396 ENT emergencies
TRAUMATIC CONDITIONS OF THE EAR
Subperichondrial haematoma
DIAGNOSIS
1 Blunt trauma to the ear causes bleeding between the perichondrium and
auricular cartilage, known as a subperichondrial haematoma.
2 This can lead to a ‘caulif lower ear’ deformity from proliferative fibrosis if left
untreated.MANAGEMENT
1 Refer the patient with a large and extensive bleed directly to the ENT team
for immediate surgical drainage.
2 Otherwise, aspirate small clots under local anaesthesia, and apply firm
pressure by packing around the interstices of the ear with cotton-wool under
a turban dressing.
(i) Refer the patient to the next ENT clinic, because the bleeding
may recur.
3 Give the patient f lucloxacillin 500 mg orally q.d.s. for 5 days to protect
against perichondritis.Wounds of the auricle
MANAGEMENT
1 Perform minimal debridement of devitalized tissue under local anaesthesia.
2 Refer the patient to the ENT team or plastic surgeons if there are extensive
lacerations or skin loss leaving exposed cartilage.
3 Otherwise, appose the edges of the cartilage with 5/0 absorbable suture such
as polydioxanone or polyglactin through the perichondrium.
4 Suture the skin with 6/0 non-absorbable monofilament nylon or polypropyl-
ene and apply a firm dressing. Remove the sutures after 5 days.
5 Give the patient f lucloxacillin 500 mg orally q.d.s. for 5 days to protect
against perichondritis, and administer tetanus prophylaxis.Foreign body in the external ear
DIAGNOSIS AND MANAGEMENT
1 A foreign body in the external ear causes pain, deafness and discharge if left.
2 Attempt gentle removal if the foreign body is superficial, with a suction
catheter, angled probe or alligator forceps.