Treatment of Traumatic Ear Injury After Assault

Diagnosis and Treatment

The American Academy of Pediatrics recommends incision and drainage as the most appropriate treatment for traumatic ear injury following assault, as the clinical presentation is most consistent with auricular hematoma or perichondrial abscess requiring urgent surgical intervention to prevent cartilage necrosis and permanent deformity 1
Auricular hematoma presents as fluctuant swelling over the cartilaginous ear, and auricular perichondritis/abscess presents as painful swelling, warmth, and redness affecting the cartilaginous portion while often sparing the earlobe 1, 2

If an abscess or significant hematoma is present, surgical incision and drainage are often necessary to prevent cartilage necrosis and permanent deformity 1
Untreated auricular hematomas lead to cartilage necrosis from separation of perichondrium from its blood supply, and once an abscess develops, good cosmetic preservation of the auricular cartilage is difficult to maintain without prompt drainage 1

The American Academy of Pediatrics recommends fluoroquinolone antibiotics (ciprofloxacin or levofloxacin) to cover common pathogens, and pain management with acetaminophen or NSAIDs as first-line agents after incision and drainage 1, 2, 3
Close follow-up within 48-72 hours to assess healing is essential 2, 3

Systemic antibiotics should NOT be prescribed for uncomplicated acute otitis externa or simple auricular trauma, and are reserved for severe perichondritis with systemic symptoms or necrotizing otitis externa in immunocompromised patients 1, 2, 3
Topical antibiotics are first-line for auricular perichondritis without abscess formation, but if an abscess is present, topical therapy alone is inadequate and surgical drainage is required 1, 2