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Piercings Can Come With a High Price

Infections in upper ear are common, doctors suspect

TUESDAY, Feb. 24, 2004 (HealthDayNews) -- Getting your upper ear pierced in a shopping mall might seem like a cool idea to some, but in one Oregon mall seven teenagers paid the price with badly infected ears.

The primary culprit appeared to be the misuse of a spring-loaded piercing gun, which shoots a stud through ear tissue.

This device was designed to pierce the ear lobe and should never be used on the upper ear, explains Elayne Angel, a well-known body piercer and medical liaison for the Association of Piercing Professionals (APP).

"The APP supports using sterile disposable equipment, which is not what ear stud guns are," she says. "Stud guns cannot be sterilized, and are not appropriate for either an ear lobe or cartilage piercing."

Having your upper ear pierced is nothing like getting your ear lobe pierced. The big difference is that your upper ear is made of cartilage, which is a soft, bone-like material, unlike your ear lobe, which is soft tissue. Because cartilage heals differently than soft tissue, it's riskier to have your upper ear pierced, Angel says.

In a paper published in the Feb. 25 issue of the Journal of the American Medical Association, researchers report on seven cases of Pseudomonas aeruginosa, a bacterial infection caused by upper ear piercing at a jewelry kiosk in an Oregon mall.

"People who were going into this shop to get their ears pierced were coming out not only with their ears pierced but with Pseudomonas aeruginosa infection as well," says lead researcher William E. Keene, an epidemiologist at the Oregon Department of Human Services.

Of 118 people who had their ears pierced from August to September 2000, there were seven confirmed cases of infection. And several of the patients ended up with a visibly deformed ear, Keene says.

This episode confirmed that cartilage piercing is more dangerous than ear lobe piercing, Keene says. "Ear piercing in its own small way is an invasive procedure, and infection control is important," he says.

Piercing guns are prohibited for piercing anything but ear lobes in Oregon and several other states, Keene says. In addition, most of the kiosk employees had little or no training, he adds.

Keene says some workers sprayed the gun and the sterile stud with a commercial disinfectant. The researchers found bacteria growing in the disinfectant, he notes.

Another problem was that doctors misdiagnosed the problem in some of the patients. They treated the infection like a regular skin infection, and gave the patients the wrong antibiotic, the study says.

Keene believes the problem isn't confined to this one outbreak or to the 40 or 50 people in Oregon who get infected each year. Based on the number of infections in Oregon, he speculates that several thousand people each year in the United States get Pseudomonas aeruginosa infection from ear piercing.

He also warns that in some people, the infection can affect the whole body, leading to a potentially fatal infection of the bloodstream called sepsis.

"If you want to have your upper ear pierced, you should try to seek out a place where they are knowledgeable about infection control," Keene advises. "But you are at the mercy of the operators when you go into one of these places."

You should pay careful attention to the after-care instructions piercers give you and try to follow them, Keene says. "With cartilage infections, the wound may not heal for months, and during that time you're at risk for infection. If infection does develop, get medical attention, and don't assume it's a minor problem that will go away by itself," he stresses.

If you want your ear or any other body part pierced, Angel recommends looking at the APP Web site to find a piercer. "APP piercers hold up a very high standard of hygiene and safety," she says. She also believes that all piercing should be regulated by states.

Myrna Armstrong, a professor at Texas Tech University Health Sciences Center School of Nursing, says health experts have been aware of the link between piercings and infections for years. She has been working with body piercing since 1995.

Stud guns, she adds, can't be adequately sterilized or decontaminated. "This paper confirms that there really is a problem."

If you are set on getting your ear pierced, avoid shopping malls and kiosks, Armstrong says. Find an experienced body piercer who understands sterile techniques, she adds.

More information

The National Institutes of Health has more information on body piercing. To learn more about Pseudomonas aeruginosa, visit the University of Wisconsin.

SOURCES: William E. Keene, Ph.D., M.P.H., epidemiologist, state health department, Oregon Department of Human Services, Portland; Elayne Angel, spokeswoman, Association of Piercing Professionals, and owner, Rings of Desire, New Orleans; Myrna Armstrong, Ed.D., R.N., professor, Texas Tech University Health Sciences Center School of Nursing, Lubbock; Feb. 25, 2004, Journal of the American Medical Association
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