in the ear lobe or ear cartilage present to my pediatric emergency room all the time.  I’ve seen patients who fell on their ears, got hit in the ear with a ball, had their earring pulled through their ear by a teammate or toddler.  Sometimes earring backs get embedded in the ear because they are pushed too tightly against the ear while sleeping.  Even if they are not yet infected, these injuries usually involve me removing earring parts with surgical instruments and the treating the wound that remains.  Some sports leagues have started a no-earring requirement to prevent these injuries.

Pyogenic granuloma is a medical complication of piercing causing a red or flesh-colored lump near or around the piercing.  This is caused by an overgrowth of tissue that can occur during wound healing.  Keloids are another medical complication of piercing that also results in a flesh-colored bump, usually at the site of the piercing.  Specialized treatment from a plastic surgeon or ENT specialist is usually necessary for both of these conditions.

back of ear

As for Kyla, she was able to avoid surgical treatment because she came to the Emergency room late that night, giving up her plans with her friends and keeping her mom up late.  Although she had to remove her piercing studs for the infection to heal well, I am hopeful she will have minimal scarring and be able to re-pierce her ear after the infection resolves.