Aural Haematoma Flashcards
What is Aural Haematoma
An aural haematoma is an accumulation of blood or serum within the concave portion of the pinna.
How does a haematoma form?
The haematoma forms when blood vessels within the ear rupture, this can be caused by excessive head shaking or scratching due to otitis externa.
List the 3 treatment options
- Leave it alone
- Drainage using a cannula
- Surgical incision and drainage
Why is leaving it alone good/ bad
- cost effective
- the ear will become contracted in appearance (cauliflower)
- becomes heavy and uncomfortable
How is drainage using a cannula performed, why is it good?
- Involves needle/ syringe to drain fluid from the ear
- provides temporary relief
- can be performed conscious or sedated
How is surgical incision and drainage performed and why is it good?
- Most effective procedure for aural haematomas.
- involves the surgeon making an incision (S shaped or straight incision) directly over the length of the haematoma.
The blood clot is removed by using moistened swabs or mosquito forceps, and the space is then lavaged using sterile saline.
Vertical mattress sutures are then placed on either side of the incision to avoid pocket formation where fluid can collect and “the incision itself should remain open to allow continual drainage”
Some surgeons will choose to use stents to aid in the even pressure of the sutures, but the use of stents is not required if the sutures are placed properly
If sutures are placed too tightly tissue necrosis will occur.
Patient Preparation
- pack the ear canal should be with swab prevent prep solutions from entering into the ear canal.
- hair clipped on both sides of the pinna using a size 40 blade,
Povidone Iodine is used at a rate of 5%, no higher. If a concentration above 10% is used it affects the Auditory Brainstem Response. Povidone Iodine is safe and is the standard topical antiseptic for all aural surgery’s
why dont we use chlorhexidine or alochol
Chlorhexidine and alcohol have toxic effects on the vestibular and cochlea function.
Patient Positioning
These patients are placed in lateral recumbency with the affected ear uppermost and flipped back so the inner concave portion is ventral.
Instrument / Materials
- general surgical kit
- extra swabs,
kidney dish to collect the blood - stents and
- sterile saline.
- fenestrated drape
post op - why do you bandage the ear?
bandage the ear post operatively to minimise further contamination, prevent trauma and head shaking.
post op - when placing a bandage what do you not cover
When placing the bandage, it is important to remember not to occlude the vertical ear canal, as some patients will be sent home with ear drops.
post op - when is a bandage required?
A bandage is required for the first three days.
Post op - how long will the sutures be in place for?
The sutures will remain in place for three weeks.
post op - what will a patient be sent home with?
These patients must be sent home with an Elizabethan collar to prevent them from scratching the surgical site.
