Eric L. Slattery, Timothy E. Hullar, and Lawrence R. Lustig

An auricular mass is a common reason for referral to the otolaryngologist. A variety of entities can present in this fashion, ranging from infectious to benign to malignant processes. Although differentiating between a malignant and benign tumor requires a biopsy, often a diagnosis of nontumor causes can be achieved by a simple examination.

Mass without Significant Skin Change

Keloid or Hypertrophic Scar

In susceptible individuals, the auricle or meatus can develop a keloid or hypertrophic scar. A common scenario is keloid formation following ear piercing of the auricle. Such scars are firm and fleshy, originating from the site of an incision or region of trauma. Keloids will extend beyond the boundaries of the original wound, whereas hypertrophic scars usually do not extend beyond the original wound boundary.

Auricular Trauma: Auricular Hematoma and Cauliflower Ear

If the vascular perichondrial lining of the auricle becomes separated from the underlying cartilage, a subperichondrial auricular hematoma can develop. This injury is particularly prevalent in boxers and wrestlers; there is invariably a history of trauma. The hematoma will present as a painful bulging auricular mass with loss of the normally delicate auricular landmarks. Failure to drain a hematoma or a history of repeated auricular hematomas may result in remodeling of the cartilage, which thickens and deforms the architecture of the auricle. The resultant deformity is known as a cauliflower ear.

Benign Idiopathic Cystic Chondromalacia (Pseudocyst of the Auricle)

Pseudocysts of the auricle occur inside the cartilage of the pinna, usually along the antihelical fold, or scaphoid fossa. These cysts have no epithelial lining and are fluid-filled. They are asymptomatic except for the visible mass and may be related to trauma, although usually no such history is noted. Auricular pseudocysts may resemble relapsing polychondritis or chondrodermatitis nodularis chronica helicis; however, pseudocysts are painless. Pseudocysts can be bilateral.

This is an exquisitely tender nodule that presents on the posterior superior helix and may be related to recurrent trauma or perhaps pressure to the auricle. Typically, the skin over the nodule is normal. These lesions are more common in younger men and can be bilateral.

Kimura Disease