Chondrodermatitis Nodularis Helicis
What is it?
Chondrodermatitis nodularis helicis is a painful inflammatory condition affecting the ear. Chondrodermatitis nodularis helicis is
inflamed cartilage of the ear with small, intensely painful nodules on the rim
or border of the helix of the ear. Chondrodermatitis nodularis helicis (CNH) is most
often seen in middle-aged men and results in a benign tender lump in the
cartilaginous portion of the ear. Although not a rare condition in females,
women account for approximately 10% of the cases. Blacks as well as whites may
be afflicted. The affected area may only be a few millimeters wide but to lie
on it causes exquisite discomfort. There is often a tiny central core which may
discharge a small amount of scaly material. The cause appears to be pressure
between the head and the pillow at night. CNH occurs in people who sleep
predominantly on one side. There is no correlation with occupation, season, or
geography, except that local repeated trauma to the ear may be a factor in
telephone operators, and in nurses or physicians using a stethoscope. Hearing
protectors can also contribute to chondrodermatitis.
It can be precipitated by minor trauma, such as tight headgear or a telephone
headset, or by exposure to cold. Reduction in the local blood supply of the ear
with aging prevents adequate healing.
What causes it?
Several
anatomic features of the ear appear to predispose it to this distinctive
clinical picture. First, the ear's exposed position
subjects the ear to constant mechanical trauma. Environmental trauma from sun,
wind, and extremes of temperature also has an effect. Trauma leads to thinning
of skin, thinning of cartilage, loss of elastic tissue, and severe degenerative
vascular and connective tissue changes. These changes multiply the ear's
vulnerability to injury. Second, there is no subcutaneous tissue padding the
external ear to insulate it. Third, only small dermal blood vessels supply
nourishment to the skin of the ear and elastic cartilage below. Fourth, cartilaginous aberrations common in the area of the human
ear where the painful nodule localizes. It seems probable that minor
trauma often precipitates focal dermal inflammation, edema, and cartilage
necrosis to initiate the disease. Inadequate circulation prevents tissue repair
and leads to secondary cartilage inflammation (perichondritis)
and epidermal damage.
How does it progress?
An
intensely painful, small, firm nodule on the helix of the ear is typical only
of the injured and inflamed cartilage of chondrodermatitis nodularis helicis.
Characteristic histopathology under the microscope establishes the diagnosis in
the doubtful lesion. Typical lesions are firm, non-mobile, round to oval, with
sloping margins, either embedded in the ear's skin or elevated several
millimeters. Chondrodermatitis nodularis helicis nodules of the ear appear spontaneously,
enlarge quickly to maximum size, and can then remain stationary unless altered
by infection or trauma. Pain or tenderness is almost always the initial presenting
complaint. Pain or tenderness of the ear may occur spontaneously, or may be
intensified by pressure or cold. Intense pain and stabbing sensations lasting
several hours can be common. Removal of the crust may relieve the pain. A
history of ulceration or drainage frequently obtained. Because of the location, chondrodermatitis nodularis helicis may be associated with precancers and cancers of the ear. The chondrodermatitis nodularis helicis is not
cancerous, but sunexposed ears in and of themselves
are often at high risk for skin cancer. No significant relation with any
systemic disease has been found. Spontaneous disappearance has been noted but
is rare. Remissions of months to years may occur, but the disease generally
continues to be active indefinitely unless adequately treated.
How is it treated?
It is important to avoid
sleeping on the affected ear. Check that your pillow is soft and consider
fashioning a "hole" in it so there is no pressure on the painful
spot. Try to sleep evenly on both sides, but it is best not to sleep on your
ears. Wear a warm hat over the ears when
outside in the cold and wind. If the CNH
is ulcerated, apply an antibiotic ointment under a light dressing. Dr. Jacobs may treat the lesion with a
cortisone injection or freeze it with liquid nitrogen. High-potency topical
corticosteroids are occasionally effective and should be tried first. Single or
multiple intralesional injections of corticosteroids
will often cause lesions to regress or disappear (triamcinolone acetonide 10 to 40 mg/ml). Cryosurgical, chemical, or
electrosurgical ablation is often helpful. The definitive treatment, excisional
surgery, eliminates the mechanical squeezing of the dermis by removing the
pathologic tissue. Excision relieves the pain by cutting the nerves, and
reduces the amount of projecting rim of helical cartilage. Unfortunately, even excision, recurrence rates of 18% and 31% have been
reported. Because chondrodermatitis nodularis helicis is caused by
repeated trauma, the most important point in treatment is to stop the offending
trauma. This means, that the patient must do something about the hard telephone
against the ear. Suggestion: Use a phone pad. This also means that the patient
should avoid sleeping on the affected ear. A special pillow made for patients
with chondrodermatitis nodularis helicis is available by calling: 800-255-7487 or
915-675-5452. This pillow is shaped like a donut with a hole in the middle. The
address: CNH Pillow, Inc. P.O. Box 1247 Abilene, Texas 79604 Toll Free: (800) 255-7487
|