What is it?
An auricular hematoma is an injury to the outer ear.  This injury can occur when the outer ear is either hit directly or receives repetitive blows.  It is more common in wrestling, rugby, boxing, and mixed martial arts.  This injury can cause blood to collect under the skin of the ear next to the cartilage.  If the blood is not removed, or if this injury happens multiple times, the cartilage in the outer ear can become permanently damaged and disfigured. This is called “cauliflower ear.”

Symptoms
The symptoms are typically limited to the outer ear.  After an injury, there is pain and swelling in the outer ear.  If this has occurred multiple times, the ear may appear deformed.  Depending on the extent of the injury to the ear, the athlete may need to be evaluated for a concussion or injury to the ear drum.

Sports Medicine Evaluation/Treatment
Auricular hematoma is usually easily diagnosed by the healthcare provider at the site of the game or in the office.  Usually, no imaging is needed.  Most of the time, the blood needs to be drained from the outer ear to prevent damage to the cartilage.  This should be done as soon as possible.  If it is not done within one week, it may be too difficult to remove the blood.  The doctor may prescribe antibiotics after the procedure to prevent an infection.

Injury Prevention
In sports that allow headgear such as wrestling and rugby, it is important that the athletes wear their headgear at all times.  If they participate in a contact sport without ear protection, they are at risk of developing this injury.

Return to Play
The timeframe for return to play depends on the amount of swelling and if the ear has to be drained.  If the swelling is mild and the ear can be protected with padding or headgear, then the athlete can return in a few days.  If the ear was drained, the athlete can return to play once the skin has healed and the swelling is resolved.  This usually occurs within 7 days and the athlete should wear protective headgear.

AMSSM Member Author: Kris Fayock, MD

Reference:
Malloy, KM. Assessment and management of auricular hematoma and cauliflower ear. In: UpToDate, Stack, AM, Wolfson, AB (Ed), UpToDate, Waltham, MA, 2014.