Auricular Hematoma

Trauma to the pinna may result in hematoma formation. Auricular hematomas are common in wrestlers and boxers who do not wear ear protection. Untreated hematomas can lead to infection or necrosis of auricular cartilage, resulting in a disfigured pinna (cauliflower ear).

Patients present with a painful, swollen ear shortly after a history of trauma. The physical examination reveals edema and fluctuance, most commonly just below the helical rim at the superior aspect of the pinna, as described for the boy in the vignette. The hematoma may be anterior or posterior. Erythema or bluish discoloration is common. Delayed presentation with severe pain, erythema, and edema suggest the development of an auricular abscess.

Prompt treatment of auricular hematomas is important to prevent complications. Small hematomas can be aspirated by needle successfully. Large hematomas require incision and drainage in the operating room and bolster approximation of the skin and perichondrium to the underlying cartilage. Drains often are left in place. Antibiotic therapy to cover skin flora, such as Staphylococcus aureus or group A Streptococcus, is an appropriate adjunct to prevent chondritis.

Antibiotics alone are inadequate treatment for auricular hematoma or  abscess, both of which require surgical drainage. Prednisone is inappropriate for the treatment of auricular hematoma. Excisional biopsy and tympanostomy with tube insertion are unnecessary.

Kenna MA. The ear. In: Behrman RE, Kliegman RM, Jenson HB, eds. Nelson
Textbook of Pediatrics. 16th ed. Philadelphia, Pa: WB Saunders Co;
Parisier SC, McGuirt WF Jr. Injuries of the ear and temporal bone. In:
Bluestone CD, Stool SE, Kenna MA, eds. Pediatric Otolaryngology. 3rd
ed. Philadelphia, Pa: WB Saunders Co; 1996:687-688