Sports, such as rugby, water polo, boxing, and wrestling, are associated with increased risk of auricular hematoma compared with other sports. Due to its anatomic location, the ear is an exposed structure that is at high risk for injury during head trauma. When an ear is struck, shearing forces disrupt the adherence of the perichondrium to the cartilage. In addition to blunt trauma, repeated trauma, such as occurs in wrestling, creates enough force from the friction to separate the perichondrium and the cartilage. This disruption causes the subperichondrial space to fill with blood, which is known as an auricular hematoma. Because cartilage does not have an intrinsic blood supply, it relies on the perichondrium’s circulation for a nutritional blood source. When this connection is severed by injury or compressed by a hematoma, the cartilage is at high risk for necrosis and infection. Risk of necrosis is increased when there is an anterior and posterior hematoma surrounding the cartilage of the ear; the hematomas act like a tourniquet and significantly increase the risk of cartilage necrosis. An overlying laceration increases the risk of infection; thus, care must be taken to properly decontaminate the wound and treat with antibiotics if the mechanism of injury increases risk of infection, such as a dog bite or laceration by a dirty object.

A patient reports a traumatic injury or blow to the ear followed by significant swelling or a collection of blood on the outer ear. There is usually pain and pressure. A laceration or inner ear trauma may also be present. It is important to perform a complete examination to rule out any life-threatening injuries and assess for a skull fracture.

Treatment of an auricular hematoma involves prompt drainage of the hematoma under sterile technique to minimize risk of infection. There is a choice of either aspirating the hematoma or incision and drainage.¹ For both options, several methods have been proposed (discussed later).

According to Sbaihat and Khatatbeh,² using an incision and drainage approach with application of dental rolls has the lowest incidence of recurrence when compared with aspiration or incision and drainage alone. They reported incidences of recurrence of 9.1%, 22.2%, and 37.5% for incision and drainage with application of dental rolls versus incision and drainage versus aspiration.

The goal of treatment is to prevent abscess formation or permanent deformity of the ear, also known as cauliflower ear, named after the appearance of the ear. Cauliflower ear results from fibrous deposition due to an unevacuated clot.

Protective gear should be worn by athletes at risk of receiving a direct blow to the ear. Quick and complete drainage of an auricular hematoma can prevent abscess and scar formation. Follow-up with the patient 24 hours after drainage to assess for reaccumulation of the hematoma.³

Athletes can return to play (RTP) immediately after evacuation of the hematoma if protective gear is worn and care is taken to minimize risk of infection.

Small lacerations can be sutured after minimal débridement in an effort to preserve tissue. Reattachment can be achieved as long as a pedicle of skin remains attached to the head. Before repair, irrigate the wound with normal saline.

6-0 Nonabsorbable monofilament suture.³

A helpful way to create a sterilized field during an ear laceration repair is discussed later.

Refer for avulsion injuries or lacerations requiring a higher level of expertise to repair.

With large laceration and avulsion injuries, there can be blood loss significant enough to necessitate a blood transfusion. Failure to cover cartilage with skin can result in chondritis and subsequent ear deformities.³