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# 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.

Updated Nov 5, 2026

## Key points

- Auricular haematoma: drain promptly (needle or incision) and apply a pressure dressing to stop it refilling; otherwise cauliflower ear.
- Most traumatic eardrum perforations heal on their own within weeks to a few months; keep the ear dry.
- Vertigo, sensorineural hearing loss or facial palsy after ear trauma suggest inner ear or nerve injury and need urgent ENT.
- Temporal bone fracture: Battle sign (bruising behind the ear), haemotympanum, cerebrospinal fluid otorrhoea, hearing loss and facial palsy.
- Facial palsy that is complete and immediate after a fracture has a worse outlook than delayed palsy.

## 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.

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## Connections

## Related 1

- [Otoscopy: technique and the normal eardrum](https://durgical.com/en/ent/otoscopy-technique-and-the-normal-eardrum/)

[← All of ENT](https://durgical.com/en/ent/)

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)](https://www.ncbi.nlm.nih.gov/books/NBK531499/) (StatPearls Publishing, NCBI Bookshelf, 2026); [Tympanic Membrane Perforation (StatPearls)](https://www.ncbi.nlm.nih.gov/books/NBK557887/) (StatPearls Publishing, NCBI Bookshelf, 2026); [Temporal Fracture (StatPearls)](https://www.ncbi.nlm.nih.gov/books/NBK535391/) (StatPearls Publishing, NCBI Bookshelf, 2024).

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Representative model, for educational purposes only.

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/ent/ear-trauma-auricular-haematoma-eardrum-perforation-and-temporal-bone-fracture/