II. Pathophysiology
- Repeated auricle blunt and shearing Trauma (although some cases may be spontaneous)
- Perichondrium separates from cartilage
- Allows blood to accumulate around cartilage (subperichondrial space)
- Results in interruption of cartilage perfusion with risk of necrosis and permanent deformity
III. Risk Factors: Sports Injury
- Wrestling
- Boxing
- Polo
- Water
- Rugby
IV. Signs
- Fluctuant bluish swelling of anterior superior auricle
V. Management: Decompression
- Patient positioned in lateral decubitus position with affected ear up
- Prepare the skin with Betadine, Hibiclens or chloraPrep
- Anesthetize the auricle with Ear Field Block (auricular block) or Local injection
- Lidocaine 1% in 10 ml syringe and 27 gauge needle
- Perform with sterile technique to prevent infection (perichondritis)
- Drainage
- Needle aspiration with 18 gauge or larger needle (greater risk of reaccumulation) OR
- Incision (1-2 cm superficial incision) and drainage (preferred)
- Apply Auricular Bolster (compression dressing)
- See below
- Prevents reaccumulation
VI. Management: Auricular Bolster (compression dressing)
- Indications
- Auricular Hematoma
- Auricular Laceration (consider)
- Preparation
- Ear Anesthesia (see Ear Field Block)
- Skin Preparation (e.g. Betadine or Hibiclens)
- Nylon Suture (e.g. Ethilon) 3-0 or 4-0
- Material for 2 Bolsters (choose one)
- Dental rolls
- Folded 2x2 gauze
- Rolled Xeroform gauze (e.g. adaptic)
- Cotton
- Silicone Splint
- Plastic Bolster
- Lubricant
- Bacitracin or Xeroform gauze applied to surface of bolster to keep from adhering
- Technique
- Sandwich auricle between two bolsters
- Suture through the first bolster, auricle, and second bolster and tie
- Repeat suturing at a second location along the bolster
- Apply additional compressive dressing over the top of the ear and wrapped around the head
- Resources
- Brown EM Residency Video
VII. Management: General
- Other measures
- Many ENTs will start Augmentin while treating Auricular Hematoma
- Consider Antibiotics in higher risk patients (e.g. Immunocompromised)
- Update Tetanus Vaccine status
- Wear protective ear equipment to prevent reinjury
- Avoid antiplatelet agents and Anticoagulants if possible during the healing process
- Many ENTs will start Augmentin while treating Auricular Hematoma
- Follow-up
- Re-evaluation in 18-24 hours to exclude reaccumulation (and need for repeat Hematoma drainage)
- Consider repeat evaluation daily for first 3-5 days
- Otolaryngology Consultation Indications
- Auricular Hematoma presentation at >7 days from onset
VIII. Complications: Auricular Hematoma
- Cauliflower Ear
- Irreversible External Ear deformity from inadequately drained clot and fibrous deposition
IX. Complications: Incision and Drainage
- Perichondritis
- Scar
- Failed drainage
- Recurrent Auricular Hematoma
X. References
- Claudius, LoTempio, Behar and Swaminathan in Herbert (2016) EM:Rap 16(8): 2-3
- Dreis (2020) Crit Dec Emerg Med 34(7):3-219
- Kotipoyina and Warrington (2018) Crit Dec Emerg Med 32(5): 18
Images: Related links to external sites (from Bing)
Related Studies
| Concepts | Acquired Abnormality (T020) |
| ICD9 | 738.7 |
| ICD10 | M95.1 |
| SnomedCT | 156877000, 28072004 |
| Dutch | bloemkooloor, Bloemkooloor |
| French | Oreille en chou-fleur |
| German | Blumenkohlohr |
| Italian | Orecchio a cavolfiore |
| Portuguese | Orelha em couve-flor |
| Spanish | Oreja de coliflor, oreja de coliflor (trastorno), oreja de coliflor |
| Japanese | カリフラワー耳, ｶﾘﾌﾗﾜｰﾐﾐ |
| English | cauliflower ear (physical finding), cauliflower ear, cauliflower ear (diagnosis), ear auricle malformations cauliflower ear, cauliflower ears, Cauliflower ear, Chronic haematoma of pinna, Chronic hematoma of pinna, Cauliflower ear (disorder) |
| Czech | Květákovitá deformita ucha |
| Korean | 배추꽃모양 귀 |
| Hungarian | karfiol-fül |
Ontology: Hematoma of pinna (C0271413)
| Concepts | Pathologic Function (T046) |
| ICD9 | 380.31 |
| ICD10 | H61.12 , H61.129 |
| SnomedCT | 194227001, 88050005 |
| Italian | Ematoma dell'orecchio, Ematoma del padiglione auricolare |
| Dutch | oorhematoom, hematoom van oor of oorschelp, hematoom; oorschelp, hematoom; pinna, oorschelp; hematoom, pinna; hematoom, auriculair hematoom |
| French | Hématome auriculaire, Hématome du pavillon de l'oreille, Othématome |
| German | Haematom der Ohrmuschel oder des Aussenohrs, Haematom der Ohrmuschel |
| Portuguese | Hematoma da orelha, Hematoma auricular |
| Spanish | Hematoma de la oreja, hematoma del pabellón auricular [dup] (trastorno), hematoma del pabellón auricular [dup], hematoma de pinna, hematoma del pabellón de la oreja (trastorno), hematoma del pabellón de la oreja, Hematoma del pabellón de la oreja |
| Japanese | 耳介血腫, ｼﾞｶｲｹｯｼｭ |
| English | hematoma of pinna, hematoma of pinna (diagnosis), Auricular haematoma, Auricular hematoma, Hematoma auricle/pinna, Hematoma of pinna, unspecified ear, auricular hematoma, auricle hematoma, Aural hematoma, Hematoma of auricle, Hematoma of pinna, Haematoma of auricle, Haematoma of pinna, Hematoma of pinna (disorder), auricle, ear; hematoma, hematoma; auricle, ear, hematoma; pinna, pinna; hematoma, Hematoma of pinna [dup] (disorder), Hematoma of auricle or pinna |
| Czech | Ušní hematom, Hematom ušního boltce nebo lalůčku |
| Hungarian | Haematoma auriculare, Fülkagyló vagy fülcimpa haematomája |
