The goal of treatment is to promote healing of the injury so that
the appearance of the auricle is preserved as far as possible
the cartilage is not left exposed.
Lidocaine/adrenaline combination may be used for local anaesthesia of the auricle.
Treatment
Strictly aseptic techniques should be used in the treatment of injuries. If cartilage or a perichondrium is exposed it must be covered with skin. Save as much skin as possible.
Small clean incision wounds can be sutured with e.g. a 5-0 monofilament thread. In small wounds the cartilage is supported by the skin, in larger wounds the perichondrium must sometimes be sutured with e.g. a 4-0 or 5-0 resorbable thread.
Contusions and contaminated incision wounds must first be cleaned mechanically and then rinsed with saline. If parts of the auricle have to be excised this is best performed by a wedged incision so that the sharp edge of the wedge is directed towards the centre of the auricle. When the margins of the incision are sutured together the auricle remains in its original shape but becomes smaller. More skin can be transplanted on the auricle using a pedunculated flap.
Treatment can be carried out at the primary care level
in all injuries located in thearea of the ear lobe (no cartilage)
in injuries of the cartilaginous areas of the auricle provided that the cartilage can be covered without problems.
Further treatment
In more extensive injuries it is worthwhile to support the auricle in its natural position after suturation by using cotton wool and dressings.
A blunt wound may cause a haematoma between the cartilage and the perichondrium. A fluctuating, non-tender mass can be felt in the auricle, usually in the upper part of it.
Evacuate the haematoma aseptically by aspirating with a needle and a syringe. After the procedure apply a compressive, well-aligned dressing. A sports headband may be used to aid compression. Sometimes the aspiration must be repeated several times over the next few days.
An old haematoma that cannot be aspirated with a needle and a syringe can be evacuated aseptically through a small incision. A compressive dressing is applied in this case also.
An untreated auricular haematoma results in deformation of the cartilage and the whole auricle.
Frostbites and burns
Burns should be treated according to the same principles as burns elsewhere.
For frostbite injuries, the treatment practices are similar to those for frostbite injuries of the limbs: immediate warming is important, tetanus booster given if necessary, pain medication, revision of blisters and covering them with a protective wound dressing.
Mild frostbite tends to heal spontaneously. Severe frostbite may result in auricle necrosis that requires resection of a part of the auricle (in specialized care).
Perichondritis of the auricle
Infection can result from injuries to the external ear.
There is severe pain as a symptom. The skin over the inflamed area becomes red, tender, and swollen. As the condition progresses, pus is accumulated between the perichondrium and the cartilage.
The condition usually requires intravenous antimicrobial treatment in specialized care. The abscess is surgically incised.
If left untreated the infection may result in widespread destruction of the cartilage and changes in the form of the auricle.
References
Zimmerman ZA, Sidle DM. Soft Tissue Injuries Including Auricular Hematoma Management. Facial Plast Surg Clin North Am 2022;30(1):15-22.[PubMed]
Dalal PJ, Purkey MR, Price CPE, et al. Risk factors for auricular hematoma and recurrence after drainage. Laryngoscope 2020;130(3):628-631.[PubMed]