Incision, Repair of Ear Hematoma Recommended

MARCO ISLAND, FL—A procedure in which a hematoma in the ear is repaired through definitive incision and drainage appears to result in good cosmetic outcomes, researchers reported at the combined sections meeting of the Triological Society.

Kenneth Iverson, BS, a medical student at the University of South Carolina School of Medicine in Columbia, said that hematomas form in the ears generally due to blunt trauma—the kind of trauma that is associated with contact sports injuries, accidents, or barroom discussions gone bad.

“Complications that can arise from these injuries include infection, cartilage necrosis, and the dreaded cauliflower ear,” he said in an oral presentation.

“Auricular hematomas require early and effective management,” Mr. Iverson said. He said his chart review study showed that incision and drainage with absorbable mattress sutures is a superior technique to other methods. “It is a relatively simple technique; it has a low recurrence rate and has desirable cosmetic outcome,” he said.

Mr. Iverson said the diagnosis is made on the observation of the loss of landmarks to the injured ear, due to swelling. He said that patients often exhibit what appears to be a disproportionate amount of pain.

The goal of treatment, he said, is to evacuate the hematoma in order to remove the nidus for neocartilage formation. Evacuation of the hematoma also allows for the stimulation of perichondrial mesenchymal cells. The elimination of dead space is accomplished through a compression method. With the space compressed, the recurrence of the hematoma is thwarted, he suggested.

He said that treatment options in the past have been less than optimal. “Repeated needling was one of the earlier methods employed in the treatment of auricular hematoma,” he said. “It is very painful and has poor cosmetic results.”

A number of other procedures have also been tried with varying degrees of success, Mr. Iverson said. Among them:

Needle aspiration followed by casting or molding or use of absorbable mattress sutures.

Incision and drainage followed by drain placement, button compression with through-and-through sutures; thermal plastic splinting; dental roll bolsters with mattress sutures.

Retrospective Chart Review

In his retrospective five-year chart review covering the period from September 2001 to September 2006, Mr. Iverson scrutinized outcomes among patients who were treated three difference methods of treating auricular hematomas:

• In one method, an incision to allow evacuation of the hematoma is made, followed by drainage and then closure with mattress sutures.
• The second procedure involved needle aspiration techniques.
• In the third procedure, incision and drainage were followed by wick placement.

Fourteen of the 22 patients in the study were under the age of 20; 18 of the patients were under age 40; two patients were in their 70s. Twelve of the injuries occurred during wrestling bouts—the usual cause of the injuries, although they can be mitigated by wearing protective headwear. Six of the cases resulted from trauma due to automobile accidents or altercations. Four of the causes of the hematomas were not described in the charts. All but one of the patients in the study were male.