Auricular pressure-relieving cushions for treatment of chondrodermatitis nodularis helicis: a series of 75 cases and a review of the literature

Chondrodermatitis nodularis helicis (CNH) is a relatively uncommon, painful condition affecting the ear. Since the lesions appear to occur only on the pressure-bearing areas of the ear, and never on the concha or ear lobule, it has been postulated that pressure is an aetiological factor contributing to the disease process. Ninety-four patients were treated at the Maxillofacial Laboratory of Queen Victoria Hospital, East Grinstead between 1996 and 2003, with clinically diagnosed CNH. Prior to treatment, each patient was questioned regarding their sleeping position, use of steroids, previous surgery and their use of soft cushions. They were also asked to grade their pain on a scale of 1–5 (1 = no pain, 2 = mild discomfort any time, 3 = night pain only, 4 = moderate pain/tenderness and 5 = severe pain/tenderness). Each patient was individually fitted with a customised ear prosthesis. Mean follow-up time was 51.7 months. Following treatment, 47% of lesions completely resolved, 27% were improved, 25% showed no change and 1% worsened. In the one case that worsened, however, the subjective pain score had improved. Seven patients (9%) went on to have surgery. Twenty-three (31%) patients reported a recurrence of their symptoms after more than 6 months, although only one of these cases had completely resolved previously. While spontaneous remission of this condition has been documented, this is rare. The recurrence rate of the CNH within this study was 31%, a similar figure to quoted post-operative recurrence rates. Conservative management with pressure-relieving devices should be considered before embarking on surgery.