Ear Injury

Although sustaining a trauma and hematoma to the auricle does not usually affect the function of hearing, the cosmetic changes that follow can be disfiguring. Auricular hematoma, an injury very common amongst wrestlers and mixed-martial arts athletes, can lead to an irreversible condition known as cauliflower ear. It is therefore, essential to treat auricular hematoma as soon as it is diagnosed.

Anatomy

What makes up the auricle of the ear?

The auricle is mainly comprised of skin on both sides and cartilage in the middle. The cartilage gives the auricle its shape and structure. The lobule is the only location in the auricle that is does not have any cartilage under the skin.

Figure 1. Normal ear anatomy demonstrates well-defined folds of cartilage and overlying skin.

What happens when I have an auricular hematoma?

A hematoma is a collection of blood inside the body. An auricular hematoma is caused when the trauma leads to accumulation of blood on top of the cartilage.

Diagnosis

How do I know I have an auricular hematoma?

A typical auricular hematoma is swollen, red, and tender. Further more, the normal contour of the ear has changed. If the hematoma is bad, it can occlude the opening of the ear canal and lead to decrease hearing.

When should I see a doctor?

If you suspect that you have an auricular hematoma, you should see a physician immediately. If auricular hematomas are not addressed early they can lead to a condition called cauliflower ear.

What is cauliflower ear?

Cauliflower ear is the permanent change to the shape of the ear as the result of scarring. It occurs when auricular hematoma is not addressed immediately or appropriately. The pressure from the hematoma causes permanent damage to the cartilage of the ear and leads to scarring and disfiguring of the auricle. A cauliflower ear is much harder to treat and difficult to reverse. As such the best treatment for cauliflower ear is prevention with immediate and appropriate treatment of auricular hematoma.

Figure 2. This is a case of an early cauliflower ear after an untreated auricular hematoma. The auricle is already beginning to lose its normal shape. Further trauma can lead to permanent disfigurement of the auricle.

Figure 3a,b. This case demonstrates an auricular hematoma involving the right superior helix. Notice the distortion of the auricle by blood collecting between the overlying skin and the underlying cartilage 3a. Early evaluation of the ear after drainage and splinting of the auricle demonstrates normal ear contours and no re-accumulation of fluid or blood. This ear will heal normally with no risk of cauliflower ear deformity.

Treatment

What are my treatment options?

The only way to treat an auricular hematoma is with a procedure that includes making a small incision on the skin. Through this incision the hematoma is then drained completely. A pressure dressing is then applied to the ear so that another hematoma does not re-accumulate. This procedure is called incision and drainage of hematoma.

My trainer says that all you need is to use a needle to drain the blood is that true?

A needle drainage of auricular hematoma is not the appropriate treatment to prevent a cauliflower ear. Frequently, after needle drainage of the hematoma the blood begins to re-accumulate. Furthermore, the needle is not able to remove any blood clots that have already formed. As such, needle drainage of an auricular hematoma is not the appropriate treatment.

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