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 presented. A survey of 14 businesses that pierce ears was conducted using a scheduled interview. Information regarding the type of piercing instrument, composition 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. The cosmetic shops and earring kiosks both used hand-powered earring "guns" to pierce ears, while the tattoo parlors used sterile needles and forceps. All of the businesses interviewed used earrings composed of either 14K or 24K gold, stainless steel, and other piercing-grade metals. None of the businesses used earrings made of nickel. The cosmetic shops and kiosks used a combination of videos, demonstrations, and direct supervision to train employees but did not have a specified training period. The tattoo parlors required their employees to complete an apprenticeship training program of varying time lengths. All of the businesses pierced the lobe and cartilaginous portions of the ear. The cosmetic shops and kiosks used benzalkonium chloride or isopropyl alcohol as ear preparation agents, while the tattoo parlors used only iodine-based solutions. At all of the businesses, minimal aftercare instructions were given and they typically dealt with maintaining ear-hole patency.
Conclusion: The cosmetic shops and earring kiosks used piercing methods that predisposed to auricular chondritis, such as poor training of employees and use of benzalkonium chloride as a preparation agent. Emergency physicians need to be aware of the severity of these types of infections, which often require surgical management and intravenous antibiotics covering Pseudomonas.