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Localized Liquified Pinna Haematoma


Pinna Haematoma


Haematoma need to be evacuated as the cartilage will be deprived of its nutrients and oxygen supply as its perichondrium becomes separated. 

Diagnostic aspiration revealed dark-red blood.  

Temporary pressure bandage and an antibiotic course usually prescribed. 

Traumatic Pinna Laceration


 Complete horizontal cut of right pinna sustained after metal rod hit.

Toilet and suturing with minor debridement was performed and antibiotic prescribed.

Ear Canal Trauma: Healed Laceration

Healed ear canal skin laceration complicating self ear cleaning using metal ear curette.

Ear Canal Trauma: Blood Clot

Ear canal trauma can results in abrasion or laceration.  In this case the trauma was caused by accidental poking by sharp end of metal curette.  It heals readily.

Iatrogenic Lacerations

Iatrogenic lacerations (X) and eardrum perforation (arrow) complicating removal of tic (T) by inexperienced hands!

Traumatic Eardrum Perforation

The edges of an eardrum perforation due to injury are usually jagged or non-smooth.  Fresh blood, clots and subepithelial bruises are usually present depending on severity and duration.  Concomitant middle & inner ear injury need to be excluded.  Audiometry test is strongly recommended; beware of potential medico-legal implications.

Fresh traumatic eardrum perforation involving posterior pars tensa with its torn segment still attached and flipped anteriorly.

A recent eardrum perforation complicating a hard slap onto the right ear.

Linear eardrum perforation located adjacent to the cone of light area.

Careful history revealed these perforations were traumatic in nature.

 Accidental injury sustained while performing self-cleaning of the ear canal using cotton bud which resulted in ear canal laceration and eardrum perforation (arrow).  The left figure is the endoscopic view 2 weeks after the injury showing dry adherent clot (black coloured) which will eventually cleared naturally by intrinsic epithelial migration of the ear canal. 


 An estimated forty percent anterior central perforation 72 hours after the traumatic insult. Note the folded torn membrane anteriorly and blood clot in the middle ear.


A large traumatic central perforation.  (green arrow -incudospedial joint, white arrow - lateral process of malleus)


Recent barotraumatic perforation resulting in a large central perforation. 

Bare distal handle of malleus and middle ear mucosa were clearly seen.


 Traumatic double perforations of left eardrum.

Cerebrospinal Fluid (CSF) Otorhinorrhoea

Cerebrospinal Fluid Otorrhoea

Blood-mixed CSF otorrhoea of traumatic origin.

Haemotympanum in Skull Base Fracture

Haemotympanum appears as bluish/reddish fluid behind the eardrum.

  It is usually related to trauma e.g.,skull base fractures

and can be mixed with cerebrospinal fluid (CSF).

Frank haemotympanum in a patient with base of skull fracture.

Haemotympanum of few days duration complicating skull base fractures after head injury during fits.

Temporal Bone Fractures: Frank Blood Otorrhoea

Conservative management of fractures showing drying up of fresh blood in the ear canal over few days and resolving haemotympanum.  There was minimal conductive hearing loss and the facial nerve was intact.  CT-scan confirms the fracture sites and its extent.

Axial view CT-scan showing the fractures (arrows).  (X - blood in sphenoid sinus or haemosinus)

Eardrum & External Ear Canal Injuries

The endoscopic view of ear canal shows torn right eardrum and lacerated ear canal skin (arrows) in longitudinal fractures of temporal bone.  (TM- tympanic membrane, M - handle of malleus, stars - blood clots).

 Endoscopic appearance of the ear canal of the same patient 2 weeks after the traumatic injury.  Diamond - fractured bony edges with healed overlying epithelium, TM - tympanic membrane covered by a thin sheet of dried blood.  The earlier "torn" eardrum was unintentionally reported as torn tympanic membrane by high resolution CT-scan of the temporal bone.

Healed fractures with deformed osseous external auditory meatus (arrow).  The eardrum is retracted with middle ear effusion formed due to Eustachian tube dysfunction secondary to fractures involvement during impact.

The "Blue" Eardrum

Confluent bluish-red fluid behind the eardrum in a patient with postnasal tumour.


This is an acute condition whereby otological injury occurs as a result of significant differential pressure between the middle ear and the atmospheric air pressure outside the eardrum.  Its symptoms include ear discomfort, earache, fullness sensation, reduce in hearing, and dizziness. Depending on its severity, eardrum erythema, retraction, subepithelial bleed, haemotympanum,

and even perforation can happen.

Figure shows patchy subepithelial bleeding of the eardrum

with visible blood streaks alond the border of malleus handle.

Barotrauma resulting in haemorrhage into middle ear

and suffusion of peripheral eardrum vasculatures.

Blood-tinged middle ear effusion.

Middle ear haemorrhage and eardrum retraction resulted from barotrauma.  The patient had taken air flight despite having flu and thereafter experienced persistent left earache upon descent.

Barotrauma resulted from scuba diving 2 days earlier.  Note middle ear effusion with tinge of purplish discolouration due to middle ear bleeds. 


The opposite eardrum of the same patient above showing blood-stained middle ear effusion with retracted eardrum. 

Perforation resulted from barotrauma of scuba diving 1 month after injury.  The middle ear mucosa is healthy and hypotympanic air cell are seen clearly.

Hair Fragments

2 pieces of hair fragments which unintentionally entered the ear canal

during hair cut.  Epithelial migration can eventually extrude it naturally. 

A long hair fragment reaching lateral process of malleus which had caused irritating sensation in the ear. 

Foreign Body Just Beyond External Ear Introitus

Although easily visible, its removal often end up being done under general anaesthesia in children due to fear and uncooperativeness.

Round-Shaped Foreign Body- Instrument for Its Removal

Figure shows a round-shaped foreign body in the ear canal.  Ring-curette or angled/spoon-shaped instrument as illustrated are suitable to be used for its removal.  Crocodile forceps can be slippery and unsuitable for this purpose. 

Small foreign body can also be removed by syringing provided

there is no eardrum perforation.

Foreign Body Removal by Using Suctioning Technique

A shiny diamond-shaped foreign body being removed by using suction cannula under endoscopic view. Inset figure in the right is the dimension of the foreign body.

Quire's Ear Forceps


 At rest.


In engaged position (upturn end) to sinuate and rake out foreign body (FB) - typically suitable for round-shaped FB.

Q-Tip Related Issues

Foreign Body in The Ear Canal

Cotton tip usage is not necessary as the ear canal has self cleasing property. 

It can potentialy cause injury and foreign body impaction.  This image shows retained cotton of Q-tip cotton left inside the osseous meatus

with surrounding epithelial reactions.

Retained cotton with evolving otomycosis.

2 pieces of Q-tip fragments impacted beyond the second isthmus

of ear canal without local reactions.

Ear canal wall abrasion (arrow).

Impacted cotton bud tip with blood-stained discharge and reactive otitis externa.

Left cotton fibre (dotted rectangle) in the ear canal from cotton bud usage.

Peri-handle of malleus perforation complicating cotton bud tip impaction with acute otitis media.  Arrow - exposed handle of malleus, TM - tympanic membrane, 1 - lateral process of malleus, 2 - umbo.

Foreign Body: Organic Material

Chilli fragment which had caused right ear irritation and pain in a 3 year old boy.

Foreign Body in The Ear: Insect

      Foreign body in osseous meatus               Removed ants fragments.

         with secondary otitis externa.

Trapped insect in right auditory meatus which had caused troubling tinnitus and was found dead upon examination.  Left upper image - pre ear toilet view.

Cockroach in the ear.

Cochroach rendered dead by instilling olive oil prior to its removal.

Blood-Sucking Ectoparasite in The Ear Canal


The recovered dead tic.

 Live tick with its proboscis embedded into the introitus of the ear canal.  The black materials are its faecal material.  This patient also has impacted earwax.


Embedded Earring

 A partially-embedded earring in the right ear lobule (top left figure) and after its manipulation (top right figure) prior to removal.

Removed earring showing its components.