A 25-year-old man comes to the emergency department due to pain and swelling in his right ear. The patient sustained several blows to his ear during a wrestling match a few hours ago. He had no loss of consciousness and has no headache, neck pain, or hearing loss. Blood pressure is 110/55 mm Hg, pulse is 84/min, and respirations are 14/min. On examination, the right ear is red and swollen, and there is an auricular hematoma. The tympanic membrane is normal without hemotympanum. The auditory canal is within normal limits. There is no mastoid erythema or tenderness to palpation. There is no facial swelling or tenderness, and the neurologic examination is intact. Which of the following is the best next step in management of this patient?

Question

A 25-year-old man comes to the emergency department due to pain and swelling in his right ear.  The patient sustained several blows to his ear during a wrestling match a few hours ago.  He had no loss of consciousness and has no headache, neck pain, or hearing loss.  Blood pressure is 110/55 mm Hg, pulse is 84/min, and respirations are 14/min.  On examination, the right ear is red and swollen, and there is an auricular hematoma.  The tympanic membrane is normal without hemotympanum.  The auditory canal is within normal limits.  There is no mastoid erythema or tenderness to palpation.  There is no facial swelling or tenderness, and the neurologic examination is intact.  Which of the following is the best next step in management of this patient?

Quizplus · Accepted Answer

11ec25c8_d835_964e_bc81_273756daa664_MD0003_00 This patient who sustained trauma to the ear has an auricular hematoma, which is a collection of blood between the perichondrium and cartilage of the outer ear. Athletes who participate in contact sports, such as wrestling or martial arts, are at highest risk of ear injury. Physical examination is diagnostic with a swollen, erythematous, tender area of fluctuance at the site of the hematoma. hematoma The complications of an untreated auricular hematoma are significant. Infection can develop rapidly (2-3 days) and lead to an abscess. In addition, because the auricular cartilage has no direct blood supply and receives all nutrients via diffusion from the perichondrium, an auricular hematoma can cause avascular necrosis of the outer ear cartilage. Subsequent fibrocartilage overgrowth can lead to a permanent deformity known as cauliflower ear. cauliflower ear Therefore, management includes prompt aspiration or incision and drainage of the blood collection with application of a pressure dressing to prevent reaccumulation of the hematoma. Patients are treated with oral antibiotics that include coverage for skin flora and Pseudomonas aeruginosa. Daily follow-up for 3-5 days is recommended to assess healing and evaluate for signs of infection (eg, fever, purulent drainage) or blood reaccumulation. (Choice A) Although antibiotics are prescribed to prevent secondary infection, the hematoma must first be evacuated to avoid complications such as abscess or cauliflower deformity. (Choice C) Failure to promptly drain an auricular hematoma can result in significant consequences (eg, infection, cauliflower ear deformity). (Choice D) After incision and drainage, a pressure dressing should be placed to compress the perichondrium to the auricular cartilage to restore nutrient diffusion to the cartilage. However, this is not effective unless the hematoma is drained first. Educational objective: Blunt trauma to the ear can cause an auricular hematoma, which is a collection of blood between the perichondrium and cartilage of the outer ear. Prompt evacuation of the hematoma is required to avoid complications of infection, avascular necrosis, and permanent cauliflower ear deformity.

A 25-Year-Old Man Comes to the Emergency Department Due to Pain