期刊名称：Journal of Education and Teaching in Emergency Medicine
印刷版ISSN：2474-1949
出版年度：2018
卷号：3
期号：4
页码：17-19
DOI：10.21980/J8S63X
出版社：University of California Press
摘要：History of present illness: A 40-year-old male with no past medical or surgical history presents to the
emergency department for evaluation of a growth on his left ear over the past month. He reports a history
of trauma three weeks ago, where he was involved in a bar fight and was punched in the ear. He denies any
discharge, hearing loss, bleeding or being bitten. He states that since the injury his ear has become more
swollen.
Significant findings: On exam, the patient has a gross deformity to the left pinna that was not painful to touch
or fluctuant. Findings and history are consistent with cauliflower ear, secondary to a chronic auricular
hematoma.
Discussion: Auricular hematomas are a common complication after blunt trauma to the outer ear.1 Blood
gathers between the perichondrium and cartilage after being separated due to the trauma.1-3 Usually, the
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perichondrium adheres to the cartilage of the outer ear through an extensive layer of blood vessels. Blunt
trauma to the ear causes its separation, allowing for blood to collect and form a hematoma. If the blood is
not drained, the collection causes infection or cartilage necrosis, leading to perichondritis, and ultimately
causing the cosmetic complication of what is known as cauliflower ear.2-5
Indications for drainage of hematoma within the emergency department include any traumatic swelling to
the pinna that is within seven days of the initial trauma. Procedure for drainage is as follows: 1) Perform an
auricular block, 2) Remove the clot either by making an incision on the auricular crease or by needle
aspiration, 3) Place a compression or bolster dressing to prevent further clot formation. Patients should be
given antibiotics that cover Pseudomonas and Staphylococcus aureus such as ciprofloxacin, and need close
follow-up with otolaryngology (ENT) for wound check within 2-3 days.3-5 Contraindications to drainage
within the emergency department include patient presenting more than one week after the initial trauma,
and history of recurrent hematomas or cauliflower ear.3-5
In addition to the cosmetic complication of cauliflower ear, a more serious complication of auricular
hematomas is septic necrosis due to infection with gram-negative bacilli, such as Pseudomonas aeruginosa
and E. coli; approximately 95% of cases are due to Pseudomonas aeruginosa, with co-infection with E. coli
in half those cases,
5 Staphylococcus aureus is less common and has been found in roughly 7% of cases.5
Septic necrosis of the ear requires incision and drainage, and hospitalization for intravenous antibiotics
with antipseudomonal and gram-positive coverage, such as ciprofloxacin, clindamycin, or a 3rd or 4th
generation cephalorsporin.4-6
Once cauliflower ear forms, treatment from an emergency department standpoint is limited, especially if
there is no evidence of infection. However, there are several case reports showing successful correction by
plastic surgeons through surgical removal of the calcified hematoma and reshaping of the fibrous cartilage.7
The patient in this case was offered follow-up with ENT for surgical removal and cosmetic repair.
