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In the ENT subsection of his paper (March 2002 JRSM1) Dr Le Fanu quotes a patient's description of sore ear, affecting a ‘line of rigid muscle alongside the soft outer ear’. Whilst there exist fine muscles on the posterior, or cranial, surface the skin adheres closely to the anterior, or lateral, surface of the auricle, which has very little subcutaneous tissue2. Seemingly the patient refers to a fold in the elastic cartilage known as the antihelix.
The symptoms in this case closely resemble those of chondrodermatitis nodularis helicis. Histologically such lesions show focal degenerative change with surrounding perichondritis and overlying hyperkeratosis and acanthosis3. The usual treatment is simple excision, but a patient who declined surgery later told me how he had invented his own method to avoid discomfort at night—cutting a hollow into his foam pillow to reduce pressure on the ear.