Aural Haematoma

What is an Aural Haematoma?

Aural haematoma is the collection of blood between the cartilage and inner surface layer of the ear flap. The cause is not well understood but appears in most cases to occur as a result of head shaking or scratching at the ear resulting from soreness or irritation associated with an infection of the ear canal. The head shaking causes fracture of the cartilage in the ear flap and haematoma results from bleeding from the blood vessels within the fractured cartilage.

Some cases of aural haematoma formation may occur without the presence of a concurrent ear infection, and may actually be associated with increased capillary fragility. This can occur with Cushing disease.

How Can it be Detected?

Haematoma initially appears as a soft fluid filled swelling of the inside of the ear flap. It gradually becomes firm and thickened due to fibrosis, and eventually develops a cauliflower appearance.

How Can it be Treated?

Firstly, any underlying ear infections should be treated appropriately. Some cases can be treated medically by attempting to drain the haematoma through a hypodermic needle, and once drained injecting the ear flap with corticosteroids. However, recurrence is common with this method of treatment.

Surgery is the preferred means of treatment with the goal being to remove the haematoma, prevent recurrence and minimise any thickening and scarring of the ear flap. There are many techniques that have been used surgically to treat haematoma of the ear. The most commonly used procedure involves cutting the tissue overlying the haematoma, removing the blood clots and fibrin, and holding the ear cartilage in apposition with sutures until scar tissue is formed. Haematoma must be treated soon after it occurs to prevent enlargement or fibrosis.

Once surgically drained a bandage can be used to protect the ear from contamination and self trauma after repair. The affected ear is placed over the top of the head when bandaging and a non-adhesive pad is placed over the drained area. Once this has been applied the bandage is placed over the ear flap and around the head.

How Successful is the Treatment?

Recurrence is rare if the haematoma is treated properly and the underlying disease is appropriately treated.