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Current Evidence
Injury to the external ear can include laceration to the skin, soft tissue, or
cartilage, as well as hematoma with risk of cartilage necrosis. The cartilage of the
ear is nourished and oxygenated by diffusion via the perichondrium. With an
auricular hematoma, bleeding avulses the perichondrial layer off the cartilage as
the blood collects between them. This separation of the perichondrium can lead to
cartilage necrosis if not decompressed in a timely fashion. In addition to blunt or
sharp trauma, the external ears are also susceptible to thermal injuries including
both burn and frostbite.

Clinical Considerations
Clinical Recognition
Injuries to the external ear can manifest as laceration, ecchymosis, or hematoma.
Thermal injury may present with bullous or peeling skin. Most commonly, there
is a reported history of trauma or symptoms of pain or bleeding that prompts the
emergency clinician to recognize the injury. However, unwitnessed or
asymptomatic injuries may also be identified during examination.
Triage
Any child with an external ear injury associated with serious trauma, active
bleeding, new hearing loss, or neurologic symptoms should be evaluated
emergently. Most children will present with mild to moderate discomfort without
associated symptoms and can be seen urgently.
Initial Assessment
The initial assessment should focus on the mechanism and severity of the injury,
examination for foreign body, and evaluation for other associated injuries. The
auricle should be inspected for any externally visible deformity/injury including
lacerations or avulsions, with attention to any cartilage exposure, ecchymosis, or
hematoma. Note that isolated ecchymosis to the external ear canal without other
signs of injury or with an inconsistent mechanism of injury should raise suspicion
for nonaccidental trauma. Diagnostic imaging is not routinely indicated for
simple, isolated injuries. Imaging should be considered to evaluate for associated

injuries, including closed head injury or facial fractures, in the setting of
concerning symptoms or findings (see Chapters 107 Facial Trauma and 113
Neurotrauma and Head Injury Clinical Pathway at ).