Emergency War Surgery NATO Handbook: Part IV: Regional Wounds and Injuries: Chapter XXVI: Wounds and Injuries of the Ear

The External Ear

United States Department of Defense

Trauma to the auricle is usually quite obvious and, unless treated promptly, may result in considerable cosmetic deformity. Among the more common injuries are lacerations, avulsions, contusions, or thermal injury.

In simple lacerations, the auricle should be debrided carefully with minimum excision of only the devitalized tissues. The physician then should close the laceration in layers, being careful to realign cartilage with absorbable suture material and the skin and subcutaneous tissues with a fine, atraumatic suture. All cutaneous sutures should be removed in 3-5 days.

If the auricle is partially avulsed, careful surgical debridement and reapproximation should be accomplished as soon as possible. In those instances when a portion of the auricle is missing, approximation of the anterior and posterior layers of skin over the exposed cartilage should be accomplished. Fragments of the auricle which are still present should not be sutured out of their normal anatomical alignment. In instances of total avulsion, the cartilage should be debrided of all overlying tissue and buried subcutaneously in the abdominal wall (or other suitable area) so that it may be used for reconstruction at a later date.

When there is a hematoma of the auricle, the hemorrhage is usually subperiochondral in origin. Such hematomas are evacuated surgically and a sterile pressure dressing is applied. The dressing should be removed at least every 48 hours and the wound inspected for recurrence of the hemotoma.

Thermal injury should be treated by careful cleansing and application of topical antibacterial agents such as mafenide (Sulfamylon) on fine mesh gauze. Asepsis is critical. Suppurative chondritis can be prevented by careful attention to the avoidance of further trauma. A mesh dressing can be used to protect the entire head. No pillows are used.

In all of the cited injuries, systemic coverage with broad spectrum antibiotics, tetanus toxoid booster, and aseptic technique are essential.

If a laceration of the external auditory meatus is recognized early, precise initial suture repair is indicated. However, lacerations of the external auditory canal or fractures through its bony portion are less obvious and may be overlooked. Thus, they often do not become apparent until secondary infection has occurred. The external canal should be cleansed as aseptically as possible and a cotton or gauze wick impregnated with broad-spectrum antibiotic ear drops placed in the canal. Such patients should then be referred to the care of an otolaryngologist because of the strong possibility of stenosis as the canal heals.

The problems of external otitis, especially in tropical and subtropical climates, is well known to combat physicians. As innocuous as this entity may seem, it has caused considerable morbidity. In such circumstances, the skin of the external canal becomes macerated, affording an excellent culture medium for secondary infection. The organisms most commonly encountered are various species of Pseudomonas and Proteus with an occasional Staphylococcus. Thus, thorough cleansing plus broad-spectrum topical (and at times systemic) antibiotics are the treatment. A wick placed into the swollen canal allows topical medicines to be more effective. Water precautions are instituted. Such infections are often extremely painful, requiring analgesics.

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Operational Medicine 2001

Health Care in Military Settings

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