Ear trauma: auricular haematoma, eardrum perforation and temporal bone fracture
- Emergency
An auricular haematoma is drained promptly, a torn eardrum usually heals, and a temporal bone fracture needs hearing and facial nerve checks.
What it is
Ear injuries range from the auricle to the inner ear. An auricular haematoma, after a blow to the ear in contact sports, is blood between the cartilage and its perichondrium; untreated, the cartilage loses its blood supply and becomes a deformed «cauliflower ear». A traumatic eardrum perforation follows a slap, a cotton bud, an explosion or pressure change, and most heal on their own. A temporal bone fracture comes with major head injury and can cause hearing loss, vertigo, a cerebrospinal fluid leak and facial palsy.
How to recognise it
- Haematoma: a tense, fluctuant swelling of the anterior auricle that hides its normal folds, after a blow.
- Perforation: pain, sudden hearing loss, bloody discharge; a visible hole in the drum on otoscopy.
- Clear fluid from the ear or nose after head injury suggests a cerebrospinal fluid leak.
- Fractures are described as otic capsule sparing or otic capsule violating; violating fractures cause more sensorineural loss and facial palsy.
Step-by-step management
- In head injury, follow trauma priorities first: airway, cervical spine, breathing, circulation and neurological status.
- Examine the auricle, the canal and the eardrum; test hearing with tuning forks and look for nystagmus.
- Examine facial nerve function early and record it, because immediate and delayed palsy differ in prognosis.
- Auricular haematoma: drainage by a trained doctor and a pressure dressing, with review in the following days for refilling.
- Perforation: keep the ear dry, avoid ototoxic drops, and review with otoscopy and audiogram until healed.
- Suspected fracture: CT of the temporal bones; ENT and neurosurgery assess hearing, the facial nerve and any CSF leak.
Three ear injuries compared
| Injury | Key finding | Main risk | Management |
|---|---|---|---|
| Auricular haematoma | Fluctuant swelling of the auricle | Cartilage necrosis, cauliflower ear | Prompt drainage and pressure dressing |
| Eardrum perforation | Hole in the drum, conductive loss | Infection; inner ear injury if vertigo | Keep dry, review healing, audiogram |
| Temporal bone fracture | Battle sign, haemotympanum | Facial palsy, CSF leak, deafness | Head injury care, CT, ENT |
Red flags
- Vertigo, nystagmus or sensorineural hearing loss after trauma (inner ear injury, perilymph fistula).
- Facial weakness after head or ear trauma.
- Clear fluid from the ear or nose (cerebrospinal fluid leak).
- Exposed cartilage, or a red, hot, painful auricle (perichondritis).
- Reduced consciousness or other signs of brain injury.
Next step / Initial management
- Workup: CT head and temporal bones for significant head injury; audiogram for perforation or fracture; facial nerve grading.
- First-line: drainage and pressure dressing for haematoma; dry-ear care for perforation, with non-ototoxic (quinolone) drops only if infected.
- Refer to ENT urgently, the same day, trauma with vertigo, sensorineural loss, facial palsy or CSF leak, and any haematoma that cannot be drained.
- Refer routinely to ENT a perforation that has not healed after about three months, for possible repair.
Test yourself
Think of the answer, then tap the question to see it.
A wrestler has a tense, fluctuant swelling of the front of the auricle after a match. What is it and why treat it promptly?
An auricular haematoma. Blood separates the cartilage from its perichondrium and blood supply; without drainage and a pressure dressing the cartilage dies and a cauliflower ear forms.
After a slap on the ear, a patient has a small eardrum perforation and also vertigo. Why does this change the plan?
Vertigo suggests inner ear injury (for example a perilymph fistula); the patient needs urgent ENT review and an audiogram, not just watchful waiting.
Which signs suggest a temporal bone fracture after head trauma?
Battle sign (bruising over the mastoid), haemotympanum, bleeding or clear fluid from the ear, hearing loss, vertigo and facial palsy.
Connections
Educational content; it does not replace a medical assessment and is not a clinical instruction. For a real case, follow current guidelines and specialist advice.
Sources: Auricular Hematoma (StatPearls) (StatPearls Publishing, NCBI Bookshelf, 2026); Tympanic Membrane Perforation (StatPearls) (StatPearls Publishing, NCBI Bookshelf, 2026); Temporal Fracture (StatPearls) (StatPearls Publishing, NCBI Bookshelf, 2024).
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Representative model, for educational purposes only.