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.
Open wounds 
- Apply local pressure to achieve .
- Provide local anesthetic or use a field block (e.g., with 1% lidocaine with epinephrine). 
- Examine wounds for foreign bodies, contamination, and exposed cartilage.
- Consult plastic surgery if there is an or significant loss of overlying tissue. 
- Proceed to acute wound management for simple ear lacerations.
Avoid leaving cartilage exposed, as it can lead to chondritis.
Significant trauma 
- Assess for , , and other associated injuries.
- Perform otoscopy to inspect for:
- Lacerations and foreign bodies
- Consult ENT and conduct audiological testing if there is evidence of hearing loss.
- Consult oromaxillofacial and/or neurosurgery if there are fractures.
- Manage auricular hematoma and TM perforation as indicated.
For initial management steps, see “Approach to ear injuries.”
- Clean grossly contaminated wounds.
- Avoid antiseptic solutions that may cause further damage (e.g., chlorhexidine). 
- Manually remove any residual foreign bodies.
- Remove necrotic cartilage or jagged skin through debridement.
Wound closure technique 
- Approximate wound edges and use single-layer closure if cartilage is not involved.
- If cartilage repair is needed, use absorbable sutures.
- For grossly contaminated wounds or wounds involving cartilage, consider prophylactic antibiotics with Pseudomonas coverage: e.g., ciprofloxacin (off-label). 
- Apply after repair of extensive injuries.
- Nonabsorbable sutures holding the bolster dressing are typically removed after 7 days. 
- See also “Follow-up” in “ .”
- Blunt trauma: blows to the ear (e.g., during boxing or wrestling)
- Penetrating trauma: lacerations and/or perforation of the ear (e.g., due to earring misplacement, ear piercing)
- Develops after blunt trauma or injury to the external ear
- Blood accumulates between the cartilage and perichondrium, which leads to cartilage separation.
Clinical features 
- Sudden tense, tender, and fluctuant swelling of the auricle
- Loss of normal anatomical landmarks of the anterosuperior aspect of the auricle
- For initial management steps, see “Approach to ear injuries.”
Drain any tender auricular fluid collection after ear trauma.
- Standard technique: incision and drainage
- Needle aspirations are not routinely recommended. 
- Consult otolaryngology or plastic surgery if:
- Using a scalpel, incise skin along the natural skin folds.
- Evacuate the accumulated hematoma.
- Consider irrigating the pocket with sterile saline.
- Place to prevent reaccumulation.
- Consider prophylactic antibiotics with coverage against skin flora and P. aeruginosa, e.g., ciprofloxacin (off-label). 
- Inspect the ear within 24 hours for reaccumulation of hematoma.
- Remove after a week.
- Cauliflower ear: a permanent deformity of the ear caused by an untreated or inadequately drained auricular hematoma
- Piercing injury, e.g., cartilage piercing, acupuncture 
- Extension of otitis externa
- Most common organism: P. aeruginosa 
Clinical features 
- Perichondritis is a clinical diagnosis.
- Initiate empiric antibiotics based on local protocols. 
- If there is evidence of an abscess or necrotic cartilage, consult ENT for surgical management.
- Direct blow
- (e.g., )
- Penetrating trauma, instrumentation (e.g., cotton-tipped applicators)
- Ear foreign bodies (e.g., toys, jewelry)
- Acute otitis media
Clinical features 
- Clinical diagnosis after visualizing ruptured membrane via otoscopy
- Formal audiometry may be performed if there is hearing loss.
- Management is mainly supportive; consult ENT if there is hearing loss or vertigo.
- Instruct patients to keep the ear canal dry.
- Consider topical antibiotics if there is evidence of infection (e.g., otorrhea) or remaining foreign bodies; see “ ” for agents and dosages.
- Tympanoplasty is reserved for perforations that do not heal spontaneously. 
- For cause-specific treatment, see also “Ear barotrauma,” “Acute otitis media,” and “Ear foreign body.”
Most tympanic membrane perforations heal spontaneously.