Auricular hematoma
- Etiology & Pathophysiology:
- Blunt shearing trauma to the external ear (classic in wrestling, boxing, rugby).
- Separation of perichondrium from underlying cartilage → subperichondrial hematoma → cartilage ischemia and avascular necrosis.
- Clinical Presentation:
- Acute, tender, tense, fluctuant swelling over the anterior pinna (typically scaphoid fossa or concha).
- Loss of normal cartilaginous architecture and ear landmarks.
- Diagnosis:
- Clinical diagnosis (no labs/imaging routinely required).
- Non-contrast CT indicated only if concomitant skull base or temporal bone fracture is suspected.
- Management:
- Prompt drainage (< 24–48 h): Incision & Drainage (I&D) is the preferred treatment (needle aspiration carries high recurrence; reserved for < 2 cm). c
- Bolster / Pressure dressing: Mandatory post-drainage step for 3–7 days to re-approximate perichondrium to cartilage and prevent reaccumulation.
- Empiric PO Abx: Coverage for skin flora and Pseudomonas aeruginosa (e.g., ciprofloxacin or amoxicillin-clavulanate).
- No return to contact sports until completely resolved (minimum 1–2 weeks).
- Key Complications:
- “Cauliflower ear” (permanent deformity due to neocartilage formation and avascular necrosis).
- Suppurative chondritis / abscess (often Pseudomonas or S. aureus).
- Recurrent hematoma (highest risk if bolster dressing is omitted).
Tympanic membrane perforation
- Etiology & Triggers:
- AOM with spontaneous rupture (most common infectious cause).
- Mechanical trauma (e.g., cotton-tipped applicators/Q-tips, foreign bodies).
- Barotrauma (e.g., blast injury, direct slap to the ear, scuba diving).
- Clinical Presentation:
- Sudden relief of otalgia immediately followed by otorrhea (bloody or purulent).
- Conductive hearing loss (CHL): Weber lateralizes to affected ear; Rinne negative (BC > AC).
- Tinnitus; vertigo or SNHL suggests inner ear/ossicular injury.
- Diagnosis:
- Otoscopy: Direct visualization of TM defect; avoid pneumatic otoscopy.
- CT temporal bone: Indicated only for head trauma/basilar skull fracture, suspected ossicular disruption, or persistent vertigo.
- Management:
- First-line: Conservative management (dry ear precautions; plug ear with petroleum-coated cotton when bathing; no swimming). c
- Most (>80–90%) heal spontaneously within 2–3 months.
- Avoid ototoxic topical drops (e.g., neomycin, gentamicin, alcohol).
- If infected/draining: Topical fluoroquinolones (e.g., ofloxacin) ± oral antibiotics for AOM.
- Surgery: Tympanoplasty if non-healing after >2–3 months, large defect (>50%), or ossicular damage.
- Complications:
- Acquired cholesteatoma (inward migration of squamous epithelium).
- Chronic suppurative otitis media (CSOM).
- Permanent CHL or ossicular chain erosion.