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Causes

1. Anatomical reasons: The blood vessels in the auricle are superficially located, resulting in poor blood circulation, which weakens its resistance to infection. Additionally, the skin of the auricle is thin with little subcutaneous tissue, so during acupuncture, the needle usually penetrates into the cartilage. If the needle or the acupoint area is not properly sterilized, pathogenic microorganisms can be directly implanted into the cartilage or bone membrane, causing inflammation. Moreover, the auricular cartilage has a special affinity for Pseudomonas aeruginosa, which is resistant to common antibiotics, making treatment more difficult.

2. Operational reasons: Inadequate sterilization of the auricle or acupuncture tools. Prolonged needle retention, especially in summer, increases the risk of infection. Excessive pressure on ear points, use of three-edged needles for pricking or incision therapy, or the use of needle-embedding guns overseas, which cause larger injuries, can all increase the incidence of infection. Clinical Manifestations

Auricle infections can be divided into superficial infections and chondritis (membrane inflammation).

1. Superficial infections are often caused by inadequate sterilization, superficial needle embedding, or acupuncture. Symptoms include local skin redness and swelling, epidermal injury, mild pain, surrounding skin congestion, and minor exudation. Excessive pressure on ear points, prolonged duration, especially with repeated twisting, can also lead to this.

2. Auricular chondritis (membrane inflammation) can occur due to deep ear acupuncture or prolonged needle retention with inadequate sterilization. Superficial infections can also spread to the cartilage if not properly treated. Additionally, using inadequately sterilized three-edged needles for deep pricking or incision therapy can injure the cartilage. Symptoms include significant local redness, swelling, heat, and pain, with severe cases showing redness and swelling of the entire auricle, eventually forming an abscess. Systemic symptoms such as fever, headache, loss of appetite, and increased white blood cell count are common. Prevention Methods

1. Strict sterilization is key to prevention. Ear acupuncture tools should be sterilized under high pressure. Before acupuncture, the entire auricle should be disinfected with a cotton ball soaked in 2.5% iodine, followed by deiodination with a 75% alcohol cotton ball. Acupuncture should only be performed after the skin surface is dry.

2. Pay attention to the operation: After needle embedding, fix it with small adhesive tape. The needle retention time should not be too long, generally 2-3 days, and should be shorter in summer. If there is local swelling and pain or significant pain upon pressing within one or two days after needle embedding, consult a doctor immediately. Check for redness and swelling, and do not mistakenly believe that the more painful the ear acupuncture, the better, as this can delay treatment. For three-edged needle pricking or surgical incision therapy, besides ensuring aseptic operation, avoid inserting too deep; pricking the epidermis is sufficient. Ear point pressure, although a simple and safe method, can damage the skin and cause inflammation if the pressure is too heavy or prolonged. We recommend rhythmic simple pressing. Treatment Methods

1. For superficial infections, apply 2.5% iodine locally 2-3 times daily or use anti-inflammatory ointment. Local helium-neon laser irradiation once daily for 3-5 minutes, combined with external application of hydrocortisone ointment, is also effective. Superficial infections, if treated promptly, usually heal within 3-5 days.

2. Auricular chondritis (membrane inflammation) is more common clinically, with auricular chondritis being more severe and difficult to treat.

For less severe cases, moxibustion therapy can be tried. The specific operation is as follows: Use a lit moxa stick (available on the market) to perform direct moxibustion on the inflamed area of the auricle, keeping a distance tolerable to the patient, for 15-20 minutes each time, 2-3 times daily, until the inflammatory fluid is completely absorbed and the inflammation subsides. For suppurative lesions, after disinfection, use a vascular clamp to enlarge the wound, drain all the pus, and then perform moxibustion. If the inflammation is significant, intramuscular injection of penicillin and streptomycin should be used in combination. If there is a large amount of fluid, perform puncture and aspiration under aseptic conditions.

If the condition is severe or cannot be cured by this method, surgical treatment is required, including debridement, drainage, and other methods. If simple incision and drainage methods cannot effectively stop the progression of inflammation, the auricle grid resection technique can be attempted. The method is as follows:

First, perform auricular block anesthesia with 1% procaine (when injecting, avoid introducing pus into healthy tissue). Using a scalpel and small scissors, make 2-3 minor incisions, each about 0.7-1.2 cm long, at the most inflamed areas of the auricle, based on the extent of the lesion, on the skin in front of and behind the ear, either at non-corresponding or corresponding positions. Any necrotic cartilage around the incisions should be excised along with the skin of the incision. Use a curette to scrape away necrotic tissue near the incisions. Prophylactically remove 0.2 cm of surrounding non-necrotic cartilage as much as possible.

After excision, rinse thoroughly with sterile saline, then rinse once more with 0.1-0.2% gentamicin solution, followed by wiping with alcohol. Insert several skin strips from one incision to another for drainage, ensuring the drainage is unobstructed and preventing the incisions from clotting with blood. Postoperatively, a single layer of gauze dressing is sufficient. Rinse and change the dressing daily, replacing the drainage strips once until the redness and swelling subside and secretions are controlled. If redness and swelling reappear postoperatively and the inflammation continues to develop, perform additional incision excisions as described above.

While applying the above surgical methods, it is advisable to combine the use of antibiotics and Chinese herbal medicine for clearing heat and removing toxins, or local laser irradiation.

Case Example

The patient, a 47-year-old female, had a needle embedded in her right ear during a weight loss treatment. Subsequently, she experienced redness, swelling, and pain in the ear. Initially, hydrogen peroxide was used to clean the affected area, and anti-inflammatory ointment was applied, but this method was ineffective. She then consulted a doctor, who diagnosed her with ear chondritis, with a white blood cell count reaching 20,000/mm³. She was hospitalized and treated with gentamicin injections (she was allergic to penicillin), along with debridement and drainage measures. Two weeks later, the inflammation was controlled, but most of the ear cartilage tissue had fibrosed, leaving her with auricular deformity (39).

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This case reports an overseas patient who suffered severe ear chondritis due to inadequate sterilization during ear acupuncture for weight loss. Despite taking various active measures, it still resulted in auricular deformity, a lifelong regret, which should indeed serve as a cautionary tale.