Injuries to the external ear may be open or closed. Blunt external ear trauma may cause a hematoma (otohematoma) of the pinna, which, if untreated, may result in cartilage necrosis and chronic scarring or further cartilage formation and permanent deformity (“cauliflower ear”). Open injuries include lacerations (with and without cartilage exposure) and avulsions.
Management and Disposition
Pinna hematomas must undergo incision and drainage or large-needle aspiration using sterile technique, followed by a pressure dressing to prevent reaccumulation of the hematoma. This procedure may need to be repeated several times; hence, after ED drainage, the patient is treated with antistaphylococcal antibiotics and referred to ENT or plastic surgery for follow-up in 24 hours. Lacerations must be carefully examined for cartilage involvement; if this is present, copious irrigation, closure, and postrepair oral antibiotics covering skin flora are indicated. Simple skin lacerations may be repaired primarily with nonabsorbable 6-0 sutures or surgical glue as appropriate. The dressing after laceration repair is just as important as the primary repair. If a compression dressing is not placed, hematoma formation can occur. Complex lacerations or avulsions normally require ENT or plastic surgery consultation.
Pinna Contusion. Contusion without hematoma is present. Reevaluation in 24 hours is recommended to ensure a drainable hematoma has not formed. (Photo contributor: Lawrence B. Stack, MD.)
Pinna Hematoma. A hematoma has developed, characterized by swelling, discoloration, ecchymosis, and flocculence. Immediate incision and drainage or aspiration is indicated, followed by an ear compression dressing. (Photo contributor: C. Bruce MacDonald, MD.)
Cauliflower Ear. Repeated trauma to the pinna or undrained hematomas can result in cartilage necrosis and subsequent deforming scar formation. (Photo contributor: Timothy D. McGuirk, DO.)
Complete Avulsion of Partial Pinna. This ear injury, sustained in a fight, resulted when the pinna was bitten off. Plastic repair is needed. The avulsed part was wrapped in sterile gauze soaked with saline and placed in a sterile container on ice. (Photo contributor: David W. Munter, MD.)
Partial Avulsion of Pinna. Partial avulsion of the pinna seen at its superior junction with the scalp. Cartilage exposure and injury prompts ENT consultation for repair. (Photo contributor: Eric Wu, MD.)
Pinna hematomas may take hours to develop, so give patients with blunt ear trauma careful discharge instructions, with a follow-up in 12 to 24 hours to check for hematoma development.
Failure to adequately drain a hematoma, reaccumulation of the hematoma owing to a faulty pressure dressing, ...