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.

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]

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]


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]

Perichondritis of the pinnatoggle arrow icon

Etiology [11]

Clinical features [11][15]

Management [11][15]

Complications [11]

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]

Referencestoggle arrow icon

  1. Tintinalli JE, Stapczynski JS, Ma OJ, Yealy D, Meckler GD, Cline DM. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 9th edition. McGraw Hill Professional ; 2019
  2. Roberts JR. Roberts and Hedges' Clinical Procedures in Emergency Medicine and Acute Care. Elsevier ; 2018
  3. Walls R, Hockberger R, Gausche-Hill M, Erickson TB, Wilcox SR. Rosen's Emergency Medicine 10th edition- Concepts and Clinical Practice E-Book. Elsevier Health Sciences ; 2022
  4. Cho DY, Willborg BE, Lu GN. Management of Traumatic Soft Tissue Injuries of the Face. Semin Plast Surg. 2021; 35 (04): p.229-237.doi: 10.1055/s-0041-1735814 . | Open in Read by QxMD
  5. Nojoumi A, Woo BM. Management of Ear Trauma. Oral Maxillofac Surg Clin North Am. 2021; 33 (3): p.305-315.doi: 10.1016/j.coms.2021.04.001 . | Open in Read by QxMD
  6. Greywoode J, Pribitkin E, Krein H. Management of Auricular Hematoma and the Cauliflower Ear. Facial Plast Surg. 2010; 26 (06): p.451-455.doi: 10.1055/s-0030-1267719 . | Open in Read by QxMD
  7. Jones SE, Mahendran S. Interventions for acute auricular haematoma. Cochrane Database Syst Rev. 2004.doi: 10.1002/14651858.cd004166.pub2 . | Open in Read by QxMD
  8. Carniol ET, Bresler A, Shaigany K, et al. Traumatic Tympanic Membrane Perforations Diagnosed in Emergency Departments. JAMA Otolaryngol Head Neck Surg. 2018; 144 (2): p.136.doi: 10.1001/jamaoto.2017.2550 . | Open in Read by QxMD
  9. Jellinge ME, Kristensen S, Larsen K. Spontaneous closure of traumatic tympanic membrane perforations: observational study. J Laryngol Otol. 2015; 129 (10): p.950-954.doi: 10.1017/s0022215115002303 . | Open in Read by QxMD
  10. Rosenfeld RM, Schwartz SR, Cannon CR, et al. Clinical Practice Guideline: Acute Otitis Externa. Otolaryngol Head Neck Surg. 2014; 150 (1_suppl): p.S1-S24.doi: 10.1177/0194599813517083 . | Open in Read by QxMD
  11. Prasad HKC, Sreedharan S, Prasad HSC, Meyyappan MH, Harsha KS. Perichondritis of the auricle and its management. J Laryngol Otol. 2007; 121 (6): p.530-534.doi: 10.1017/s0022215107005877 . | Open in Read by QxMD
  12. Stewart GM, Thorp A, Brown L. Perichondritis-A Complication of High Ear Piercing. Pediatr Emerg Care. 2006; 22 (12): p.804-806.doi: 10.1097/01.pec.0000248687.96433.63 . | Open in Read by QxMD
  13. White A. A Cumulative Review of the Range and Incidence of Significant Adverse Events Associated with Acupuncture. Acupunct Med. 2004; 22 (3): p.122-133.doi: 10.1136/aim.22.3.122 . | Open in Read by QxMD
  14. Klug TE, Holm N, Greve T, Ovesen T. Perichondritis of the auricle: bacterial findings and clinical evaluation of different antibiotic regimens. Eur Arch Otorhinolaryngol. 2019; 276 (8): p.2199-2203.doi: 10.1007/s00405-019-05463-z . | Open in Read by QxMD
  15. Rivera-Morales MD, Rodriguez Belén JL, Vera A, Ganti L. Perichondritis: Not All Ear Pain Is Otitis. Cureus. 2020.doi: 10.7759/cureus.11141 . | Open in Read by QxMD
  16. Meltzer DI. Complications of body piercing. Am Fam Physician. 2005; 72 (10): p.2029-34.
  17. Kouba DJ, LoPiccolo MC, Alam M, et al. Guidelines for the use of local anesthesia in office-based dermatologic surgery. J Am Acad Dermatol. 2016; 74 (6): p.1201-1219.doi: 10.1016/j.jaad.2016.01.022 . | Open in Read by QxMD
  18. Hafner HM, Rocken M, Breuninger H. Epinephrine-supplemented local anesthetics for ear and nose surgery: Clinical use without complications in more than 10,000 surgical procedures. J Dtsch Dermatol Ges. 2005; 3 (3): p.195-199.doi: 10.1111/j.1610-0378.2005.04758.x . | Open in Read by QxMD
  19. Gailey AD, Farquhar D, Clark JM, Shockley WW. Auricular avulsion injuries and reattachment techniques: A systematic review. Laryngoscope Investig Otolaryngol. 2020; 5 (3): p.381-389.doi: 10.1002/lio2.372 . | Open in Read by QxMD

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