Managing Auricular Hematoma: An Emergency Medicine Narrative Review

Abstract

Background: Auricular hematoma is a condition commonly seen in the emergency department among patients presenting with trauma to the ear. It may result in several complications such as perichondritis and cauliflower ear if not managed appropriately.

Objective: This narrative review provides an evidence-based summary of the evaluation and management of auricular hematoma.

Discussion: Auricular hematoma is most commonly associated with shearing or blunt trauma to the ear, resulting in formation of a hematoma within the subperichondrial space. This hematoma obstructs the nutrient supply from the perichondrium to the avascular cartilage. Without a nutrient supply, the ear is at risk for infection, necrosis, and fibrocartilaginous deposition causing cauliflower ear. If a fluctuant hematoma is present within the cartilaginous auricle within 7 days of injury, evacuation should be offered. Prior to the procedure, analgesia should be performed using an auricular block. The hematoma can then be evacuated via needle aspiration or incision and drainage followed by a bolster compression dressing to prevent reaccumulation of blood within this potential space. Despite limited data, 7-10 days of antibiotics are currently recommended with coverage for Pseudomonas aeruginosa (eg, fluoroquinolones in adults, amoxicillin-clavulanate in children). This may mitigate the risk of perichondritis. Patients should be reevaluated at 24-48 hours and abstain from contact sports for at least 2 weeks.

Conclusion: Emergency clinicians must be knowledgeable regarding the evaluation and management of auricular hematoma, including the various drainage techniques.

Keywords: anesthesia; aspiration; auricular hematoma; block; drainage; incision; nerve block; otolaryngology; perichondrium.