Othematoma is an effusion between the cartilaginous pinna of the ear and the cartilaginous membrane. Because it is usually caused by a shearing force, such as a blow to the ear from the side, it is also called boxer’s ear. Othematoma should always be treated promptly because, if left untreated, it can lead to complications such as permanent changes in the shape of the pinna and infections that are much more difficult to treat.
What is an othaematoma?
The accumulation of bloody or protein-rich (serous) fluid between the cartilage and the cartilaginous membrane (perichondrium) of the pinna is called an othematoma. The auricle consists of a cartilaginous framework that gives the ear its characteristic shape. The cartilage is covered by a cartilaginous membrane, which in turn is joined by the outer skin. this is rich in blood vessels and nerves. The cartilaginous skin is normally so close to the cartilage that there is no space between the two structures. The outer skin also adheres tightly to the perichondrium from the other side. However, as a result of trauma, the perichondrium may become detached from the cartilage, creating a space that does not naturally exist, but in which fluid can now accumulate. The development of an ohematoma is the result.
Causes
In most cases, an othaematoma is caused by external force. In this case, shearing as well as tangential force impacts on the auricle are usually causative for the development of the disease. A lateral blow to the auricle during a boxing match is probably the most common cause for the development of the othaematoma. For this reason, the disease is called boxer’s ear. Furthermore, prolonged lying on the bent ear can be causative for the development of the effusion. This is especially typical in people who sleep in a lateral position and very quietly.
Symptoms, complaints and signs
The othematoma appears as a pink, bulging swelling on the front of the auricle. Much like a blister in burns, it bulges convexly under the skin and can cause a strong sensation of pressure. Affected individuals usually do not complain of pain. The ear is often only slightly reddened and usually not overheated. In many cases, however, a displacement of the effusion can be noticed when pressure is applied from above or from the side. If infection with bacteria occurs, severe local pain, redness, swelling, and hyperthermia may occur. In addition, secretion of pus-containing fluid from the sore area may occur. Mild bleeding is also possible in this case. If an othaematoma is not treated, the effusion will grow into connective tissue. The othaematoma becomes solid, grows together with the surrounding cartilage and makes the auricle appear cauliflower-like deformed. This occurs primarily with recurrent effusions that either have not been properly treated or are due to a recent application of force. This complication can be easily averted with early diagnosis and treatment.
Diagnosis and disease progression
Othematoma is usually a visual diagnosis made by the otolaryngologist. Matching events in the near past, such as a blow to the affected ear or the onset of symptomatology immediately after waking, support the diagnosis. Imaging procedures such as an ultrasound examination or X-ray are usually not required. The diagnosis of an acute othmatoma always requires therapeutic intervention, as the condition does not heal on its own. The connective tissue remodeling of chronic otechematoma, although not dangerous, can be unaesthetic. Treatment of the disease at this stage is far more complex and has lower success rates.
Complications
If an othematoma is not treated, the swelling can become inflamed and cause severe pain. In addition, fluid can leak from the sore area and cause severe infection. In the further course, a connective tissue growth of the effusion occurs, which is associated with visual changes and chronic pain, among other symptoms. This complication occurs primarily with recurrent hematomas that are inadequately treated. In severe cases, an othematoma may be associated with damage to the tympanic membrane and total or partial hearing loss.Martial artists are particularly affected by this. In addition, a hematoma can cause serious damage to the surrounding tissue structures. If muscles and nerves are damaged, this can lead to so-called compartment syndrome with permanent sensory disturbances and signs of paralysis in the affected part of the body. Finally, an othaematoma can cause severe pain and permanently damage the muscles in the event of recurrent trauma. Treatment of an othematoma can promote severe adhesions, bleeding, and infection (in the case of drainage), as well as hemorrhage, rebleeding, and scarring (in the case of surgical procedures). Drug treatment may cause side effects and interactions. Inadequate follow-up may result in recurrence of trauma.
When should you see a doctor?
If there is bleeding or dizziness after an accident or blow to the ear, an othaematoma may be present. A doctor should be consulted if the discomfort has not subsided after a few hours or should become more severe within a short time. After a serious accident or fall, emergency medical services must be called. Depending on the severity of the injury, first responders may need to provide first aid and place the victim in the recovery position to allow blood to drain from the ear. Those who repeatedly expose their ear to concussions – such as boxers and other martial artists – risk permanent disfigurement of the auricle. Since this visual blemish can also be a psychological burden, a family doctor and therapist must be consulted. It may be possible to correct the deformity surgically. The othaematoma itself is treated by a sports physician, ear specialist or general practitioner. If the injury is severe, the wound must be closed surgically and the blood stasis removed. In the first few weeks after a surgical procedure, the ear doctor must monitor wound healing and prescribe painkillers and anti-inflammatories if necessary. Thus, the othaematoma always requires medical treatment and aftercare. Otherwise, serious complications may arise, which in the worst case may result in loss of hearing.
Treatment and therapy
Since the accumulation of fluid between the cartilage and the cartilaginous membrane becomes organized and solidified over time and can thus lead to a deformation of the auricle, the othaematoma must always be treated promptly. This usually involves making a small incision on the front of the auricle (incision), through which the fluid can be drained (drainage). A pressure dressing should then be applied to the ear to prevent the space between the cartilage and the cartilaginous membrane from filling with fluid again. The pressure dressing supports the adhesion between the two tissues and ensures that the unnatural space closes sufficently. Particularly in the case of recurrent effusions at the same site, a small cartilage window can be created at the back of the auricle. This involves cutting out the altered cartilage, which is very effective in preventing a new formation of an othaematoma at this site. Infected othaematoma should be treated with medication. Antibiotic-containing solutions may be required for this. Furthermore, it is important to have the wound cleaned regularly and thoroughly by an experienced physician and to avoid renewed trauma.
Outlook and prognosis
If treated promptly, the prognosis of the ohematoma is usually favorable. In most affected individuals, recovery is achieved through the use of various therapeutic modalities. Fluids formed are drained away, so that any visual change in the auricle may resolve within a few weeks. A pressure dressing is necessary to prevent pathogens from entering the organism during the healing process. In some patients, if the course is unfavorable, surgery must be performed, otherwise secondary diseases may develop. The intervention is described as simple and in only rare cases leads to an unwanted health development. If, contrary to expectations, complications arise from the operation, a delay in the healing process must be expected. Permanent disturbances are usually not documented. If seeking medical care is avoided, the risk for secondary disorders or long-term impairments is significantly increased. In these cases, the prognosis deteriorates to a significant extent.Deformities of the ear may occur, which cannot be adequately corrected later in life. In addition, the repeated development of infections is often observed. Overall, this leads to a weakening of the health sensation and thus of the organism. In particular, patients at risk, this course can become difficult.
Prevention
The best way to prevent an othaematoma is to avoid combat sports. Boxers should ensure adequate head protection and avoid aiming at their opponent’s ears. Susceptible people can fix their earlobes to their head with plasters at night to prevent chapping. Sleeping in a supine position can also have an effect on preventing the development of an othaematoma. If, despite precautions, an othaematoma does develop, prompt treatment can achieve complete healing and prevent it from becoming chronic.
Follow-up care
In most cases of an othematoma, the options for aftercare are relatively limited or are not even available to affected individuals. First and foremost, a quick and early diagnosis must take place in this case, so that there is no further worsening of the symptoms or complications. Therefore, affected persons should consult a doctor at the first symptoms and signs of the disease. As a rule, the symptoms can be relatively well alleviated by a minor surgical intervention, so that no complications arise in the further course. After the operation, patients should rest and take it easy, and the sensitive area should be particularly well protected. A pressure bandage should also be worn for several days to prevent infection or inflammation. Regular checks and examinations are also necessary after the operation to monitor the condition of the othaematoma. Further measures and options for aftercare are usually not available to those affected by this condition and are usually not necessary. Othematoma has no negative impact on life expectancy.
What you can do yourself
An othaematoma should be treated by a doctor as soon as possible. After puncturing the swelling, which leads to the swelling of the othaematoma, the wound must be well cared for and kept away from dust, dirt and aggressive care products. The swelling should be completely gone after one week at the latest. During this period, the affected ear must not be strained by earmuffs and the like. However, should complications arise, it is best to consult the doctor. Inflammation or bleeding should not be treated independently, as improper treatment can lead to infection and skin damage. A recurrent othematoma requires close monitoring by a physician. In addition, the patient should perform the measures described after each procedure. Recurrent symptoms often have unknown underlying causes that must be identified and corrected. The patient should look for possible triggers both at work and in his or her personal life and examine the connection to the recurrent effusion. Healing of an othematoma can be aided by various natural remedies. For example, devil’s claw, aloe vera, and various essential oils promote circulation and support wound healing.