FIGURE 118.6 Gauze wick (ẳ ì 1ẵ in) being placed in ear canal to facilitate topical treatment of otitis externa Auricular Perichondritis Auricular perichondritis is a rare but serious infection of the cartilage of the ear that can occur in the setting of trauma or surgery, or even after ear piercing The infection is usually caused by P aeruginosa, and patients present with severe swelling, erythema, and pain of the pinna ( Fig 118.7 ) Untreated, it can lead to permanent cartilaginous deformity The diagnosis is made clinically, and treatment should be initiated promptly with agents that have activity against P aeruginosa such as fluoroquinolones or third- or fourth-generation cephalosporins Fluoroquinolones are particularly useful as they have excellent cartilage penetration Their use in children should NOT be swayed by the minimal risk of tendon rupture complications