Managing auricular haematoma to prevent 'cauliflower ear'

This article describes the typical signs of auricular haematoma, how people who have the condition should be treated in emergency departments and the problems that can arise if they are managed inappropriately.

Treatment of pinna haematoma with compression using Leonard buttons

The standard treatment of a pinna haematoma involves drainage and compression to prevent recurrence and subsequent disfigurement. Compressive methods can be non-invasive or invasive, utilising a head bandage or through and through sutures, respectively, to keep compression in place. Leonard buttons are effective alternative compressive devices. They are simple to use and easily available.

Simple compressive method for treatment of auricular haematoma using dental silicone material

Most of the previous treatment methods for auricular haematoma are inconvenient for both patients and doctors because they are time-consuming and complex and must be performed under sterile conditions. The purpose of this study was to evaluate the effectiveness of a simple compressive method using a dental (silicone) impression material and comparing it with other methods for treatment of auricular haematomas. The authors aspirated a haematoma and then placed a mixed base and catalyst of silicone putty material on the anterior and posterior surfaces of the auricle in the shape of an inverted U for seven days.

From the 24 cases managed with this method, 23 cases (95.8 per cent) were successfully healed. Eight patients were treated with a collodion-cotton wool cast and 16 of 19 patients were successfully treated with dental cotton-wool rolls. The average number of those visiting the hospital was 2.7 for the collodion-cotton wool cast, 6.9 for the dental cotton-wool roll, and 3.1 for dental silicone. The mean treatment durations were 8.1 days for the collodion-cotton wool cast, 13.8 days for the dental cotton-wool roll, and 8.6 days for dental silicone. The authors believe that this compressive method using dental silicone material is simple and appropriate for the treatment of auricular haematoma.

Case presentation: a novel way of treating acute cauliflower ear in a professional rugby player

Acute auricular haematoma is a common problem in rugby players and can be difficult to treat due to re-accumulation of the fluid and can subsequently cause the unsightly cauliflower ear. We present a case of auricular haematoma affecting the central part of the pinna in a professional rugby player. This was treated successfully by aspiration and the use of silicone splints which allowed the player to continue training and competing.

Otoplasty: sequencing the operation for improved results

LEARNING OBJECTIVES

: After studying this article, the participant should be able to: 1. Understand the anatomy and embryology of the external ear. 2. Understand the anatomic causes of the prominent ear. 3. Understand the operative maneuvers used to shape the external ear. 4. Be able to sequence the otoplasty for consistent results. 5. Understand the possible complications of the otoplasty procedure. Correction of prominent ears is a common plastic surgical procedure. Proper execution of the surgical techniques is dependent on the surgeon's understanding of the surgical procedure. This understanding is best founded on an understanding of the historical bases for the operative steps and the execution of these operative steps in a logical fashion. This article describes the concept of sequencing the operation of otoplasty to produce predictable results combining the technical contributions from many authors. The historical, embryological, and anatomic bases for the operation are also discussed. Finally, the authors' preferred techniques are presented. Sequencing the steps in the preoperative assessment, preoperative planning, patient management, operative technique, and postoperative care will produce reproducible results for the attentive surgeon. Careful attention to the details of the operation of otoplasty will avoid many postoperative problems.

Interventions for acute auricular haematoma

BACKGROUND

Acute haematoma of the pinna is a condition where a collection of blood forms beneath the perichondrial layer of the pinna. It is usually caused by blunt trauma, and if untreated will ultimately result in a deformity commonly known as 'cauliflower ear' or 'wrestler's ear'. Various treatments are employed to relieve the haematoma but no clear consensus exists on the best way to do so in order to produce the best cosmetic result with the least permanent deformity.

OBJECTIVES

To assess the effectiveness of treatment options in acute auricular haematoma.

SEARCH STRATEGY

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library Issue 2, 2003), MEDLINE (1966 - 2003) and EMBASE (1966 - 2003) with pre-specified terms. The date of the last search was April 2003.

SELECTION CRITERIA

Randomised controlled trials, case controlled trials and cohort studies including children and adults undergoing any intervention for acute auricular haematoma.

DATA COLLECTION AND ANALYSIS

Fifty-nine references were identified from the searches. Forty-eight were retrieved and assessed for eligibility by the authors. None met the inclusion criteria.

MAIN RESULTS

Due to the lack of data from trials fulfilling selection criteria no results could be presented.

REVIEWERS' CONCLUSIONS

There is no clearly defined best treatment for acute auricular haematoma. There are no good quality data to determine either the optimal management strategy or even whether post-drainage intervention (such as splinting or bandaging) is necessary. Further research is required before any specific treatment may be recommended.

Could ionizing radiation forestall cauliflower ear?

Repeated trauma to the ear very often results in "cauliflower ear." Many methods have been suggested to prevent an injured ear from demonstrating a cauliflowerlike deformity. The principles of treatment are evacuation of the hematoma, control of the reaccumulation of fluid, and maintenance of the cartilage contour. The authors studied the effect of ionizing radiation on deformed rabbit ears induced by repeated trauma. Twenty ears (10 rabbits) were used in the experiment. The animals were divided into four groups (control, preradiation, low dose, and high dose). Hematoma was produced by pounding the lateral side of the auricle 10 times with a 50-g weight at a height of 15 cm. The thickness of the injured and uninjured sites was measured, and histological analysis was performed for each group. The thickness of the ears of the irradiated groups was significantly less than the control group. The authors think that radiation treatment of repeatedly injured ears could prevent ear deformity, and could possibly be an adjunctive form of management of cauliflower ear in addition to hematoma evacuation and compression therapy.

A pressure prevention device for burned ears

Full-thickness burns to the external ear can produce loss of skin and cartilage and can result in severe cosmetic deformity. Even partial-thickness burns render the ear vulnerable to tissue loss if the helix is subjected to pressure from pillows, dressings, or straps that are used to secure endotracheal tubes. Because of the incidence of burned ear deformities and the difficulty in reconstructing the external ear, an ear protection device has been designed. The bilateral ear protection device, referred to as "headgear", is fitted to all patients in the burn center who require intubation for an inhalation injury; it is worn continuously until extubation. During a 15-month period 39 consecutive critically burned patients were fitted with the headgear because of the need for ventilator support and/or for protection of the burned ear(s). Pressure necrosis of ear tissue was prevented in all 33 survivors.

Antibiotic iontophoresis in the management of burned ears

Severe deformities of the ears are a distressing problem after burn injury. Successful management of chondritis has been elusive. Antibiotic iontophoresis has been used in the management of burned ears in patients who have been admitted to the St. Vincent Medical Center Burn Unit since 1983. There were 145 ear burns in 92 consecutive patients who received prophylactic penicillin or gentamicin iontophoresis and who were admitted from 1983 through 1990. A retrospective analysis of all patients who were admitted to the burn unit from 1967 to 1983 was done to review the outcome for patients with burned ears when conventional treatment was used. The incidence of infection, need for chondrectomy, and ear infection were virtually eliminated by management with antibiotic iontophoresis. In addition, no complications were noted when antibiotic iontophoresis was used. Antibiotic iontophoresis provides a safe, simple, and effective way to manage burned ears and thereby limits postburn ear deformities.

Perichondritis of the auricle

A search of the literature reveals reports of only 191 cases of auricular perichondritis. The present study includes 15 further cases caused by pseudomonas and proteus. Stroud's excision technique was used in four cases and resulted in marked deformity, repeated debridement, and protracted treatment. Tubal drainage was used in the remaining ears with very good esthetic results. It has been demonstrated in experimental animals and in humans that new cartilage forms in the subperichondrial auricular space in the second postoperative week, being maximum in the fourth week. In the present study tubes were retained two to four weeks to maintain an elevation of the perichondrium from what remains of the auricular cartilage to ensure homogeneous cartilage formation and provide local antibiotic treatment. Hospitalization is required for only two days. The four weeks tubal drainage method should be the method of choice for all cases of perichondritis and the excision method abandoned, even in gram-negative infections. A case of relapsing polychondritis is also presented because it is important to distinguish auricular perichondritis from relapsing polychondritis as the treatment of the latter is not surgical but with steroids.

Preventing collapse of external auditory meatus during audiometry

Occlusion of the external auditory meatus resulting from earphone pressure can produce a pseudoconductive hearing loss. I describe a method for detecting ear canal collapse by otoscopy and I suggest a method of correcting the problem with a polyethylene tube prosthesis.