An ear hematoma (auricular or perichondrial hematoma) is a common injury where blood collects under the skin of the outer ear (pinna). This condition is linked to physical trauma and requires timely intervention because it can permanently alter the ear’s shape if not addressed promptly. Understanding this injury involves defining its characteristics, identifying its causes, detailing treatments, and recognizing potential long-term complications.
Definition and Appearance
An ear hematoma is a collection of blood that pools between the cartilage of the outer ear and the perichondrium, the connective tissue layer that surrounds the cartilage. The cartilage receives its blood supply and nutrients from this overlying perichondrium. When trauma causes a hematoma, the pooling blood separates these two layers, effectively cutting off blood flow to the underlying cartilage.
Symptoms present as a noticeable swelling or lump on the ear, typically on the front surface where the skin is tightly attached to the cartilage. This swelling is often accompanied by pain, tenderness, and bruising, sometimes causing the ear’s normal contours and folds to be lost. The area feels tense and fluid-filled upon touch, similar to a small water balloon. Failure to treat this separation quickly can lead to a long-term change in the ear’s structure.
Causes and Risk Factors
The cause of an ear hematoma is a blunt force or shearing injury to the outer ear. This trauma ruptures small blood vessels, leading to the internal bleeding that forms the blood pocket. The force does not need to be severe, but it must be sufficient to tear the connection between the perichondrium and the cartilage.
Participation in contact sports increases the risk of this injury, as athletes are exposed to glancing blows or friction on the side of the head. Wrestling, boxing, rugby, and mixed martial arts are activities where auricular hematomas are commonly observed. Falls, physical altercations, or a severe strike from a ball can also generate the necessary force. Wearing specialized protective headgear, such as head guards or scrum caps, can substantially reduce the incidence of this type of trauma.
Treatment Options
Prompt treatment is required to prevent deformity, ideally within the first few days of the injury. The goal of medical management is to remove the collected blood and restore the close contact between the perichondrium and the cartilage. The treatment chosen depends largely on the size and age of the hematoma.
For smaller, newer hematomas, a procedure called needle aspiration may be performed, where a sterile needle is used to drain the fluid. Larger or older hematomas, particularly those with clotting, often require a small incision and drainage to fully evacuate the blood and fibrin. Following drainage, the application of a compression dressing is necessary. This dressing, which may involve sutures securing cotton bolsters or splints on both sides of the ear, prevents the space from refilling with blood and holds the perichondrium firmly against the cartilage. The compression must be maintained for several days to allow the two layers to reattach and heal properly.
Potential Long-Term Effects
If an ear hematoma is not treated quickly and effectively, the separation of the perichondrium from the cartilage leads to a lack of oxygen and nutrients. This deprivation causes the underlying cartilage tissue to die, a condition known as necrosis. When the body attempts to heal this damaged area, it lays down new, unorganized fibrocartilage and scar tissue.
This process results in a permanent, thickened, and distorted appearance of the outer ear, commonly referred to as “cauliflower ear.” The ear’s once-smooth contours become lumpy and misshapen, reflecting the underlying fibrosis. Beyond the cosmetic alteration, this deformity can lead to practical issues, such as difficulty wearing headphones or glasses. In some instances, the swelling and scarring may also affect the ear canal, which can lead to hearing impairment or increased risk of infection.