Current Evidence Injury to the external ear can include laceration to the skin, soft tissue, or cartilage, as well as hematoma with risk of cartilage necrosis The cartilage of the ear is nourished and oxygenated by diffusion via the perichondrium With an auricular hematoma, bleeding avulses the perichondrial layer off the cartilage as the blood collects between them This separation of the perichondrium can lead to cartilage necrosis if not decompressed in a timely fashion In addition to blunt or sharp trauma, the external ears are also susceptible to thermal injuries including both burn and frostbite Clinical Considerations Clinical Recognition Injuries to the external ear can manifest as laceration, ecchymosis, or hematoma Thermal injury may present with bullous or peeling skin Most commonly, there is a reported history of trauma or symptoms of pain or bleeding that prompts the emergency clinician to recognize the injury However, unwitnessed or asymptomatic injuries may also be identified during examination Triage Any child with an external ear injury associated with serious trauma, active bleeding, new hearing loss, or neurologic symptoms should be evaluated emergently Most children will present with mild to moderate discomfort without associated symptoms and can be seen urgently Initial Assessment The initial assessment should focus on the mechanism and severity of the injury, examination for foreign body, and evaluation for other associated injuries The auricle should be inspected for any externally visible deformity/injury including lacerations or avulsions, with attention to any cartilage exposure, ecchymosis, or hematoma Note that isolated ecchymosis to the external ear canal without other signs of injury or with an inconsistent mechanism of injury should raise suspicion for nonaccidental trauma Diagnostic imaging is not routinely indicated for simple, isolated injuries Imaging should be considered to evaluate for associated injuries, including closed head injury or facial fractures, in the setting of concerning symptoms or findings (see Chapters 107 Facial Trauma and 113 Neurotrauma and Head Injury Clinical Pathway at https://www.chop.edu/clinicalpathway/head-trauma-acute-clinical-pathway )