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Ear Injuries

Sports-related ear injuries are not uncommon and may affect the external, middle, or inner ear. Direct trauma to the auricle commonly occurs in wrestling and rugby and may result in the infamous “cauliflower ear.” External ear infection is so common in swimmers that it has come to be referred to as “swimmer's ear.” Middle ear injury may involve perforation of the eardrum, and inner ear barotrauma is often associated with diving. In this entry, we will review the evaluation and management of the most common sports-related ear injuries.

Auricular Hematoma

Auricular hematomas result from blunt trauma to the ear, most commonly in contact sports such as boxing, wrestling, and rugby. The skin overlying the anterior ear is thin and tightly adherent to the underlying cartilage, so it does not easily slide over the cartilage when direct force is applied. Instead, there is a shearing force between the perichondrium and the underlying cartilage, and the blood vessels supplying the cartilage are torn. Blood accumulates between the perichondrium and the cartilage, resulting in a hematoma. Complications of the hematoma may include necrosis and infection of the underlying cartilage because of loss of blood supply from the torn perichondrial vessels. Also, the subperichondrial hematoma actually stimulates new cartilage formation, leading to an asymmetric deformity often called “cauliflower ear.”

Athletes with an auricular hematoma will present with painful swelling of the external ear and loss of ear landmarks. Timely evaluation by medical staff is important as those athletes who wait several days for treatment are at risk for significant fibrosis, which may require surgical debridement. The key components to treatment are (a) complete evacuation of the hematoma, (b) elimination of the perichondrial dead space, and (c) approximation of the overlying tissues.

The ear is initially anesthetized with 1% or 2% lidocaine and sterilely prepped. A curvilinear incision following the natural curve of the pinna is made using a blade along the entire length of the hematoma. The hematoma is then removed with gentle suctioning. Studies have shown that simple needle aspiration is not adequate in removing the clot. Following evacuation of the clot, the dead space is eliminated using a dental roll, button, or silicone splint, which is fit firmly over the area of the incision. The dental roll or button is sutured in place with through-and-through sutures, and antibiotic ointment is applied to the incision and suture sites. The athlete should return in 1 to 2 days to ensure adequate evacuation of the clot and then have the sutures removed in 7 to 10 days.

Otitis Externa

Otitis externa (OE) is an infection of the external ear canal. Heat, humidity, and water in the ear canal from swimming or bathing are associated with OE; they can cause irritation and breakdown of the protective barrier. Studies have shown that the incidence of OE is nearly 2.5 times greater in swimmers than in nonswimmers, thus leading to the common term swimmer's ear.

Early symptoms of OE may include pruritus, otalgia, erythema, and discharge from the ear. Pain may be worsened with manipulation of the auricle or direct pressure on the tragus. In more severe cases, the pain may be accompanied by edema, purulent discharge, and lymphadenopathy. If left untreated, it can progress to malignant (necrotizing) otitis, with concomitant temporal bone osteomyelitis. Examination may reveal a narrowed external canal due to edema, with erythema, debris, and purulent discharge. There is often erythema of the tympanic membrane (TM), which may lead to incorrect diagnosis of otitis media.

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