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.
References:
Kenna MA. The ear. In: Behrman RE, Kliegman RM, Jenson HB, eds. Nelson
Textbook of Pediatrics. 16th ed. Philadelphia, Pa: WB Saunders Co;
2000:1938-1962
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