Problems with ear piercing

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Krystal is seven going on seventeen and is brought in by her mother because she is unable to take her earrings out.  She had her ears pierced a week ago.

 

Bottom Line

  • Infection due to poor hygiene is the most common complication of ear piercings
  • The mainstay of treatment is removal of the foreign body not antibiotics
  • Infection (often with Pseudomonas spp.) is more likely in high cartilage piercings

 

What are the standard methods used in high street ear piercing?

Most high street piercers (as opposed to specialty piercing/tattooists) use a gun that fires a blunt stud through the lobe.  This is then attached to a butterfly to keep the earring in place. Professional piercers use a hollow needle to form a track for the stud.

What are the potential complications?

Early infection is common especially in children who may not be as fastidious as teenagers with hygiene with their piercings.  Lobe piercings may become infected leading to oedema and swelling around the retaining butterfly.  Higher piercings through the cartilage are at risk from perichondritis.  Both may lead to later piercing-related keloid formation.

Nickel alloy piercings can lead to contact dermatitis.

A piercing is also a great handle for bullies to grab and rip out.

Sounds like Krystal has a retained butterfly, how do you go about releasing it?

The technique is essentially the same no matter what the age.  The challenge is providing adequate pain relief and/or sedation to an inflamed ear.  Younger children respond well to topical EMLA with adjunctive nitrous, whereas older children may need only need some EMLA and ice.  Very occasionally true procedural sedation is required.

Using sterile technique identify the point where the back of the butterfly is nearest the surface of the skin on the back of the lobe and make a small nick.  Then push on the front of the lobe to expose the butterfly, like shelling a pea.  You should then be able to remove the backing without difficulty.  There may be a small amount of bleeding that can be covered with a sticking plaster.

What is perichondritis?

High piercings can lead to infection of the cartilage and overlying soft tissue with possible disfiguring abscess formation.  The commonest organisms involved are Pseud. aeruginosa and Staph. aureus

How do you treat it?

They may require IV anti-pseudomonal antibiotics as well as removal of the foreign body.

What advice would you give Krystal about getting her ears pierced again?

She should  wait until the wound has healed and choose an alternative site, ideally done by a professional piercer and be meticulous when it comes to hygiene.

 

Outcome

Krystal screams when you try to remove the butterfly under nitrous so you elect to perform procedural sedation using intravenous ketamine and EMLA.  Whilst adequately sedated and no longer wriggling, you manage to pop the butterfly out without further fuss.

 

References

“High” ear piercing and the rising incidence of perichondritis of the pinna Junaid Hanif, Adam Frosh, C Marnane, K Ghufoor, R Rivron, G Sandhu BMJ. 2001 April 14; 322(7291): 906–907

Fijałkowska M, Pisera P, Kasielska A, Antoszewski B. Should we say NO to body piercing in children? Complications after ear piercing in children. Int J Dermatol. 2011 Apr;50(4):467-9

Timm N, Iyer S. Embedded earrings in children. Pediatr Emerg Care. 2008 Jan;24(1):31-3

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About 

An Emergency Physician with a special interest in education and lifelong learning. When not drinking coffee and reading Batman comics he is playing with his children.

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