Cauliflower ear. The phrase conjures up visions of flat-nosed ex-boxers with a stogie clamped in their teeth, not a pretty blond 15-year-old. But these days, that's who is most likely to end up with an auricular hematoma, or cauliflower ear – a condition that is on the rise because of the recent craze of piercing the cartilage at the top of the ear.

The more piercings, the more danger there is that problems will result. Auricular hematoma is precipitated by trauma to the ear and, unfortunately to an ear, trauma is trauma, whether it is from a gloved blow to the head or driving a metal post through with a piercing gun.

More than just an ugly lump, cauliflower ear can result in a life-threatening infection, as it almost did with my daughter, Wende. Fortunately, she was left with just a small scar, but some cases of upper-ear piercing result in such unsightly damage that reconstructive surgery is warranted.

Worst Case Scenario
That's what happened to Anna Hartle of Advance, Mo. In July of 2001, when her mother, Beverly Rose, offered her a treat to thank her for a summer of helping to care for her younger siblings, Anna chose to have her upper ear pierced.

"Not only did I never consider it a problem, my friend and I thought it was so cool we considered having it done ourselves," says Rose.

Then, after about a week, it began to swell. Rose wasn't concerned, because Anna had been following the directions she had been given, so she told Anna to just keep cleaning it. After a few days, it looked worse and was becoming painful. Anna took her earring out, and her mom took her to the doctor where she was put on antibiotics.

By the next day, the ear had swollen to twice its size, but Rose assumed the antibiotics were working. Coincidentally, she had an appointment to give blood at a blood drive that day, and she took Anna along. One of the RNs there noticed Anna's ear and urged Rose to take her to the emergency room immediately.

By the time Anna arrived at the emergency room, she was running a fever. The emergency room doctor took one look at her and called in an Ear, Nose and Throat (ENT) specialist who told them that Anna needed to go to Children's Hospital of St. Louis. There, the ENT drained the fluid from Anna's ear to culture the bacteria.

"When they drained Anna's ear, it completely went flat, as if there was no ear there at all," says Rose. "It was really scary."

The culture came back positive for pseudomonas bacteria, which had completely eaten away the cartilage in Anna's ear. She was admitted to the hospital, where she was kept for five days. Even then, she had to wear an IV line in her hand for another two to three weeks to make sure the infection didn't recur.

Unfortunately, there wasn't anything they could do to make the cartilage come back. Anna still has to have reconstructive surgery to make her ear look normal, but her doctor wants to wait at least a full year after the infection is completely gone.

Mall Menace
Dr. Gregory Branham is going to be performing Anna Hartle's reconstructive surgery. He is also a professor of otolaryngology at St. Louis University School of Medicine. Although he says the procedure should be kept in perspective, because the majority of people don't have problems, they have definitely seen an increase in cartilage damage due to high ear piercings and to nose piercings.

In most cases, including Anna Hartle's, Dr. Branham believes infections are caused by inadequate sterilization. Most teens get their ears pierced at kiosks or stores in a mall or boutique. Although the employees may be very conscientious, just swabbing the area to be pierced with an antiseptic solution is not enough to kill the bacteria on the skin. When the stud of the earring is shot through the ear, it catches and drags some of that bacterium through the open wound and "seeds" the bacteria in the cartilage. The bacteria then feeds off the cartilage, and the infection simmers until it becomes a full-blown abscess.

Dr. Branham hasn't seen this same level of complication with other types of piercings, such as regular ear lobe piercings, tongue piercings or lower lip piercings, because they involve mostly skin and fatty tissue. Although he does caution that any body piercing carries a certain level of danger from infection. Also, in the case of tongue piercing, the after effects can be severe, such as swelling that lasts for weeks.

In an extremely rare case, Drs. Richard Martinet and Elizabeth Cooney, infectious disease specialists at Yale University, tell of a young woman developing a near-fatal brain abscess that they believe resulted from a tongue piercing. Other dangers of tongue piercing, aside from the initial pain and swelling, are chipped teeth from metal studs and difficulty eating.

Piercings in the belly button and more private body parts can include complications in the case of emergency situations when X-rays may be needed.

How to Avoid Piercing Problems
Although most medical professionals are hoping the growing trend of piercings – especially piercings of unusual body parts – starts to die down, they also suggest that the best place to get a piercing done is the doctor's office. Just wiping down piercing instruments with antiseptic isn't enough. The instruments should be autoclaved and the skin around the piercing professionally sterilized.

After the piercing, handling of the area should be kept to an absolute minimum to alleviate the risk of infection from bacteria on hands. Follow all directions for cleaning, but use sterile gauze or cotton tips. The area should also be watched closely for any sign of infection such as swelling or discharge.

Anna Hartle is not planning on getting any more piercings under any conditions. In fact, she's talked a couple of her friends out of it. They may only listen to their parents' warnings with half an ear, but actually seeing Anna's half an ear is enough to turn them toward a safer form of self-expression.

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