Auricular Hematoma
Commonly referred to as Cauliflower Ear, this is historically seen in wrestling and boxing participants. This is a condition that occurs when the outer portion of the ear (the auricle) suffers a blunt injury and results in blood and fluid to collect under the skin, adjacent to the cartilage. This separates the cartilage from the overlying perichondrium tissue that contains its blood supply. This separation of the cartilage from its blood supply results in cartilage necrosis and in the formation of fibrous tissue in the overlying skin. Thus, the outer ear becomes permanently swollen and deformed, resembling a cauliflower.
Treatment consists of drainaing the blood and fluid and placing a pressure dressing for 5-7 days to prevent the blood-fluid from reaccumulating. This is done in the clinic with local anesthesia. The area usually heals enough to return to action in a week, but the patient is at a higher risk of recurrence with any further trauma.
Headgear that protects the ears is worn in wrestling and rugby, many martial arts, and other contact sports to help prevent this condition.
Nasal Fracture
The nasal bones are the most commonly fractured bones of the human body. Its central position of the face, as well as its projection, predispose it to this condition. Symptoms of a nasal bone fracture include moderate to severe pain, swelling and bruising of the nose and central face, nosebleeding, difficulty breathing through the nose, and obvious deformity of the external nose. It is important to initially keep the head elevated and apply a gentle ice pack. The bleeding typically resolves within the first 30 minutes. If there is concern of a fracture or the nosebleed persists, then the patient will need evaluated by a physician.
Often, there is no need for any imaging studies needed to diagnose a nasal bone fracture. However, if there are questions of other proximal fractures (such as the cheek or jaw bones) then a CT scan would be needed. A physician evaluation is also needed to ensure there is no septal hematoma, which is a rare injury that requires immediate surgery and antibiotic therapy.
Treatment goals for a nasal bone fracture are to restore normal cosmesis and nasal airflow. The most common treatment for a nasal bone fracture is a Closed reduction, which consists of reapproximating the fractures and placing a nasal splint. This is typically done using local anesthesia or mild sedation. An open reduction is often not needed, only being utilized where there is both significant injuy to the overlying soft tissues and nasal bones. If patient delay the surgery too long (typically more than 2-3 weeks from the injury) and allow the fractures to heal then they will often need a more extensive surgery such as a septorhinoplasty.
Swimmer’s Ear
Acute otitis externa is an inflammtory condition of the outer ear and the ear canal, often associated with getting water in the ear canal. It is caused from bacteria (rarely can be a fungal infection) that contaminate the skin and cause the infection. Some patients have dermatitis of the ear canal skin, thus predisposing them to an infection. The infection can also be caused by trauma done during self-cleaning with swabs.
The main symptom of an outer ear infection is pain of the ear, particularly when gently moving the auricle. Patients often note mild hearing loss due to the swelling and drainage. Often there will be redness and swelling noted in the ear canal, and drainage may be seen in the ear canal. More agressive infections will extend to the soft tissues of the face and neck, and cause fever and enlarged lymph nodes in the neck. Patients with diabetes or immune system deficiencies may have a more aggressive infection (known as Malignany otitis externa) that requires intravenous antibiotics and possibly surgery.
Diagnosis is based on exam and the treatments consist of cleaning the ear (by the physician only) and starting antibiotic ear drops. Rarely oral or intravenous antibiotics are needed.
The most important thing to prevent further infection is to keep the ear dry and to not clean the ear with swabs. Following swimming, it is advisable to dry ear with low heat from a hair dryer. Another method is to apply an acetic acid : alcohol solution (multiple ones are available over the counter at your pharmacy) to prevent a build-up of bacteria.
Robert Wilson, MD.