A patient, aged 15 years, presented for evaluation of a deformed ear of recent onset. He was on the football and wrestling teams.
Physical examination revealed slight erythema, swelling and bogginess of the patient’s right ear. There was minimal tenderness to palpation and cervical and posterior lymph nodes were nonpalpable. The left ear was without pathology.
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An auricular hematoma is a collection of fluid in the perichondrial layer of the pinna. It is a somewhat common condition in athletes that play contact sports such as wrestling, boxing, and martial arts.1 Ear protectors during contact sports can prevent the formation of these hematomas.
Trauma such as a blow to the anterior skin of the ear will cause the perichondrium layer to detach from the underlying cartilage. Blood then begins to accumulate between the perichondrial layer and the cartilage, forming a hematoma. When left untreated, fibrocartilage forms and causes a permanent ear deformity, known as cauliflower ear.1-3
Diagnosis is readily achieved based on history of trauma and physical examination revealing loss of typical auricular landmarks. Small hematomas of recent onset, which may be painful, can be aspirated with a needle; however, such therapy is not recommended for chronic lesions due to the propensity for subperichondrial fluid accumulation.4-6 Incision and drainage with suture closure or fibrin glue has been advocated for these lesions.7-8 A novel, nonsurgical approach, utilizes magnets placed on either side of the hematoma reported to induce resolution within two weeks.9
Recognition and treatment of auricular hematoma by a clinician is important to prevent ear deformity and avoid uncommon sequelae such as infection, cartilage necrosis, contracture, and neocartilage formation. Counseling patients on wearing protective gear during contact sporting activities will protect against the causative shearing forces.
Megha D. Patel, is a student at the Commonwealth Medical College, Scranton, Pennsylvania.
Stephen Schleicher, MD, is an associate professor of Medicine at the Commonwealth Medical College and an Adjunct Assistant Professor of Dermatology at the University of Pennsylvania Medical College. He practices dermatology in Hazleton, Pennsylvania.
- Filippone LM. Emergency Medicine News. 2006; 28(4): 22-26.
- O’Donnell BP et al. Dermatol Surg. 1999; 25: 803-805.
- Skoog T et al. Scand J Plast Reconstr Surg. 1972; 6:123-125.
- Summers A. Emergency Nurse. 2012; 20(5): 28-30.
- Sarck WJ et al. J Oral Maxillofac Surg. 1992; 50:800-802.
- Schuller DE. Arch Otolarynxgol Head Neck Surg. 1989; 115: 202-206.
- Giles WC et al. Laryngoscope. 2007; 117(12): 2097-2099.
- Mohamad SH et al. Clin J Sport Med. 2014; Volume 24(6), p 65-67.
- Park TH et al. Clin J Sport Med. 2013; 23(4):329.