What are the other Names for this Condition? (Also known as/Synonyms)

• CDNH (Chondrodermatitis Nodularis Helicis)
• Perichondritis of Pinna
• Winkler’s Disease

What is Chondrodermatitis Nodularis Helicis? (Definition/Background Information)

• Chondrodermatitis Nodularis Helicis (CNH) is a small inflammatory growth (red sore) that forms on the outer surface of the ear cartilage. Any pressure to the area of the lesion is intensely painful
• Chondrodermatitis Nodularis Helicis is derived from the terms ‘chondro’ meaning cartilage, ‘derma’ meaning skin, ‘itis’ meaning inflammation, ‘nodularis’ meaning bump, and ‘helicis’ that forms a part of the outer ear rim
• Chondrodermatitis Nodularis Helicis is a common skin condition of the ear that can cause severe discomfort and be annoying. It most frequently occurs due to chronic pressure (compression) on the ear. CNH is frequently observed in elderly men
• The outlook of Chondrodermatitis Nodularis Helicis is good with conservative non-surgical therapy and lifestyle changes; in some individuals, surgery may be required. In about 30% of the cases, CNH may recur

Who gets Chondrodermatitis Nodularis Helicis? (Age and Sex Distribution)

• Chondrodermatitis Nodularis Helicis (CNH) can affect individuals of any age; however, it is most commonly observed among adults over 50 years old
• CNH is much more common in men than women in the ratio of 10:1. Some studies show that the lesion or bump is generally seen on the helix (outer rim of the ear, top portion) in men, whereas the lesion is more common on the antihelix (inner rim of the ear, just around the conchal bowl - the well into which a hearing aid might be fitted) in women
• There is no racial or ethnic preference noted; CNH occurs in men and women all over the world. There is no particular geographical restriction observed

What are the Risk Factors for Chondrodermatitis Nodularis Helicis? (Predisposing Factors)

The following factors can be risks for developing Chondrodermatitis Nodularis Helicis:

• Exposure of the ears to cold weather
• Exposure of the ears to the sun and the resulting damage
• Trauma to the ear either once or multiple times
• Factors that may augment or aggravate the ear condition, including the use of headphones, ear muffs, headsets, the use of turbans or tight headgear/headwear, etc.

Note: Not all individuals are known to have an obvious trigger that can cause Chondrodermatitis Nodularis.

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Chondrodermatitis Nodularis Helicis? (Etiology)

The exact cause of Chondrodermatitis Nodularis Helicis (CNH) is unknown. It may develop in individuals without a risk or precipitating factor. However, researchers believe that the possible cause for this condition is continuous and chronic pressure on the ear. This may occur due to:

• Sleeping on the same side for prolonged periods
• Regular use of headphones and headsets
• It can be also caused from exposure to cold weather or to the sun

Researchers believe that in some individuals the arteriolar (very small blood vessel) narrowing may play a role. The blood supply and the anatomy of the rim of the ear may also play a role in the development of CNH.

• The rim of the ear has very little subcutaneous tissue that can act like a cushion; thus, it has the potential to get damaged even with minimal trauma
• Blood supply in the ear cartilage is comparatively lesser than to other parts of the face, which may prevent adequate healing (especially as one gets older)
• Cartilage is much slower to heal than skin and most skin-adjacent structures

What are the Signs and Symptoms of Chondrodermatitis Nodularis Helicis?

The signs and symptoms of Chondrodermatitis Nodularis Helicis include:

• The individuals generally present with one small swelling or lump on the top curve of the outer ear
• In most cases, the lump appears suddenly, then enlarges to measure 4-12 mm in size
• The swelling is generally red and sore. It usually is apparent visually and by palpation (feeling) as a growth on the cartilage
• The lesion may have scabs (crusts), scales, or an ulcer over it
• This benign bump is usually painful. Sometimes, the pain can be brought on by sleeping on the affected side
• CNH can cause severe discomfort and disruption while sleeping
• Occasionally, the pain can be brought on by exposure to cold weather
• During physical examination, the lesion can be painful to touch and is clearly distinguishable from the surrounding areas. Sometimes, its appearance mimics skin cancer

How is Chondrodermatitis Nodularis Helicis Diagnosed?

The following procedures may be used to diagnose Chondrodermatitis Nodularis Helicis:

• Thorough evaluation of the individual’s medical history and a complete physical examination, including of the ear. CNH is usually diagnosed by history and physical examination
• During history taking the physician may want to know the following:
  • When the symptoms began and whether they are becoming worse
  • About the presence of risk factors that may result in Chondrodermatitis Nodularis, such as sleeping position, use of headphones, etc.            
• In situations where the diagnosis is not clear, or if the condition resembles a cancer, then biopsy of the lesion may be required
• Tissue biopsy: In this procedure, the physician removes a sample of the skin tissue and sends it to the laboratory for a histopathological examination. The pathologist examines the biopsy under a microscope and arrives at a definitive diagnosis after a thorough evaluation of the clinical and microscopic findings, as well as by correlating the results of special studies on tissues (if required)

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Chondrodermatitis Nodularis Helicis?

Chondrodermatitis Nodularis Helicis (CNH) is a common benign (non-cancerous) condition. It is improved with either non-surgical or surgical approaches. The complications are few and may include:

• Recurrence: The lesion can recur (in up to 30% of the cases) even after successful treatment
• Disturbed sleep for many months because the lesion may take a long period to heal
• Superimposed bacterial infections
• CNH is not associated with any other illnesses

How is Chondrodermatitis Nodularis Helicis Treated?

The swelling rarely resolves on its own and would therefore require some form of therapy, if it is causing symptoms. The treatment options for Chondrodermatitis Nodularis Helicis (CNH) include:

• Lifestyle changes are the initial approach, which is meant to decrease the pressure on the lesion and help the lesion to heal
• The affected individuals should avoid using headphones or headsets, if possible. They may switch from “over the ear” headphones to earphones/earbuds
• Use a soft pillow to sleep to avoid pressure on the ear. Another option would be to sleep on a pillow with a “donut” hole
• A protective headgear may be made using a bath sponge or foam. There are also over-the-counter devices available to protect the ears from external trauma
• Silicone splints can help reduce pressure on the ear
• Avoid excess exposure to cold weather or sun
• Petrolatum jelly is helpful, if there is ulcer on the lesion
• Nitroglycerin cream may benefit some individuals
• If a bacterial culture of the area reveals disease causing bacteria, oral and topical antibiotics can be helpful

If conservative measures and lifestyle changes do not improve the condition; then, the physician might consider the following options:

• Corticosteroid injections into the lesion may relieve the discomfort
• Tissue fillers may be injected into and around the lesion. By doing so, a cushion is created between the skin and the underlying cartilage preventing further damage and allowing it to heal. The fillers used for cosmetic purposes would be employed
• Freezing and destroying the swelling with liquid nitrogen (cryotherapy), ablative laser, or electrical cautery
• Surgery might be needed for some cases. Under local anesthetic, the damaged cartilage is excised along-with the unhealthy overlying skin. Both cartilage and skin are sutured in separate layers. Protective bandaging for several weeks are required to avoid the same forces that created CNH from disrupting the surgical repair

How can Chondrodermatitis Nodularis Helicis be Prevented?

Chondrodermatitis Nodularis may be prevented by:

• Avoiding excessive pressure on the ear by switching sides while sleeping
• Minimizing the use of any devices or instruments that compresses the ear
• Avoiding excessive exposure to cold weather and sun

CNH cannot be prevented once the lesion has occurred. However, one can avoid the occurrence of future lesions in vulnerable individuals.

What is the Prognosis of Chondrodermatitis Nodularis Helicis? (Outcomes/Resolutions)

• Chondrodermatitis Nodularis Helicis (CNH) usually resolves with treatment. But the condition may sometimes persist for several months
• Recurrence of CNH is possible even after surgery in some individuals

Additional and Relevant Useful Information for Chondrodermatitis Nodularis Helicis:

Biopsy of the tissue (from the ear lesion) may identify ulceration in the center and acanthosis and hyperkeratosis in the periphery; granulation tissue may be seen under the ulcer; and vessel proliferation may also be seen.