Auricular Hematomas



Ovid: 5-Minute Sports Medicine Consult, The


Auricular Hematomas
Kevin E. Elder
Todd Toriscelli
Basics
Alert
Failure to diagnose and promptly treat this condition with evacuation of the hematoma may lead to permanent deformation of the ear.
Description
  • Auricular hematoma is an injury caused by trauma or friction of the ear that often occurs in contact sports such as rugby, wresting, 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
  • The incidence of this condition is higher in young males owing to their predilection to participate in the sports most often producing this injury. One study of collegiate wrestlers found a statistically significant difference in wrestlers developing auricular hematoma while wearing headgear (26%) versus those who were not wearing headgear (52%) (1).
  • This is a reported 50% decrease in incidence of the condition in wrestlers who consistently wore protective headgear during training and competition (1).
Prevalence
  • This condition is more prevalent in young males because they are most often the participants in the specific organized team sports associated with the injury, but it may occur in males or females.
  • There are no well-established records of the exact prevalence of this condition.
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.
General Prevention
  • 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.
Etiology
  • 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.
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 (2)[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 head gear 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
  • 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.
  • Associated ear drainage should prompt consideration for rupture of the tympanic membrane.
  • Assessment to rule out signs and symptoms of concussion should be performed.
Diagnostic Tests & Interpretation
Diagnosis of this condition is based on history and clinical exam.
Lab
  • No specific lab tests confirm diagnosis.
  • CBC or ESR may aid in the diagnosis of associated infection.
Differential Diagnosis
  • Ear laceration
  • Cellulitis of ear
  • Perichondritis
Ongoing Care
Follow-Up Recommendations
Daily follow-up is needed to observe for signs of hematoma redevelopment, pressure necrosis, allergic reaction to materials, and infection.
Patient Monitoring
Follow-up with ENT or plastic surgery after acute treatment is recommended because of the risk of poor cosmetic result even with proper treatment of the condition.
Patient Education
  • Return to play too early, prior to fully healing of the injury, will increase the risk of a poor outcome.
    • No definitive return-to-play protocol exists.
    • Some authors recommend no competition while wearing ear compression dressing, whereas others allow full activity with ear protection being worn (10).
    • The decision should be made in consultation with the athlete, recognizing the potential for poor cosmesis with recurrence of the injury.
  • Ear protectors and headgear always should be worn in high-risk sports.
  • Ice and pressure applied at the end of practices and matches may help to prevent recurrence of injury.
Prognosis
  • Best prognosis is achieved by prompt aspiration and compression if needed.
  • Poorer outcomes are associated with repeated need for aspiration and earlier return to contact sports/reinjury.
Codes
ICD9
380.31 Hematoma of auricle or pinna


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