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Ear injuries

Last updated: October 25, 2023

Summarytoggle arrow icon

Ear injuries are usually caused by penetrating trauma, blunt trauma, or barotrauma. Common injuries include ear lacerations, which involve skin breakage; auricular hematoma, resulting in a swollen, tender ear; perichondritis, manifesting with erythema and warmth of the pinna; and tympanic membrane (TM) perforation, which causes sudden pain and, in some cases, hearing loss. For all of these conditions, the diagnosis is clinical; additional testing (e.g., audiological tests) may help establish a diagnosis or rule out complications. Management depends on the type of injury: Lacerations require wound closure, auricular hematomas must be drained, perichondritis is treated with antibiotics, and tympanic membrane perforation may heal spontaneously or require surgery. Complications include deformities and long-term hearing issues.

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Approachtoggle arrow icon

Open wounds [1][2]

After wound management or hematoma drainage, consider a bolster dressing to prevent hematoma (re)accumulation.

Avoid leaving cartilage exposed, as it can lead to chondritis.

Significant trauma [1][2]

If tympanic membrane perforation is suspected, do not perform irrigation to clear blood or debris, as it can force contaminants into the middle ear. [6]

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Ear lacerationtoggle arrow icon

For initial management steps, see “Approach to ear injuries.”

Wound irrigation and debridement [1][6][7]

Wound closure technique [1][6][8]

Follow-up

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Auricular hematomatoggle arrow icon

Etiology [2]

Pathophysiology [2]

Clinical features [1]

If there is erythema, drainage from the ear, and hearing loss, consider an alternative diagnosis, such as auricular abscess.

Management [1][6]

Draining an auricular hematoma prevents infection, relieves pressure, and preserves ear function and appearance. [10]

Incision and drainage

  • Using a scalpel, incise skin along the natural skin folds.
  • Evacuate the accumulated hematoma.
  • Consider irrigating the pocket with sterile saline.
  • Place bolster dressing to prevent reaccumulation.

Follow up

Complications [1]

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Perichondritis of the pinnatoggle arrow icon

Etiology [11]

Clinical features [11][15]

Management [11][15]

Complications [11]

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Tympanic membrane perforationtoggle arrow icon

Etiology [7][17]

Clinical features [7]

Diagnosis [7]

Management [7][17]

Most tympanic membrane perforations heal spontaneously. [17][18]

Avoid ototoxic topical medications (e.g., aminoglycosides) in patients with tympanic membrane perforation. [19]

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