Auricular Hematoma

1. Introduction

• Mechanism
  • Blunt trauma directly to the auricle
  • Typically in sports, e.g. boxing, wrestling, rugby
• Pathoanatomy
  • Occurs due to lack of subcutaneous fat cushioning impact
  • Shearing force of the perichondrium from the underlying cartilage, tearing adjoining blood vessels
• Associated injuries
  • Intracranial, tympanic, skin/laceration

2. Anatomy

• Often occurs in the crura of the anti-helix or the superior portion of the ear

3. Presentation

• Symptoms
  • Pain
• Physical Exam
  • Tender, tense, fluctuant mass
  • Timing varies; swelling may accumulate immediately or several hours following injury
  • Most commonly seen on the anterior pinna within the scaphoid fossa

4. Imaging

• Clinical diagnosis
• No further imaging necessary unless suspecting additional intracranial injury

5. Treatment

• Depends on size:
  • Small hematomas (<2 cm) - needle aspiration may be successful
  • Large hematomas (>2 cm) - warrant incision and drainage
  • Often aspiration alone does not completely evacuate the clot and can lead to increased deformity and morbidity
  • Note: both needle aspiration and incision and drainage techniques require pressure packing post drainage
• Auricular Hematoma Drainage
  • See Procedure: Auricular - Needle Aspiration
  • See Procedure: Auricular - Incision & Drainage (I&D)
• Post-Drainage Auricular Pressure Dressing
  • Should be placed following evacuation to prevent reaccumulation over several days
  • Several options exist but all include pressure on both posterior and anterior aspect to maintain pressure
  • See Procedure: Auricular Pressure Dressing
• See Video: Auricular Hematoma - Brown EM Residency

• Prophylactic antibiotics
  • Not routinely indicated
  • Should be reserved for immunocompromised patients and should cover for Pseudomonas aeruginosa and S. aureus, the two likely culprits in post-traumatic chondritis
  • But may differ pending local practice patterns, ask your local specialist
• Tetanus booster
• Follow-up with ENT/Plastics should be scheduled until the wound is healed
  • Very important to reassess for reaccumulation and may require repeat drainage
• Undrained hematomas >7 days old
  • Will likely formed granulation tissue
  • Requires ENT/Plastics referral

6. Complications

• Given that the cartilage depends on on perichondrial blood vessels for viability, interruption of the blood supply can result in necrosis
• Cauliflower ear
  • Cartilage necrosis, fibrosis, and neocartilage formation
  • Permanent deformity from untreated auricular hematoma
  • Commonly seen in wrestlers and boxers secondary to repetitive head and ear trauma
  • May consider elective repair with Plastics/ENT