Ear-piercing techniques as a cause of auricular chondritis

Objective: To investigate the different methods of ear and body piercing as possible sources of infection, and to provide a brief literature review of infections resulting from high ear piercing as well as bacterial coverage of common disinfectants used as preparation agents. Methods: Two cases of auricular chondritis caused by Pseudomonas are presen ted. A survey of 14 businesses that pierce ears was conducted using a sched uled interview, Information regarding the type of piercing instrument, comp osition of earring, training of employees, anatomic placement of earrings, and preparation and aftercare of ears was obtained. Results: One hundred percent of the interviews attempted were completed. Th e cosmetic shops and earring kiosks both used hand-powered earring "guns" t o pierce ears, while the tattoo parlors used sterile needles and forceps. A ll of the businesses interviewed used earrings composed of either 14K or 24 K gold, stainless steel, and other piercing-grade metals. None of the busin esses used earrings made of nickel. The cosmetic shops and kiosks used a co mbination of videos, demonstrations, and direct supervision to train employ ees but did not have a specified training period. The tattoo parlors requir ed their employees to complete an apprenticeship training program of varyin g time lengths. All of the businesses pierced the lobe and cartilaginous po rtions of the ear. The cosmetic shops and kiosks used benzalkonium chloride or isopropyl alcohol as ear preparation agents, while the tattoo parlors u sed only iodine-based solutions. At all of the businesses, minimal aftercar e instructions were given and they typically dealt with maintaining ear-hol e patency, Conclusion: The cosmetic shops and earring kiosks used piercing methods tha t predisposed to auricular chondritis, such as poor training of employees a nd use of benzalkonium chloride as a preparation agent. Emergency physician s need to be aware of the severity of these types of infections, which ofte n require surgical management and intravenous antibiotics covering Pseudomo nas.