Auricular Hematoma

Aka: Auricular Hematoma, Pinna Hematoma, Aural Hematoma, Ear Hematoma, Cauliflower Ear, Auricular Bolster, Auricular Compression Dressing

1. Risk Factors: Sports Injury
   1. Wrestling
   2. Boxing
   3. Polo
   4. Water
   5. Rugby
2. 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
3. Signs
   1. Fluctuant bluish swelling of anterior superior auricle
4. Management: Decompression
   1. Prepare the skin with betadine or hibiclens
   2. Anesthetize the auricle with Ear Field Block
   3. Perform with sterile technique to prevent infection (perichondritis)
   4. Drainage
      1. Needle aspiration with 18 gauge or larger needle OR
      2. Incision (1-2 cm superficial incision) and drainage
   5. Apply Auricular Bolster (compression dressing)
      1. See below
      2. Prevents reaccumulation
5. 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
         1. Dental rolls
         2. Folded 2x2 gauze
         3. Rolled Xeroform gauze (e.g. adaptic)
      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
6. Management: General
   1. Other measures
      1. Many ENTs will start Augmentin while treating Auricular Hematoma
      2. Update Tetanus status
      3. Wear protective ear equipment to prevent reinjury
   2. Follow-up
      1. Re-evaluation in 18-24 hours to exclude reaccumulation (and need for repeat hematoma drainage)
7. Complications
   1. Cauliflower Ear
      1. Irreversible External Ear deformity from inadequately drained clot and fibrous deposition
8. References
   1. Dreis (2020) Crit Dec Emerg Med 34(7):3-21
   2. Claudius, LoTempio, Behar and Swaminathan in Herbert (2016) EM:Rap 16(8): 2-3