Auricular Hematomas

Steven K. Poon, MD, CAQSM

Kimberly G. Harmon, MD

BASICS

DESCRIPTION

Auricular hematoma is an injury caused by trauma or friction of the ear that often occurs in contact sports such as wrestling, rugby, boxing, and judo.
Trauma or continuous friction to the auricle leads to bleeding into the soft tissues of the ear.
Bleeding often occurs anteriorly at the junction of the perichondrium and elastic cartilage of the ear.
Recognition of this condition as a result of trauma led to the development of treatments during the latter half of the 20th century.

EPIDEMIOLOGY

Incidence

Most injuries occur while engaged in combat sports such as wrestling while not wearing protective headgear.

Prevalence

Studies estimate ear injuries account for up to 23.4% of all reported wrestling related injuries.

ETIOLOGY AND PATHOPHYSIOLOGY

The condition is caused by trauma owing to a direct blow or frictional forces to the auricle.
Bleeding into the auricle, specifically between the skin and auricular cartilage, results in a hematoma in this space.
Untreated, the hematoma can cause pressure, necrosis, and scarring of the auricular cartilage leading to a “cauliflower ear,” which is the name given to the characteristic deformity to the ear:
- Neocartilage formation at the site of the clot also plays a role in the associated deformity.
- This deformity is disfiguring and permanent.

RISK FACTORS

Failure to wear headgear while participating in sports such as wresting, rugby, or martial arts disciplines such as judo may increase the risk of ear trauma.

COMMONLY ASSOCIATED CONDITIONS

Auricle laceration
Rupture of tympanic membrane owing to associated trauma
Concussions related to head trauma
Cellulitis and perichondritis may mimic or be associated with this disorder.

DIAGNOSIS

Diagnosis is made based on clinical exam and history of trauma/excessive friction to the ear (1)[C].
The absence of associated factors that may lead to cellulitis of the ear may aid in the correct diagnosis.

HISTORY

History of direct and recent trauma to the auricle with resulting hematoma
Lack of protective headgear while participating in high-risk sports for this injury should raise level of suspicion.
The athlete complains of a painful ear and may have associated hearing loss.

PHYSICAL EXAM