Bangladesh J Otorhinolaryngol 2017 ; 2311): g3-87

Article
Management of Haematoma Auris by Minimal
Access Surgery and Steroid lnjection
Mahmydul Hassanr, Aftab U.Atuned2

,]
Abstract:'
Haematoma auis is a colledion of serosanguinousfluid between perichondrium and cartilage
of pinna. Vaious methd of aspiration / indsion and pressure bandage used to treat the
condition, here we are using steraid at the site after aspiration with a needle, no pressure
bgndage ordrain used. Totat 49 patientsweretreatedwith no untoward events.
Key word : Haematoma auris, aspiration, steroid injection

lntroduction: haematoma tocollect underthe Perichondrium

Haematoma auris is a collection of blood /
serosanguinous fluid between the auricular
Cartilage and perichondrium.
The haematoma is usually produced by
trauma or occaslonally spontaneously,
Specially during sleep time there may be
collection of fiuid due to torsional affect of
perichondrium & cartilage in the pinna.
This occurs almost exclusively on the anterior
surface of the auricle where the skin is tightly
adherent to the underlining perichondrium
so that shearing force applied to the ear
separates the Perichondrium form the
cartilage. On the other hand on posterior
surface intervening areolar tissue allows the
skin to glide over the Perichondrium .
Rarely a tear through the cartilage can allow
1. Professor of Otolaryngology, National
institute of ENT, Dhaka
2. Associate Prof. of ENT, Green Life Medical
College, Dhaka
Address of Correspondence: Dr. Mahmudul
Hassan, Professor of Otolaryngology, National
institute of ENT, Dhaka. Mobile: 0'1819211501
on both sidel
Ohnsen et al2 demonstrated the sub
perichondrialsite of the haematoma in rabbits
and that while subcutaneous haematoma
reabsorbs without consequence. sub-
perichondrial serosanguinous fl uid stimulates
the proliferation of mesenchyma cells in the
overlying perichondrium with these
chondroblast forming new cartilage in 7-10
days which result in cauliflower ear deformity.
Schuller eta13 stated there is usually a history
of trauma after sports like rugby, like
wrestling or occurs spontaneously. The
haematoma is painless, after some time
present with slight itching and inflammation
is minimal. there is always a tendency of
patient to palpate it, squeezes it, with the
intention of recover away spontaneously, such
a subperichondrial haematoma tends not to
be absorbed but to persists unless drained
or deformed ear.
lf left untreated ,the natural out come is
thought to be deformity of the pinna and the
classic "cauliflower" or "wrestler"s ear, rnore
 rarely supervening infection either
spontaneously or iatrogenic,
may lead to
perichondritis and cartilage
n""ro.i..
Pandyaa demonstrated experiment
in rabbits
and found components of fibrosis
, immature
chondrogenesis and osteogenesi.
organizing haematoma.
in ti"
Mana.gernent option of the hematoma
requirils evacuation with strict
,="p"ir. ini,
is achieved through eitiier u"pir"tion,
incision, either anteriorly or po.t.rioriy
io
prevent recollection, use oi
pressure
bandages or splintss of various
rn.t"rilf,
applied on both side
them in prace with ;r:t
ff,lJ:i: :::H: department of ENT & Head_Neck
recollection; or a drain is lelt
rn incislon site6 i S.:-:=-,
a posterior incision rryith excision Shahid Suhrawardy Medicai
of
a disc Co, ._,
cartilage and placement of Dhaka, Nationat lnstitute
a suction drains. of ENT (N E.. _
-of
Through and through mattress or quilting Tejgaon, Dhaka, and private
Chambe::.._:
sutures for compression, these from January 20OS to Dece__:-
ir.frJ.
cotton wool bolstern, buttons,o,.,1
:lth:,
2A16 for a duration
anO sificon of eleven yuur. __ ,, i
rubber splintsl2. 49 PatientS were studied,
"rong -=-
were female & 36 were male.
tf e* _
: t

Most authors says, after seven

to ten days
Ale _=
was 15-45years.
aspiration is ineffective and
that rrrg"ry for r
removalof the organizing
hematomulf n.*fV Selection of patients:
formed cartilage with/without
perichondriurn is necessary."r"rfy.irg a. lnclusion criteria _ patient
with Haerr= :,_-, t
Giffinj: auris with in 2 week of duration
t
described doing this through ai _ _ _
incisions parallel acute inflammEtion were
to the helix or antihelix. included
b. Exclusion criteria _ patients I
ha. -
Aims and objective: perichondritis, thickened pinna
or a:-
I
The objective of this study lnflammation were excluded E
was tPtruut
perichondritis
t
aylis bV compterety evacuating
l^ffir*u
ano-to prevent its reacumulation
. F

and
preventing known complications thu] Procedure with Equipment
:
like
cauliflower deformity and perichonOrites 1 . Syringe -3mt- (2) for aspiration.
iy
applied a very minimal surgicalinterference.
2. 5 mg/ml Dexamethsone.

Materials & methods; 3. 1}%povidone iodine solution forclean _:

(^
The present study was a prospective 4. Positioning:- patient in sitting positior-
:
observational study carried in the lateraldecubitous position
out at the on:_=
unaffected side. F
B4
Managemeni oi Haerraioma Auris It,linrmal Access
Preparation :
1) Clean the pinna skin overthe Haematoma
with 10% povidone iodine sotution and let
it dry.
2) Put on sterile gloves by surgeon.
3) Now in one syringe drawdexamethasone
3 cc.
4) Needle.asliration -use an
1B/20 gauge
needlg to aspirate blood/serum from the
most non dependant side of swelling tili
there is no fiuid inside the sri'relling after
aspiration. Take out the syringe along wrth
fluid keeping needle in situ, the othei-
syringe with Dexamethasone inject it
gently into the site exactly the same
amountof fluid drawn from hematoma auris
thorough the previous needle kept in
situ, after injecting the Dexamaethasone
at the site take out the syringe & needle,
\'---r
lVahn:udul Hassan & Aftab U. Ar
_",.
*),
give light pressure at the penetrating site
with sterile cotton then flucloxacillin 25t
mg x 6 hourly for 5 days along with
analgesic parcetamol given with advice
to come after2 weeks and not to palpate
it.
Results:
The average amountof fluid /blood aspirated
2.5 ml. Post operative complications were
nil, only 2 patients required repeate:
aspiration and injection dexamethasoi're
trr,rice. only one patient required 3 trme.
aspiration & injection. patients were followe-:
up after 2 weeks.
No perichondritis or thickening of pirr,
noticed in any case. lt was noticed all tr:
case were almostnormal pinna after2 wee'-rs
and rest 3 cases also noticed normal pir::
afler 2d & 3'd injection.
o

Fig.-2:

ffi
.;:. ,

Fig.-3

B5
 Discussions:
Vol.23, No
There is littr lrrrLrr)\
.'",rlo[ll u *^]1,
recommendeJ:","^:,.1::." about cr
desisned rria, j11"'"'"o" il;;;i n ilY rr e
;il[i{':L1J*:,-,
way incision,

Ha e m a tom
r]iq r," ,.,"
i J ll::.:iJ
JrJ ;"rH:
a, ;"J:: " References:
ourcome documenrins
of lare "rl r,Jliijstudy
.dl;;-:"-it reatrnent rhe
or rhe sruccess
1. Scott_Brown,s
ru, ora,
As before e ya
o r i, ur"" torlu"
}t;;,rr,,
",
2. Oilsen L,
fti,ffiry*flftH,;#; Skoog T, Sc_-
rathogenesis
c
experimenrr, "^3'Y',t,o*u' ==
eA
-'.il'
x,6TJ ;lt{i:.;:;:T i : I; ;:,? r j::::;;;;r:J,:,1,",,?,
ot a smarr fi
I xeconslructive =.:,.,
r,,oj,li'Lj l"_lion wirr .".n'orur 3. schurer or ";"'"'' 197: -'
S
advocated.
napirr,^^"^,^udrulage has been
jlj *,v il. n,n
rne perichondriurn":o"il X."liff :y:r,
resuts
-r tre-coliection
strrr"."RH"n'ur-uan k Ie s K, i,''

;,t#nr#,1*ii:.:l{|-IT":#
i- ^-- till
;lnt*ffiii{;=r..;
u-. .,=.".'
Surgery ,;u;:rir rlill
stdes of the
pinnri-^L_ "s- applied on both 4.
enough ," then in
^r^^

fi ,.ffil
;il:;[ive&
pre ve n
"#""i,rr=ePrng t
^ "-"li'" "i'l"Jn
s :Ut-=-1,,f:,rur |i,r::, _
j
"-
,'":["#::T;;S"ru ;,"**i'fd ;;:r,fu;tjlr",::;
j"j,l;'Jy:;:*IffiT".ffi 5i*nr*;"rl,,iln, ,
6
lszu7,'::=. _'
Kooprnan

[il*il:"'["#lHij:= ,,=
7.

i*ruri*****u*l' 5:il"t1""1
^:* s_A, Joachin
,::ffmy:i:i;.ili!,ii:. .
;il:T:di":,"J'}',"# j,i-''.
_

^Ei:I:#::=
ff#il::?^r i'ii7ri,,"i,ilr:_:.
otorarynsoros . ..
-

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#"1,?; l1i":1fl rrearmer: .

Conclusion: fiilH"",'#r i ;iili,,t:,;,1' =

.

9. vuyt uo,
iil[LHj*"f,?[];,J;#[J?]::? Bakkers .,,,1 o' o,-
B6
ili*:,1::":::l;i:
I r v,,,er rr uI aUrtcularhae16Sfg,- .
Laryngoscope .1991; ., t,
1ot, y):qli",
 of Haematoma Auris by Minimal Access
10. Kelleher JC, Sullivan K, Baibak G, Dean
RK. The wrestler's ear. Plastic and
Reconstructive Surgery. 1967; 40:
54M.
11. Talaat M, Azab S, KamelT. Treatment
of auricular haematoma using button
technique. Journal of Otorhino-
Laryngo.logY and its Related
Specialities. 1985; 47 : 1 86-8.
Mahmudul Hassan & Aftab U. Ahrned
12. NahlSS, KentSE, CurryAR. Treatmeni
of auricular haematoma by silicone
rubber splints. Journal of Laryngology
and Otology. 1 989; 103: 1146-9'
13. Thewrestle/sear (acuteaurianlar
Giffi n CS.
hematoma). Archives of Otolaryngology
(Chicago). 1985; 111 :1614.
14. Davis PK. An operation for haematoma
auris. British Journal of Plastic Surgery'
1971;24:277-9.
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