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A hematoma
Last reviewed: 05.07.2025
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A hematoma is a limited accumulation of blood in the area of the auricle, which occurs spontaneously (rarely) or as a result of a local contusion of the auricle.
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What causes a hematoma?
Spontaneous hematoma may occur from slight pressure on the auricle in leukemia, hemophilia, vitamin deficiency, trophic disorders, alimentary dystrophy, some infectious diseases accompanied by disorders of the blood coagulation system, as well as due to degenerative changes in cartilage under the influence of cold. Hematoma of traumatic genesis most often occurs with tangential blows, or sharp pressure on the auricle, or with its fractures (deliberate blow, in sports - boxing, various types of martial arts, especially the so-called wrestling without rules).
Symptoms of hematoma
The hematoma is most often localized in the upper part of the outer surface of the auricle. Externally, it is a fluctuating swelling of a reddish-blue color, covered with normal skin. Symptoms of the hematoma are usually absent, it is painless upon palpation. The hematoma contains a fluid consisting of blood and lymph, with the latter predominating, so the color of the contents of the hematoma is light yellow and the fluid itself does not clot. As a result of damage to the lymphatic and blood vessels, the fluid accumulates between the skin and the perichondrium or between the latter and the cartilage. A capsule does not form around the hematoma. Damage to the cartilage may be observed.
The cause of vascular damage is mechanical separation of the skin from the subcutaneous tissue. Since the connection of the skin with the perichondrium on the medial surface of the auricle is more elastic than on the lateral surface, hematomas do not occur on it. Minor hematomas can be absorbed, but large ones, if left untreated, are organized into dense scar tissue within 3-5 weeks, as a result of which the auricle loses its relief and takes the form of a shapeless "cake". A feature of hematoma is its frequent recurrence due to damage to the lymphatic vessels and the predominant content of lymph in the fluid and weakness of the muscular system of the vascular wall in this area (vasoconstrictors) and local blood clotting disorders.
The danger of a hematoma is the possibility of its secondary infection. In this case, hyperemia of the skin of an inflammatory nature occurs over the hematoma, spreading beyond its limits, pain in the area of the auricle, radiating to neighboring areas, and an increase in body temperature. Untimely opening of the abscess leads to perichondritis and cartilage necrosis, which results in deformation of the auricle.
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Treatment of hematoma
A small hematoma can spontaneously resorb when a pressure bandage is applied, with the skin above and around the hematoma first being lubricated with an alcohol solution of iodine. To increase the effectiveness of pressure, 2-3 gauze balls should be fixed over the swelling with adhesive tape and only then a pressure bandage should be applied. Cold is also applied, and after 2-3 days - massage. The use of heat is contraindicated.
In case of a large hematoma with a period of no more than 2-3 days, its contents can be removed under strictly sterile conditions by means of suction with a syringe and a thick needle, followed by the introduction of several drops of an alcoholic iodine solution into the cavity to accelerate the adhesion (scarring) of the cavity walls. After this, a pressure bandage is immediately applied for 3 days or more. If it is necessary to change the bandage, the time interval between its removal and application should be minimal.
When applying a pressure bandage, a thick gauze roll of the appropriate size is placed under the auricle, and 2-3 gauze balls are placed on the lateral surface of the cavity area to increase pressure, and a general bandage is applied to the ear.
Large unresorbed hematomas should be removed by opening. To do this, make an arcuate incision at the edge of the swelling above or below it, remove the contents by blotting and wiping the cavity with sterile turundas, scrape out the pathological contents from the cavity, and wash with a sterile antiseptic solution. After this, either sutures are applied along the edges of the incision, leaving part of the wound unstitched for subsequent drainage with rubber strips, or the wound is not stitched at all.
After this, a pressure bandage is applied, which is changed every day. If the course is favorable, the drainage depth is reduced with each bandage, trying not to destroy the area of the current adhesive process. Healing occurs in 1-2 weeks. To remove the hematoma, an incision is also used through the back surface of the UR: part of the cartilage is removed, forming a small window (5x5 mm), the hematoma is emptied, the cavity is drained, and a pressure bandage is applied. In all cases, local treatment of the hematoma is supplemented with general treatment with antibiotics and sulfonamides.
How is hematoma prevented?
Hematoma is prevented by preventing ear trauma. Contusions and wounds of the auricle are considered infected injuries, and before providing appropriate specialized care, they are thoroughly antiseptically treated and hemostasized.
What is the prognosis for a hematoma?
The prognosis for recovery from hematoma is favorable, but in cosmetic terms it is cautious, especially if complicated by perichondritis; in case of chondritis it is questionable and even unfavorable.