Management Lacerations should be thoroughly irrigated and the wound closed primarily in a layered fashion If the injury involves cartilage, then these edges must be approximated and closed prior to repairing the cutaneous layers Hematomas should be drained and a pressure dressing applied to prevent accumulation Prompt drainage reduces the risk of permanent external ear deformity often referred to as “cauliflower ear.” In these cases, the wide incision should be made along or within the cartilaginous folds of the auricle to fully evacuate clot or fluid and to maximize cosmesis Some practitioners prefer to place a compression dressing utilizing dental rolls or petroleum gauze, while others prefer to place “quilting” sutures through-and-through the auricle with nonabsorbable suture There is demonstrated safety and effectiveness for surgical management Patients with traumatic ear injury who are discharged home should be encouraged to keep ear dressings in place to avoid infection, bleeding, or reaccumulation of hematomas The ears should be protected from further injury and exposure until fully healed They should be seen in to days by an appropriate medical provider to remove dressings and sutures For patients with auricular hematoma, assessment for any reaccumulation is also important Although data are limited, patients who have auricular hematomas drained may have a tenuous blood supply and, therefore, should receive a short course (commonly to 10 days) of prophylactic antibiotics Quinolones are often utilized as they cover routine skin flora (e.g., staphylococcus) as well as Pseudomonas aeruginosa , and have effective penetration into cartilage Although there are reported risks of arthropathy with quinolones, no clinical studies have demonstrated these findings in children Therefore, quinolones are felt to be the best choice in young children as well Amoxicillin with clavulanate is commonly recommended when there is hesitancy to use quinolones Even with empiric antibiotics, close monitoring for signs of chondritis including fever, erythema, or purulent drainage is important, which should prompt admission for intravenous antibiotic therapy Ears with cold thermal injury should be rapidly rewarmed and recooling should be avoided Hot thermal injuries should receive symptomatic care, avoiding excessive cooling or ice in direct contact of the ear skin MIDDLE EAR Current Evidence