1. Needle Aspiration: Cleanse the overlying skin with Betadine or other cleanser. Anesthetize the skin with 1% lidocaine with 1:100,000 adrenalin. Use a 10cc or 20cc syringe and an 18 gauge hypodermic needle to aspirate the hematoma. Apply digital pressure for 5-10 minutes. Most patients can hold the pressure themselves.

Overview of Auricular Hematoma

One should ask why auricular hematoma is included in the ENT Ambulatory Healthcare Pathways. It is an uncommon problem and with today's ever improving athletic head gear is a decreasing in frequency. Nonetheless, it is an illness which requires early diagnosis and a problem easily treated by any interested physician.

The key is diagnosis. Invariably there is some inciting trauma such as a head lock applied in a wrestling match or some other shearing blow to the ear. The perichondrium is sheared from the underlying cartilage, bleeding results in the sub-perichondrial space and a hematoma develops. The concerning issue is that the cartilage derives it's blood supply from the perichondrium. With the perichondrium lifted off the cartilage, the cartilage is without blood supply and over the next several days will die and change from a nicely shaped cartilage into an amorphorous scar.

Treatment for auricular hematoma is twofold. Many of these individuals are on some medication which impairs coagulation. The use of aspirin, nonsteroidals or other anticoagulants should be discontinued.

The auricular hematoma can often be drained by needle aspiration. This is easy to do and as long as it does not reaccumulate, is all that is required. Infection is always a risk. The ear should therefore be swabbed with alcohol or betadine. A small amount of lidocaine with adrenaline should be injected into the epithelium and then using a 10 or 20 cc syringe with an 18 gauge needle, the hematoma should be evacuated. The ear should then be observed for a short period of time. If the hematoma does not reaccumulate, the patient is sent home and advised to remain at rest for 24 hours.

If one is skilled at applying a mastoid type pressure dressing, this may be beneficial. If one is not so skilled, it is probably best to leave the ear unwrapped. If the hematoma reaccumulates, it can be needle aspirated 2 or 3 times. Needle aspiration will resolve the hematoma in the majority of cases but if it does not, incision and drainage is required.

To I & D a hematoma, choose an incision site where the blood will drain dependently, anesthetize the skin, and make a 5mm incision through the skin and perichrondium. Spread the wound open with a small hemostat. The hematoma can then be squeezed or expressed through the incision, or if a small sterile Frazier or neuro sucker is available, this can be used to suction the hematoma.

At this point most people would recommend a pressure dressing to cover the wound. Those that like drains will always place a drain, those who are opposed to drains will rarely do so. The advantage of a drain is that it keeps the incision open and allows the wound to drain. Those who oppose drains argue that this predisposes to infection. If you chose to drain, all that is required is a small rubber band. If a drain is placed a dressing is required. In addition, if a drain is used, there is a sufficiently high risk of infection that oral antibiotics are now required.

The organisms present are skin bacteria and first generation cephalsporins such as Keflex are recommended.

The dressing should be changed at 24 hours. Assuming no major oozing or bleeding, the drain should be removed at 24 hours. The patient should have no residual defect or damage to the ear.