II. Pathophysiology

  1. Repeated auricle blunt and shearing Trauma (although some cases may be spontaneous)
  2. Perichondrium separates from cartilage
    1. Allows blood to accumulate around cartilage (subperichondrial space)
    2. Results in interruption of cartilage perfusion with risk of necrosis and permanent deformity

III. Risk Factors: Sports Injury

  1. Wrestling
  2. Boxing
  3. Polo
  4. Water
  5. Rugby

IV. Signs

  1. Fluctuant bluish swelling of anterior superior auricle

V. Management: Decompression

  1. Patient positioned in lateral decubitus position with affected ear up
  2. Prepare the skin with Betadine, Hibiclens or chloraPrep
  3. Anesthetize the auricle with Ear Field Block (auricular block) or Local injection
    1. Lidocaine 1% in 10 ml syringe and 27 gauge needle
  4. Perform with sterile technique to prevent infection (perichondritis)
  5. Drainage
    1. Needle aspiration with 18 gauge or larger needle (greater risk of reaccumulation) OR
    2. Incision (1-2 cm superficial incision) and drainage (preferred)
      1. Use Scalpel #15 to make a 1-2 cm incision at the base of the Hematoma, following skin folds
      2. Use suction or express the Hematoma manually
      3. Consider saline irrigation of the Hematoma
      4. Reapproximate the perichondrium and cartilage
      5. Suture incision with 4-0 Vicryl
  6. Apply Auricular Bolster (compression dressing)
    1. See below
    2. Prevents reaccumulation

VI. Management: Auricular Bolster (compression dressing)

  1. Indications
    1. Auricular Hematoma
    2. Auricular Laceration (consider)
  2. Preparation
    1. Ear Anesthesia (see Ear Field Block)
    2. Skin Preparation (e.g. Betadine or Hibiclens)
    3. Nylon Suture (e.g. Ethilon) 3-0 or 4-0
    4. Material for 2 Bolsters (choose one)
      1. Dental rolls
      2. Folded 2x2 gauze
      3. Rolled Xeroform gauze (e.g. adaptic)
      4. Cotton
      5. Silicone Splint
      6. Plastic Bolster
    5. Lubricant
      1. Bacitracin or Xeroform gauze applied to surface of bolster to keep from adhering
  3. Technique
    1. Sandwich auricle between two bolsters
    2. Suture through the first bolster, auricle, and second bolster and tie
    3. Repeat suturing at a second location along the bolster
    4. Apply additional compressive dressing over the top of the ear and wrapped around the head
  4. Resources
    1. Brown EM Residency Video
      1. https://www.youtube.com/watch?v=sIlm7vPs3q8

VII. Management: General

  1. Other measures
    1. Many ENTs will start Augmentin while treating Auricular Hematoma
      1. Consider antibiotics in higher risk patients (e.g. Immunocompromised)
    2. Update Tetanus Vaccine status
    3. Wear protective ear equipment to prevent reinjury
    4. Avoid antiplatelet agents and Anticoagulants if possible during the healing process
  2. Follow-up
    1. Re-evaluation in 18-24 hours to exclude reaccumulation (and need for repeat Hematoma drainage)
    2. Consider repeat evaluation daily for first 3-5 days
  3. Otolaryngology Consultation Indications
    1. Auricular Hematoma presentation at >7 days from onset

VIII. Complications: Auricular Hematoma

  1. Cauliflower Ear
    1. Irreversible External Ear deformity from inadequately drained clot and fibrous deposition

IX. Complications: Incision and Drainage

  1. Perichondritis
    1. Pseudomonas aeruginosa
    2. Staphylococcus aureus
  2. Scar
  3. Failed drainage
  4. Recurrent Auricular Hematoma

X. References

  1. Claudius, LoTempio, Behar and Swaminathan in Herbert (2016) EM:Rap 16(8): 2-3
  2. Dreis (2020) Crit Dec Emerg Med 34(7):3-219
  3. Kotipoyina and Warrington (2018) Crit Dec Emerg Med 32(5): 18

Images: Related links to external sites (from Bing)

Related Studies

Ontology: Cauliflower ear (C0158516)

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, ジカイケッシュ
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