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Evaluating ear cartilage piercing practices in London, UK

Published online by Cambridge University Press:  09 June 2014

R Mandavia ,
K Kapoor ,
J Ouyang  and
H Osmani
R Mandavia*
Affiliation:
Academic Surgery, Northwest Thames Foundation School, London, UK
K Kapoor
Affiliation:
ENT Department, Guy's Hospital, London, UK
J Ouyang
Affiliation:
Imperial College London, School of Medicine, London, UK
H Osmani
Affiliation:
North Middlesex University Hospital, London, UK
*
Address for correspondence: Dr R Mandavia, ENT Department, University Hospital Lewisham, Lewisham High Street, London SE13 6LH, UK Fax: 0207 723 3281 E-mail: rishimandavia@gmail.com
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Abstract

Background:

Ear cartilage piercing is increasingly popular and has a significant complication rate. Contrary to popular belief, there are no minimum qualifications required to practice ear piercing. This study evaluated ear cartilage piercing practices in London, UK.

Method:

Practitioners at 25 piercing parlours completed a telephone questionnaire assessing piercing practice.

Results:

Ninety-six per cent of practitioners were aware of the risk of infection post-piercing. Four per cent, 12 per cent and 0 per cent of practitioners were aware of keloid scarring, hypertrophic scarring and cauliflower ear respectively. No practitioners were aware of any other complications. Their consent forms did not document any ear cartilage complications. Twenty-eight per cent of participants advised clients to seek medical attention following a complication. Forty per cent did not provide written post-piercing guidance.

Conclusion:

Piercing practitioners were insufficiently aware of ear cartilage piercing complications. It is unlikely that informed consent was obtained prior to piercing. The post-piercing practice of the majority of parlours did not follow published national guidance.

Keywords

EarBody PiercingCartilageRisk
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 128 , Issue 6 , June 2014 , pp. 508 - 511
Copyright
Copyright © JLO (1984) Limited 2014 

Introduction

Body piercing has seen a sharp increase in popularity since the 1970s, particularly amongst teenagers.Reference Waugh1 The ear is the most frequently pierced site, with 80–90 per cent of females undergoing this procedure.Reference Biggar and Haughie2, Reference Cortese and Dickey3 Whilst lobule piercing predominates, there is a growing trend towards ‘high ear piercing’ and tragal piercing. This involves piercing through the cartilage, where the incidence of complications is approximately 35 per cent.Reference Fernandez, Castro, Anias, Pinto, Castro and Carpes4–Reference Stirn6

Perichondritis is the most common complication of ear cartilage piercing. Lack of treatment can potentially result in necrosis of the underlying cartilage, with long-term cosmetic abnormalities including ‘cauliflower ear’.Reference Fernandez, Castro, Anias, Pinto, Castro and Carpes4, Reference Hanif, Frosh, Marnane, Ghufoor, Rivron and Sandhu7–Reference Jervis, Clifton and Woolford9 Other complications include allergic reaction, bacterial infection, transmission of blood-borne viruses, granuloma, cyst formation, bifid ear lobe deformity, and hypertrophic scar and keloid scar formation.Reference Fernandez, Castro, Anias, Pinto, Castro and Carpes4, Reference Saleeby, Rubin, Youshock and Kleinsmith10

Under the Local Government (Miscellaneous Provisions) Act 1982, as amended, local authorities in the UK are responsible for regulating and monitoring businesses offering cosmetic body piercing.Reference Smith11 However, contrary to popular belief, there are no nationally accredited training courses and no minimum qualifications required for body piercing.Reference Saleeby, Rubin, Youshock and Kleinsmith10, Reference Smith11

This study aimed to evaluate current ear cartilage piercing practices in a sample of piercing parlours in London, UK. Specifically, we aimed to establish: piercing practitioners' awareness concerning complications of ear cartilage piercing; whether informed consent is obtained from the client; and post-piercing advice given to clients.

Materials and methods

Data collection

All piercing parlours located in London that provided ear cartilage piercing were identified via the internet and telephone directory. Each of these piercing parlours was assigned a unique number and a computer-based random number generator was used to select 40 parlours for study inclusion.

The practitioners at the included parlours were asked to complete a structured, six-item, anonymous questionnaire (Figure 1) via telephone. Questions were read out to the practitioner, whose responses were then documented. Questionnaires were completed between the 5th and 19th of February 2011. Only piercing practitioners were permitted to complete the questionnaire. Prior to answering the questions, a cover letter was read out to the practitioner describing the purpose of the study. Answers to the questions asked were not prompted by the questioner.

Fig. 1 Ear piercing questionnaire. GP = general practitioner; A&E = accident and emergency department

Data analysis

Data were analysed in terms of the absolute numbers and percentages of responses for each question.

Medicolegal literature review

A search of the medicolegal literature was conducted using The All England Law Reports, from 1936 to date,12 in order to assess previous cases of litigation associated with this practice.

Results

Practitioners at 25 of the 40 piercing parlours contacted agreed to participate in this study; 4 were chain stores and 21 were independent stores. Reasons for not taking part included: lack of time to complete the questionnaire, practitioner currently with a client or practitioner not currently at the parlour.

Responses to our questionnaire are displayed in Table I.

Table I Summary of questionnaire responses

GP = general practitioner; A&E = accident and emergency department

All piercing practitioners required clients to complete a consent form prior to piercing. None of the consent forms contained any printed information concerning ear cartilage complications.

Ninety-six per cent of the practitioners were aware of the risk of infection following piercing. Four, 12 and 0 per cent of the practitioners were aware of the risks of keloid scarring, hypertrophic scarring and cauliflower ear, respectively. No practitioners specified any ‘other’ risks of cartilage piercing (Figure 2).

Fig. 2 Percentage of responses to the question ‘Which of the following risks are you aware of concerning ear cartilage piercing?’.

In the event of post-piercing problems, 100 per cent of practitioners advised clients to return to the parlour, whilst 28 per cent also advised clients to seek medical help either from their general practitioner (16 per cent), or at an accident and emergency department (12 per cent). None of the practitioners advised the use of painkillers. Finally, 60 per cent of the practitioners provided clients with post-piercing written advice.

Discussion

Data interpretation

All parlours included in this study, both chain and independent, offered ear cartilage piercing and required clients to complete a consent form prior to piercing. However, none of the consent forms contained any printed information concerning ear cartilage complications. Furthermore, practitioners demonstrated a considerable lack of awareness concerning ear cartilage piercing complications. This deficiency of practitioners' awareness coupled with the absence of printed information regarding complications on consent forms makes it unlikely that informed consent was obtained.

Advice concerning post-piercing practice is provided by Public Health England in their recent ‘Tattooing and Body Piercing Guidance Toolkit’.13 This recommends that in the event of a complication, practitioners at piercing parlours should refer their clients urgently for medical attention. However, all practitioners in this study reported that in the event of a complication they would advise clients to return to their parlour, with only 28 per cent advising medical attention. Public Health England also recommends that clients be provided with an appropriate aftercare leaflet, to improve adherence to instructions.13 However, 40 per cent of the practitioners questioned in this study did not provide any written instructions following piercing.

This study has identified significant shortcomings concerning cartilage piercing practices in London, UK. Based on our findings, we recommend: (1) the implementation of national accredited training courses for cartilage piercing, so that piercing practitioners are aware of complications and post-piercing guidelines; (2) that clients are provided with sufficient information concerning the potential risks of cartilage piercing prior to giving consent; and (3) that clients are provided with written post-piercing instructions in accordance with Public Health England.13

  • • Ear cartilage piercing is increasingly popular and has a significant complication rate

  • • No specialist training or minimum qualification is required for ear cartilage piercing

  • • In this study, practitioners showed considerable lack of awareness concerning ear cartilage piercing complications

  • • It is unlikely that informed consent was obtained prior to ear cartilage piercing

  • • Post-piercing practice of most of parlours did not follow published national guidance

  • • Corrective actions are required to improve current practice in London, UK

Surprisingly, the medicolegal literature search revealed no cases of litigation arising from complications associated with ear cartilage piercing. One case of litigation concerning ear lobe piercing was identified, dating back to 1938 (Phillips vs William Whitely Ltd), in which the accused was found not to be negligent.13

Limitations

Our study pertains to piercing parlours in London specifically. A larger study that includes piercing parlours across the UK is required to assess the applicability of our findings.

Conclusion

Informed consent is a tenet of good practice for any invasive procedure. However, it is unlikely that informed consent was obtained by the practitioners of parlours included in this study. Furthermore, despite the availability of national guidelines, the majority of practitioners did not follow published piercing advice. We suggest recommendations to improve current practices and provide a higher standard of care to the public.

Acknowledgement

We gratefully acknowledge Miss Mahim Irfan Qureshi for her assistance in manuscript preparation.

References

1Waugh, M. Body piercing: where and how. Clin Dermatol 2007;25:407–11Google Scholar
2Biggar, RJ, Haughie, GE. Medical problems of ear piercing. N Y State J Med 1975;9:1460–2Google Scholar
3Cortese, TA, Dickey, RA. Complications of ear piercing. Am Fam Physician 1971;4:66–72Google Scholar
4Fernandez, AP, Castro, NI, Anias, CR, Pinto, PC, Castro, JC, Carpes, AF. Post-piercing perichondritis. Braz J Otorhinolaryngol 2008;74:933–7CrossRefGoogle ScholarPubMed
5Simplot, TC, Hoffman, HT. Comparison between cartilage and soft tissue ear piercing complications. Am J Otolaryngol 1998;19:305–10Google Scholar
6Stirn, A. Body piercing: medical consequences and psychological motivations. Lancet 2003;361:1205–15Google Scholar
7Hanif, J, Frosh, A, Marnane, C, Ghufoor, K, Rivron, R, Sandhu, G. Lesson of the week: “high” ear piercing and the rising incidence of perichondritis of the pinna. BMJ 2001;322:906–7Google Scholar
8Cumberworth, VL, Hogarth, TB. Hazards of ear-piercing procedures which traverse cartilage: a report of Pseudomonas perichondritis and review of other complications. Br J Clin Pract 1990;44:512–13Google Scholar
9Jervis, PN, Clifton, NJ, Woolford, TJ. Ear deformity in children following high ear-piercing: current practice, consent issues and legislation. J Laryngol Otol 2001;115:519–21CrossRefGoogle ScholarPubMed
10Saleeby, ER, Rubin, MG, Youshock, E, Kleinsmith, DM. Embedded foreign bodies presenting as earlobe keloids. J Dermatol Surg Oncol 1984;10:902–4Google Scholar
11Smith, L. Regulation of Tattooing and Body Piercing Businesses, Science and Environment Section, standard note: SN/SC/5079. London: House of Commons Library, 2010Google Scholar
12The All England Law Reports. London: Butterworths, 1936–Google Scholar
13Tattooing and body piercing guidance toolkit. In: http://www.cieh.org/WorkArea/showcontent.aspx?id=47704 [4 May 2014]Google Scholar
Figure 0

Fig. 1 Ear piercing questionnaire. GP = general practitioner; A&E = accident and emergency department

Figure 1

Table I Summary of questionnaire responses

Figure 2

Fig. 2 Percentage of responses to the question ‘Which of the following risks are you aware of concerning ear cartilage piercing?’.