Condition guide
Information relating to chondrodermatitis nodularis chronica helicis (CNH)
Clear, evidence-based information on CNH — what it is, why it happens, and the options that may help.
This website was created by The Original Pillow with a Hole Ltd at the request of our customers. Our aim is that, through education, people affected by CNH or ear pressure sores can better understand the condition and the options available to them. For more about the company and its pillows, see just below — or read on to learn about CNH. We know you’re in pain, but you’re not alone.
The Original Pillow with a Hole is a UK-made pressure-relief pillow, designed to take the weight of your head off the affected ear while you sleep.
What is chondrodermatitis nodularis chronica helicis (CNH)?
Chondrodermatitis nodularis helicis (CNH) presents itself as a painful, skin-coloured lesion on the helix or antihelix of the ear. CNH can affect anyone at any age, however the majority of studies show that it mainly affects those within the 50 to 80-year-old age group. Various treatments have been tried, including surgical techniques, laser therapy, corticosteroid creams and pressure-relieving pillows. The main aim of treatment is to reduce pain and, ideally, resolve the condition.
The images below show CNH on both the helix and antihelix.
Introduction
Chondrodermatitis nodularis helicis (CNH) was first described by Winkler just over 100 years ago, hence its alternative name of Winkler’s Disease. It is notable for its painful, skin-coloured lesions on the ear, often with an overlay of scale or crust. Both sexes are affected. While men most commonly have lesions on the helix, women tend to have lesions mainly on the antihelix.
How people develop CNH remains uncertain. The most compelling theory, and the one that correlates with what we have personally observed, is that continual pressure on the ear leads to a loss of blood flow to the cartilage. This causes the cartilage to break down and degrade, leading to a painful pressure sore. Other suggested causes include trauma, cold temperature, collagen defects, and autoimmune disease. Diagnosis is usually made by your doctor, but because chondrodermatitis can look similar to skin cancer, a biopsy may be performed. One of the simplest and lowest-cost approaches has been to remove the pressure from the ear, and in recent years some newer treatments have also been developed.
Treatment options
When the last clinical review of CNH was carried out, various treatments were available. These included pressure-relieving methods, surgical excision, lasers, injectable corticosteroids and topical corticosteroids. More recently there have been new invasive and non-invasive treatments which your doctor may discuss with you.
Pressure relief
Relieving pressure on the ear is one of the simplest options. A pillow with a hole is designed to reduce pressure on the ear so it can heal. The appeal of relieving pressure is that it aims to address the root cause rather than only the symptoms.
Small studies of pressure relief support this approach. In one study, most patients who kept up a night-time pressure-relieving method became free of pain within a couple of months. The evidence is made up of smaller studies rather than large trials, but it points consistently toward pressure relief as a worthwhile, low-risk first step.
Source: Kuen-Spiegl M et al. J Dtsch Dermatol Ges 2011;9(4):292-296.
Excision
Wedge excision has been the most commonly used surgical technique to treat chondrodermatitis. In recent years, new techniques have been developed with the aim of minimising recurrence and improving results. The ‘triangular window technique’, compared with wedge excision, avoids the canoe-shaped hole that can result from wedge excision and reduces the chance of developing two new CNH lesions at the ends of the excision. ‘Retroauricular excision’ is similar, focusing on minimising recurrence and concealing the scar, although it only works on chondrodermatitis affecting the helix.
Steroid creams
A common non-surgical approach for CNH has been corticosteroid creams. Like many treatments, they do not address the root cause — pressure on the ear.
A 2011 study looked at topical nitroglycerin cream for CNH. Of 13 lesions treated across 12 patients, eight cleared completely and four improved partially. Nitroglycerin can cause side effects such as headache, so it is a treatment to discuss with a doctor.
Source: Flynn V, Chisholm C, Grimwood R. J Am Acad Dermatol 2011;65(3):531-536.
Photodynamic therapy
One of the newer treatments for chondrodermatitis is photodynamic therapy (PDT). Light of a certain wavelength is shone on CNH lesions after they have been prepared with creams and ointments. Reported side effects are few and the results have been described as promising.
Conclusion
CNH can be a frustrating condition. It often requires a long-term commitment, can interfere with sleep, and can recur in up to 34% of patients. Cost is also a consideration. Relieving pressure on the ear — for example with a pressure-relief pillow — is a common, low-cost first step, and studies suggest it may help. Comfort matters too: a pillow only helps if it’s comfortable enough to use consistently.
This website was created by the makers of The Original Pillow with a Hole™ to help people understand the options available to them. Having spoken with many people affected by CNH over the years, our experience is that relieving pressure on the ear is often overlooked. If you’d like to see what we offer, you can visit our main site.
Looking for the pillow behind this guide?
This information site is published by The Original Pillow with a Hole Ltd. If easing pressure on the ear is the right step for you, you can find the original pillow on the company’s main site.
This website provides general information about chondrodermatitis and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or another qualified health professional with any questions about a medical condition.