When I was younger, one of my older relatives gave me some advice: “Check someone’s ears before picking a fight, and if they have cauliflower ear… run away.” I’d learn later that he meant those ears belonged to wrestlers or martial artists—people who’ve taken (and given) a lot of hits. In other words: someone I stood no chance against.
While it’s a funny memory, it highlights something important. Left untreated, auricular hematomas can lead to significant complications like cauliflower ear and severe infections. In urgent care, we’re perfectly positioned to prevent this disfigurement—and the complications that can come with it—by confidently diagnosing and draining auricular hematomas.
An auricular hematoma usually forms after a blunt shearing trauma to the ear, commonly seen in contact sports like wrestling or boxing. When the perichondrium separates from the cartilage, blood pools in that space. The result? A swollen, distorted ear—usually on the anterior pinna. The lobule is typically spared, since it lacks cartilage.
While this is a clinical diagnosis, always keep your differential broad. If there's fever, fluctuance, or signs of infection, think perichondritis or abscess. No hearing loss, ear drainage, or systemic symptoms? You’re probably looking at a straightforward hematoma.
Timing is everything. If the injury is older than seven days, refer to ENT. Clotted blood and granulation tissue make drainage less effective, and specialist intervention is needed. But for fresh hematomas (ideally within 48 hours), urgent care is a great setting for intervention, assuming there are no red flags like necrosis, infection, or associated facial trauma.
First, block the pain. An auricular nerve block is quick, safe, and very effective.
Then decide how to drain:
Needle aspiration works for hematomas <2 cm and <48 hours old.
Incision and drainage are preferred for larger or slightly older hematomas.
IV catheter drainage offers continuous decompression and can be paired with a bolster dressing.
Whichever method you choose, the real key is compression. After drainage, apply a pressure dressing that reapproximates the perichondrium to the cartilage to prevent reaccumulation. Think dental rolls and through-and-through sutures—or whatever materials you happen to have closest to you that day that will get the job done.
Current recommendations are for these patients to receive a 7-10 day course of prophylactic antibiotics. In adults, you should be reaching for fluoroquinolones to target Pseudomonas, and in kids, we are using amoxicillin-clavulanic acid to cover for skin flora. Prophylactic fluoroquinolones are not recommended in the pediatric population, given their side effect profile, but make sure you educate the family on signs of developing perichondritis. Recommend a follow-up with ENT in 24–48 hours and enforce a two-week break from contact sports. Oh, and remind them to use proper headgear to prevent future injuries.
If there’s concern for severe perichondritis that warrants admission, abscess, or significant laceration involving cartilage, send them to the ED. The same goes for hematomas related to high-impact trauma, where underlying injuries could be missed.
Auricular hematomas are a “can’t miss” diagnosis given their potential for disfiguring outcomes, but luckily, we can easily manage them in the acute care setting. Timely drainage not only spares your patient cosmetic complications but also prevents infection and necrosis. Don’t fear the ear. With the right tools and timing, this is a win for urgent care.