Cartilage Piercing today and diving in 8 days time!

[Duke Dive Medicine]

OK, here's the deal. I'll cover perichondritis and cerumen, you take everything else! The longer I am in practice, the smaller my wheelhouse gets.

Hahah give yourself a little credit mate!

 

[Steve_C]

From time to time I may have a small wound that I am not sure it is completely healed. I will bath it in antibiotic cream and then cover with one of those waterproof bandages which I find really do work pretty good. Not for anything major, just minor nicks. Not saying it is the correct way to go (I am the wrong kind of doctor) but so far have never had even a minor infection from it. Location of your piercing may make waterproof bandaid application more difficult

 

[doctormike]

From time to time I may have a small wound that I am not sure it is completely healed. I will bath it in antibiotic cream and then cover with one of those waterproof bandages which I find really do work pretty good. Not for anything major, just minor nicks. Not saying it is the correct way to go (I am the wrong kind of doctor) but so far have never had even a minor infection from it. Location of your piercing may make waterproof bandaid application more difficult

After five billion years of evolution (not applicable in some states), our immune systems have gotten pretty good at dealing with all sorts of trauma and breaks in the skin. I rarely see complications from exposure of small nicks and cuts to sea water. Trauma to the area (abrasion from gloves, exposure suits, tools, etc.. can certainly delay healing. However, it is pretty uncommon for minor local trauma to cause an infection which spreads into the surrounding soft tissue (cellulitis), as long as there is a functioning immune system and good circulation.

Important exceptions to this are tissues that do not have the same blood supply, and which are rarely exposed in minor trauma - cartilage and bone. That's the reason why an ear cartilage piercing involves risks that an earlobe piercing does not, and it's the reason why a compound fracture (exposed bone fragments) is much more of an emergency than a closed fracture.

 

[mbs]

Would it make sense to go on Levaquin prophylactically?

 

[doctormike]

Would it make sense to go on Levaquin prophylactically?

I wouldn't do that. You shouldn't use antibiotics without an infection unless you are prophylaxing for a medical reason like cardiac valve disease, ureteral reflux, etc...

Prophylaxis is becoming less and less popular, because of the risk of developing resistant organisms.

 

[W W Meixner]

View attachment 546520
hi guys! i just got a cartilage piercing today on both ears and i’m going on a diving trip in 8 days time. anybody had any experiences on diving with a fresh cartilage piercing ? :’( read online only after the piercing and found out that it’s prone to infection. i’m thinking will getting an adjustable hood or wearing a swimming cap help?

Estrella...

You can't un-ring the bell...

W...

 

[Valyngar]

Basically true but just one clarification. The pinna itself (the part of the ear that sticks out) has excellent vascularization of the soft tissue (skin and fat), and that part tends to heal well from surgical incisions, etc.. But the cartilage (the stiff part of the pinna that does not include the earlobe) gets its blood supply from the perichondrium, which is a layer that surrounds the cartilage itself. Just like in the nose, anything that interrupts the supply from the perichondrium can cause death of the underlying cartilage, with deformity as the dead tissue fibroses (becomes stiff with scar tissue). This is the way that a "cauliflower" ear forms. Trauma (classically from boxing or wrestling) cause a hematoma (a collection of blood) under the perichondrium, interrupting the blood supply to the cartilage. This can also happen with the nasal septum, and draining a hematoma like this is therefore an emergency.

With cartilage piercings, the issue isn't so much blood supply but contamination of cartilage, which can cause infections that can be difficult to treat. Usually, after a few months, the piercing tract has healed over, so the cartilage is no longer exposed to the outside world. But you can definitely have complications like this, with permanent deformity of the ear.

If there is any sign of significant infection, topical antibiotics may not be enough. The treatment is removal of the piercing and oral antibiotics may be required. Generally, for patients over 18, we use fluoroquinolone drugs like Levaquin, since they are one of the few drugs that treat pseudomonas bacteria (a common external ear organism). If you go, maybe get that at home in case you are going someone with no access to medical care, along with a topical ointment.

There really isn't any reliable way of keeping the ear completely dry when diving. As DDM said, I wouldn't rely on anything for that. If anything, a hood or pro-ear mask might make things worse by rubbing against the fresh piercing.

Why wouldn't you use in this case fucidin acid ointment as profylaxis before and after dive? Also isn't fluoroquinolone kinda overshooting it before bacterial swap results. We usually use cephalexin.

 

[doctormike]

Why wouldn't you use in this case fucidin acid ointment as profylaxis before and after dive? Also isn't fluoroquinolone kinda overshooting it before bacterial swap results. We usually use cephalexin.

Good question!

First of all, Pesudomonas species are a very common external ear organism, so just on empirical grounds, there is a good chance that any perichondritis will involve that organism. There is certainly evidence that not covering this organism initially in piercing related infections can result in significant long term deformity, with poor outcomes even if surgical reconstruction is attempted later.

Second, consider two scenarios - cellulitis (the ear is red and swollen) and abscess (there is a collection of pus). If you culture an ear with cellulitis, you are just swabbing the skin, and there is a poor correlation between what is living on the skin (often benign, non-invasive skin organisms like staph epidermidis), and the bacteria causing the infection of the underlying perichondrium. Ironically, you may have the reverse problem than the one you describe. Since pseudomonas lives in pretty much every ear canal, your culture might reveal pseudomonas when the actual invasive organism is something else, so you may end up overtreating.

If there is an abscess, that is a serious infection that needs - in addition to surgical drainage - aggressive and complete antibiotic coverage. Since pseudomonas is the most likely organism, I would definitely not wait the 2-3 days it might take to get the results of a culture and sensitivity panel before treating, and treatment in that case should be empirical (based on likely organisms, not culture), and cover pseudomonas. While you would definitely send cultures at the time of drainage, and possibly refine your antibiotic coverage later depending on those results, you would still start antibiotics immediately and they should cover likely organisms such as pseudomonas.

Of course, the idea of using a culture to determine antibiotic choice implies that you have the ability to actually get an accurate culture (and sensitivity) done, which is not a given in many dive destinations.

Topical ointment is not a bad idea to prevent an infection, but probably more because it facilitates healing and epithelialization of the tract (that is, skin grows along the path of the piercing to cover the cartilage) by reducing friction.

Of course, this is all predicated on the idea that the OP is having an elective piercing and doing an elective dive trip, and making the choice of putting those two things together within a few days. Unlike most of the questions in the dive medicine forums, where we come down pretty hard on people promoting unsafe diving practices because of the risks of serious injury or death, in this case the OP would be taking a small risk of a significant cosmetic injury to avoid rescheduling a dive trip. So that would be up to them. If it was me I would bring Levaquin. Or perhaps I would have had this discussion before the piercing, and just done it after the dive trip!

 

[arew+4]

My worthless nonmedical advice follow at your on risk.

Copious globs of Neosporin or the like pre dive, through wipe down followed by isopropanol flush post dive. Do this every dive even on the boat between dives.