Comprehensive review of petrified ears: etiologies, diagnosis, and proposed systemic workup for calcification and ossification

Petrified ears, characterized by auricular cartilage hardening due to calcification or ossification, are a rare clinical finding with a complex etiology. Traditionally linked to trauma, such as frostbite, this condition is also associated with systemic endocrine and autoimmune disorders. Despite its significance, no standardized guidelines exist for evaluation and management. This review examines newly reported cases, explores underlying mechanisms, and proposes a systemic workup for clinicians. A literature review was conducted per PRISMA guidelines using PubMed searches for “auricular calcification,” “auricular ossification,” and “petrified ear,” including studies up to September 2024. Of 280 studies screened, 91 met inclusion criteria, identifying 128 cases. Calcification was present in 60 cases, ossification in 58, and both in five. Idiopathic causes were the most common for calcification (14 cases) and ossification (18 cases). Endocrine conditions, including adrenal insufficiency, diabetes mellitus, and acromegaly, accounted for 43.8% of cases with a known etiology, while frostbite and trauma caused 34.4%. Other non-endocrine conditions, such as perichondritis and scleroderma, contributed to 16.7% of non-idiopathic cases. Petrified ears are an uncommon but clinically significant condition requiring thorough evaluation. This review highlights the need for a standardized diagnostic workup to improve recognition and management. Further studies are necessary to clarify prevalence and refine diagnostic criteria.