Pediatric Ear Trauma

Pediatric ear trauma can leave permanent cosmetic deformity or conductive hearing loss if cartilage, perichondrium, or the tympanic membrane are missed. Auricular hematoma, pinna laceration, embedded earring injuries, and traumatic TM perforation all have management details that change outcome.

External Ear Trauma in Children

• Auricular hematoma urgency: Auricular hematoma threatens cartilage nutrition through the perichondrium and can end in cauliflower ear, so prompt drainage plus a pressure dressing is the key first move.
• Abuse red flag bruising: Bruising of the outer ear is a non-accidental trauma red flag in children, especially when discoloration or blood collection does not fit the reported mechanism.
• Cartilage repair priority: Pinna cartilage does not remodel well, so precise approximation matters; small cartilage involvement may close with skin alone, but clear cartilage disruption needs dedicated absorbable repair.
• Antibiotic uncertainty: Evidence for prophylactic antibiotics after ear trauma is thin, but exposed cartilage changes the conversation because Pseudomonas becomes a relevant pathogen. We get into the practical exceptions in the episode.
• Embedded earring removal: Embedded earring backs in the lobule often require a small adjacent incision and controlled backward extraction, with no immediate re-piercing after closure.
• ENT referral triggers: Auricular avulsion, complex cartilage loss, canal extension, chronic split lobule, and external ear injuries beyond bedside comfort are appropriate reasons to involve ENT early.

Traumatic Tympanic Membrane Injury

• Typical perforation mechanisms: Most pediatric TM perforations follow penetrating trauma such as a Q-tip injury, but blast injury and a forceful slap can also rupture the membrane.
• Small perforation pathway: A perforation involving less than one quarter of the tympanic membrane, with no facial nerve findings and minimal hearing loss, can usually take a non-emergent ENT pathway.
• Topical treatment choice: Short-course antibiotic ear drops are standard initial therapy for uncomplicated traumatic TM perforation, while adding steroids does not appear to help.
• Water precaution importance: Keeping water out of the ear until healing is confirmed is a core instruction, because even a small traumatic perforation can be set back by contamination.
• Deep injury warning signs: Hearing loss above 40 decibels or facial nerve paralysis raises concern for ossicular chain or facial nerve injury and should push temporal bone imaging up the list.
• Delayed facial palsy: Facial nerve dysfunction is not always immediate after middle ear trauma, and that delayed presentation changes follow-up urgency. We walk through that distinction in the episode.