External Ear Injuries: Symptoms, Diagnosis, and Treatment

External ear injuries include mechanical damage to the auricle and external auditory canal. These conditions have varying degrees of severity, etiological factors, and injury mechanisms.

Classification of External Ear Injuries

1. Superficial injuries of the external ear:

• Otohematoma;
• Bruising of the auricle;
• Abrasions of the auricle;
• Abrasion of the external auditory canal;
• Hematoma of the external auditory canal.

2. Deep injuries of the external ear:

• Laceration of the auricle;
• Avulsion of the auricle:

1. Complete avulsion of the auricle;
2. Partial avulsion of the auricle;
3. Avulsion of the earlobe.

3. Burns of the auricle:

• First-degree burn;
• Second-degree burn;
• Third-degree burn;
• Fourth-degree burn.

4. Frostbite of the auricle:

• First-degree frostbite;
• Second-degree frostbite;
• Third-degree frostbite;
• Fourth-degree frostbite.

Etiology

Superficial and deep injuries of the auricle occur due to mechanical impact (trauma, blows, falls, bites, car accidents).

Injuries to the auditory canal often occur due to attempts at self-cleaning of earwax or the entry of foreign objects.

The extent of damage depends on the force of impact and the nature of the injury. Burns and frostbite occur due to the effects of thermal damaging factors (fire, cold).

Anatomy of External Ear Injuries

When mechanical and thermal factors affect the auricle area, tissue damage of varying depth occurs. Otohematoma occurs when a strong blunt trauma causes rupture of blood vessel walls located between the cartilage and perichondrium, forming a localized blood collection that deforms the appearance of the auricle, which becomes bluish and protrudes.

A less forceful blunt trauma causes a bruise, characterized by soft tissue contusion, primarily damaging small blood vessels without breaking the skin integrity, resulting in hyperemia and infiltration of the auricle.

Abrasions of the auricle and external auditory canal are characterized by partial damage to the epidermis, which quickly becomes covered with hemorrhagic scabs and may cause slight bleeding.

Hematoma of the auditory canal is characterized by damage to subcutaneous blood vessels. This results in a localized blood collection that protrudes and narrows the canal to varying degrees, with the skin at the hematoma site taking on a cyanotic hue.

Deep injuries of the auricle occur from various causes: sports and domestic injuries, workplace accidents (careless use of household and construction tools), animal or human bites, falls, and careless wearing of piercings.

Ear lacerations in everyday life are quite rare, usually occur in traffic accidents, in various martial arts (e.g. boxing), street fights. This type of injury is characterized by violation of skin integrity, damage to the underlying tissues, PJC, blood vessels, in some cases – cartilage, pronounced bleeding, swelling.

Burns occur from exposure to extremely high temperatures, open flames, hot objects, and substances. First-degree burns involve superficial epidermal damage, with the skin becoming locally hyperemic. Second-degree burns damage all epidermal layers, with blisters filled with serous or hemorrhagic fluid forming on hyperemic and infiltrated skin.

Third-degree burns are characterized by necrosis of all skin layers and subcutaneous fat, resulting in deep wounds and blisters with hemorrhagic fluid. Fourth-degree burns cause total necrosis, affecting underlying tissues, bones, and cartilage. Burns to the auricle may also damage the external auditory canal.

Frostbite of the auricles often occurs when exposed to extremely low temperatures, as they are among the most protruding body parts. First-degree frostbite affects superficial skin layers, causing paleness and mottling of the auricle with hyperemia of peripheral and protruding areas. Second-degree frostbite also damages superficial skin layers, with serous blisters forming on hyperemic skin. Third-degree frostbite causes necrosis of the entire skin thickness, with the auricle becoming hyperemic, infiltrated, and blisters filled with serous-hemorrhagic content; sensation in the auricle is absent.

Fourth-degree frostbite is characterized by damage to the entire thickness of the skin, subcutaneous fat, and underlying tissues (bones, cartilage). The skin becomes intensely hyperemic, cyanotic, with dry gangrene developing in distal areas, and sensation is also absent.

Clinical manifestations

In case of superficial ear injuries, there is acute pain at the moment of trauma, followed by discomfort and aching pain. The auricle swells, changes color, and then returns to its previous appearance as healing progresses. When the skin integrity is compromised in the form of abrasions, there is scant bleeding; later, they are covered with hemorrhagic crusts and heal under a scab. Otohematoma is characterized by pronounced pain and a change in the appearance of the auricle. It protrudes, fluctuates at the site of the effusion, more often on the outer surface, in the area of the scaphoid and triangular fossae, and the skin acquires a cyanotic color. In the absence of adequate treatment and drainage of the hematoma, the auricle often acquires an irregular shape due to cartilage changes resembling ‘cauliflower’ or ‘boxer’s ear’. If a large hematoma occurs in the ear canal, obstructing the lumen, conductive hearing loss may occur. Deep injuries to the auricle are characterized by pronounced pain, profuse bleeding, gaping wound edges, visible underlying tissues, and in some cases, cartilaginous or bone tissue. The wound edges have different configurations depending on the causative factor, and foreign objects, dirt, or earring remnants may be present in the wound.

Burns of the auricle have different manifestations depending on the stages, as mentioned above. It should be noted that isolated ear burns are extremely rare and often combine with injuries to the scalp, face, neck, and other body parts. In cases of extensive burn area, burn disease may develop. Common symptoms include pronounced pain, absence of bleeding, and in 3rd and 4th-degree burns, the wound bed is painless, and a necrotic scab forms.

Clinical changes in frostbite have also been described earlier. A characteristic feature is the absence of pain at the moment of frostbite; discomfort begins to be felt when the affected tissues warm up, accompanied by itching, burning, severe pain, numbness, or paresthesia.

Diagnosis

For the diagnosis of traumatic injuries to the auricle and external auditory canal, in most cases, collecting the medical history and examination are sufficient. In some cases, X-ray or computed tomography of the temporal bone and temporomandibular joint is performed to clarify the extent of the injury.

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Treatment

Abrasions of the auricle and auditory canal are treated with antiseptic solutions. In case of infection, antibiotic ointments may be applied. Under the scabs, wounds quickly epidermize and heal. Otohematoma needs to be punctured under sterile conditions, drained, and a pressure bandage applied, which is sutured to the auricle for large hematomas. Systemic antibacterial drugs are prescribed to prevent secondary infection and development of perichondritis. Hematoma of the auditory canal is also drained, the canal is tightly tamponaded, and the tampon is daily soaked with antiseptic solutions.

For deep ear injuries, primary surgical treatment is performed, and the wound edges are sutured. In case of partial avulsion, non-viable tissues are excised as sparingly as possible, and the cartilage, subcutaneous fat, and skin are sutured separately. For complete avulsion of the auricle, the viability of the amputated part is assessed – it is recommended that no more than 6 hours have passed since the injury, and the detached part of the auricle has been kept cold. If necessary conditions are met, replantation is performed, antibacterial therapy is prescribed, thrombosis prevention is implemented, and daily dressings are applied.

Burns are washed, remnants of burnt clothing and hair are removed, non-viable tissues are excised, then the wounds are treated with antiseptic solutions, cooled, and covered with sterile dressings. Before dressing changes, it is mandatory to adequately anesthetize the patient. For 2nd and 3rd-degree burns, large blisters are opened and excised; for 3rd and 4th-degree burns, the scab is excised to expose viable tissues. During daily dressings, antimicrobial and wound-healing ointments are used. To prevent cicatricial stenosis of the external auditory canal, it must be tightly tamponaded with sterile dressings and daily soaked with antiseptic solutions. If bacterial infection occurs, systemic broad-spectrum antibacterial therapy is prescribed based on sensitivity. For 3b-4th degree burns and burns over a large area, patients are hospitalized in surgical or burn departments, where they receive appropriate treatment, and skin transplantation is performed at a later date if necessary.

The treatment scheme for frostbite corresponds to that for burns, but initially, the frostbitten body part needs to be warmed. The victim is placed in a warm room and given plenty of warm drinks. The auricle should be warmed gradually, without applying harsh methods or rubbing. For this purpose, sterile heated solutions of furacilin, saline, warm compresses, or gentle massage with warm clean hands can be used. In case of severe pain, the patient needs adequate analgesia. Damaged tissues are washed, treated with antiseptic solutions, and if blisters and scabs are present, necrotic tissues are excised, and dressings with antimicrobial and wound-healing ointments are applied. For 3rd and 4th-degree frostbite, systemic antibacterial therapy is prescribed. If indicated, these patients are also hospitalized in surgical or burn departments. In the long term, neuropathy may develop, accompanied by numbness and cold sensitivity.

All patients with wounds, burns, and frostbite receive emergency immunoprophylaxis for tetanus, and anti-rabies prophylaxis is administered in case of bites.