Feb. 24, 2004 -- It's been done for centuries and few would consider it a medical procedure. But in some cases a routine piercing of the ear can result in some seriously unpleasant consequences.
Case in point: An outbreak of serious ear infections related to commercial ear piercing in Oregon affected 25 people out of 118 who received piercings. Seven people ages 10- to 19 years old had confirmed infections, and 18 had suspected infections — all from the same jewelry kiosk. Some had to be hospitalized and some ended up with ear deformities.
All of the confirmed infections, outlined in a report in the latest Journal of the American Medical Association, involved the cartilage of the upper ear. The report adds the risk of getting disfiguring ear infections is almost four times greater if the upper ear cartilage is pierced rather than the lower ear lobe.
The culprit? Pseudomonas aeruginosa, a common bacterium found in soil, on plants, in your shower, even on your hands, but which in certain situations, has the potential to cause serious infections.
Ironically, in the Oregon case, it was a disinfectant bottle that became infected with bacteria. The bottle was then continually refilled and used to spray equipment and skin before piercing. In addition, an open, spring-loaded piercing gun approved for earlobes but not cartilage piercing, was used.
Cartilage Piercing Riskier
Central to the problem is the location of the piercing on the ear.
Explains Dr. Rajiv Chandawarker, an assistant professor of plastic surgery at the University of Connecticut: "The upper part of the ear contains cartilage, which has little blood supply. The immune system does not have the ability to take care of the infection once it's in the cartilage. It stays there, and on top of that, it's difficult to get antibiotics to that site because blood can't really carry it there."
Added Chandawarker: "Once there is infection, the only choice we have is to take out the cartilage. Depending on how much needs to be taken out, patients might have to undergo reconstruction or they might end up with one ear smaller than the other one."
Brandy Murray, 16, was affected in the Oregon outbreak two years ago, and knows only too well the risks of cartilage piercing.
"I got one earring in my right upper ear cartilage. I always wanted one, so I went to a kiosk where they had an ear-piercing stand. Three days later, I couldn't sleep on it — it was big and really painful. I took out the earring and a lot of pus came out," recalls Murray.
She adds: "I had to have surgery and stayed in the hospital for a week. I couldn't do things I wanted to for a month and half afterwards because I had to heal. It ate my cartilage and now my right ear is smaller because it doesn't have cartilage."
Other Risks … And How to Reduce Them
Bacterial infection may not be the only medical consequence of piercing.
Since piercing involves needles, the risk of a getting a blood-borne infection like hepatitis, tetanus, or HIV is always present. Infections can also spread through the blood to places like the heart valves, and that can be fatal.
Dr. Michael Heffernan, assistant professor of dermatology and director of the Clinical Trials Unit at Washington University in St. Louis warns, "If improper techniques are followed, then there is the real possibility of getting infected with hepatitis or another infection. Even more common though is that some patients have an allergic reaction to the metal in the studs — usually nickel."
Chandrawarker notes there is no uniform licensing or regulation of piercers, but piercing establishments do have to be inspected so must display a certificate.
Other ways to reduce risk, he adds: "Make sure they use disposable equipment, and if there is any problem with redness, swelling, discharge, or pain afterwards, seek help right away. It might end up being nothing, but the price is high if it isn't."
It's also wise to ask about the training and experience of the piercer, what type of metal is contained in the studs to avoid an allergic response, and what aftercare instructions need to be followed.
Heffernan adds you should ask to see where and how the instruments are cleaned. And for those who aren't iodine allergic, the piercing site should be cleaned at least three times beforehand with a Betadine® solution to kill any germs before the stud is inserted.
He also encourages all patients to follow the aftercare instructions closely until the piercing site is well healed. Regular cleaning with soap and water and application of a topical antibiotic can aid healing.
The Best Place for a Piercing?
Heffernan has one more word for parents of teens who want to get pierced: "They're going to do it anyway, so I always tell parents that you can do it with them or they will do it without you. If you go with them, at least you can have input and ask the questions they may not ask."
Still, it's often difficult to judge how clean a place is and what practices it follows.
Dr. William Keene, from the Acute & Communicable Disease Program in the Oregon Department of Human Services, investigated the outbreak and says, "It's a little like eating in a restaurant. You can't really tell for sure what's going on in the kitchen."
Adds Keene: "The vast majority of the time, people heal without any problems, but we need to remind people that there is risk involved. Be aggressive in seeking medical attention if you have any signs of infection. "
What do experts feel is probably the best place to get pierced?
A doctor's office. Some physicians such as pediatricians and dermatologists offer the service and the chances that they use proper techniques are high.