Steven K. Poon, MD, CAQSM
Kimberly G. Harmon, MD
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Failure to diagnose and promptly treat this condition with evacuation of the hematoma may lead to permanent deformation of the ear.
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.
Most injuries occur while engaged in combat sports such as wrestling while not wearing protective headgear.
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.
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.
General prevention is based on proper use of headgear during participation.
Ill-fitting headgear may provide inadequate protection to the auricle.
Awareness of the importance and use of proper fitting headgear by athletes, coaches, and athletic training staff may prevent this injury.
COMMONLY ASSOCIATED CONDITIONS
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 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 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.
Examination of the auricle reveals a soft hematoma with tenderness of the auricle presenting within a few hours after the inciting injury.
Loss of the normal architecture of the auricle compared with the contralateral side
Exam should include an assessment of the athlete’s hearing.
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