Auricular Hematoma

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

1. Epidemiology
   1. Common in wrestlers
2. Pathophysiology
   1. Usually from Trauma, but may be spontaneous
3. Signs
   1. Fluctuant bluish swelling of anterior superior auricle
4. Technique
   1. Prepare the skin with betadine or hibiclens
   2. Anesthetize the auricle with Ear Field Block
   3. Drainage
      1. Needle aspiration with 18 gauge or larger needle OR
      2. Incision (1-2 cm superficial incision) and drainage
   4. Apply Auricular Bolster (compression dressing)
      1. See below
      2. Prevents reaccumulation
5. Technique: 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
   1. Other measures
      1. Many ENTs will start Augmentin while treating Auricular Hematoma
      2. Update Tetanus status
   2. Follow-up
      1. Re-evaluation in 18-24 hours to exclude reaccumulation (and need for repeat hematoma drainage)
7. References
   1. Claudius, LoTempio, Behar and Swaminathan in Herbert (2016) EM:Rap 16(8): 2-3