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Interviewer: All right, it's time to play the game ER or Not, where you get to play along and decide whether something that happened is worth going to the emergency room or not.

Dr. Troy Madsen is an emergency room physician at ÈËÆÞÖгöÊÓƵ of Utah ÈËÆÞÖгöÊÓƵ. All right, here is today's ER or Not. You've got your ear pierced. Now you believe that there might be an infection in the ear. ER or not?

Dr. Madsen: So when you think of an ear piercing, you might think, "Okay, this is a pretty minor thing." Maybe you got your ear pierced, maybe there's just a little bit of redness around it. And again, that would be a pretty minor thing and something you don't need to go to the ER for if it's just some local irritation or maybe just a small infection. You could probably go to an urgent care or go see your doctor. But there's so much else going on around the ear that can really cause problems.

So the ear is made of cartilage. If you get an infection that's spreading up beyond just the site of the piercing, where the full ear appears red and swollen or just even the lower half of it, then I would be a lot more concerned about an infection in the cartilage itself, and that would definitely be a reason to go to the ER.

Why Cartilage Infections Are Harder to Treat

Interviewer: So a cartilage infection is a lot worse than infections elsewhere. Why is that?

Dr. Madsen: It's just tougher to treat, you know? You figure cartilage doesn't have all of the blood going into it. You don't have all the vessels running into it so if you start antibiotics, it has a tougher time getting into that. So if you have an infection that's getting down into the cartilage of the ear, we may need to think about IV antibiotics, you know, something where we're admitting you to the hospital for that. And then behind the ear as well, the bones back there are notorious for getting infected and that can be a very serious thing as well.

So if someone comes into the ER and they've got ear pain and ear swelling, and then I push on the bones behind the ear, kind of at the base of the skull there, and they're really tender there, that can be a very serious thing too. And that, typically, requires IV antibiotics, sometimes even surgery.

Infections and Potential Hearing Loss

Interviewer: So beyond the dangers of an infection, which infections aren't good, is there a danger to the actual ear itself if this goes untreated?

Dr. Madsen: Absolutely. Yes, I mean, you could have damage to the cartilage, you can have a breakdown of that cartilage, something that could cause long term issues, possibly deformity there.

Interviewer: So they're hearing loss?

Dr. Madsen: Absolutely. If you get enough swelling in there and enough long term issues, you could have some sort of, at least, hearing impairment or hearing issues. So, you know, it's kind of the thing again you hear about it, maybe an infection from an ear piercing sounds pretty minor but there's just so much going on around the ear. If that infection spreads, if it's deep or if it's into the bone absolutely come to the ER. Probably IV antibiotics, hospital admission for that.

Interviewer: So be sure you're going to a reputable place and don't let your friends do it, I guess is the lesson here, right?

Dr. Madsen: Yes. To me, too many memories as a kid of seeing kids in the boy's bathroom with a needle, stick it into the ear trying to piece their ear. You don't want to do that. This is not a home procedure.

updated: June 19, 2020
originally published: April 28, 2017