Table 1. Sports-associated conditions of the ear¹

Condition	Sport	Trauma	Symptoms	Treatment	Comments	Reference
Dermatitis
Contact dermatitis	Aquatic sports	No	Erythema, pruritus, scaling	Topical corticosteroids, topical immunomodulators, oral corticosteroids for severe cases	Well defined, erythematous, scaling plaques on the ears	14,15
Environmental
Chilblain	Ice fishermen	No	Burning, itching, swelling, tenderness,	Gentle rewarming Apply dry bandage	Occurs in non-freezing conditions	16
Frostbite	Cross-country skiers, cyclists, lugers, runners, ski jumpers, snowmobilers, and speed skaters	No	Burning, numbness, swelling, throbbing Ischemic neuritis in affected area	Prewarming: thawing, avoiding trauma, Warming: rapid reheating in 104-108 °F water for 15 - 30 min Postwarming: elevation, avoiding trauma, whirlpool	Sequelae include a black scar, ischemic neuritis, and autoamputation Occurs in freezing conditions	17,18
Sunburns / UV damage	Outdoor sports²	No	Burning, pruritus Diffuse, sharply demarcated areas of erythema ending at clothing lines	Acute: Burrow’s compresses, cool water, Sarna lotion, topical petroleum jelly. Chronic: No tx Pain: Corticosteroids and NSAIDs	Prevention: avoid sun exposure between 10 am and 3 pm, SPF 30 sunscreen reapplication if sweating occurs, wearing sun-protective clothing	19,20
“Surfer’s ear”	Surfing	No	Otalgia, otorrhea, tinnitus, and vertigo	Transmeatal surgical removal of the tumors and debris	Can result in conductive hearing loss	21
Infections
Bacterial
Otitis externa	Aquatic sports	No	Conductive hearing loss, itching, otalgia, otorrhea	Topical antibiotics, topical corticosteroids, pain control, debris and exudate extraction, oral anti-Pseudomonas antibiotics	Common infectious organisms - P. aeruginosa and S. aureus	22,23
Viral
Herpes gladiatorum	Wrestling	No	Burning, itching, tingling followed by erythematous vesicular lesions	Antiviral medications³	Diagnosis via Tzanck smear and culture	24,25
Herpes rugbeiorum	Rugby	No	Burning, itching, tingling followed by erythematous vesicular lesions	Antiviral medications³	Diagnosis via Tzanck smear and culture	24,25
Traumatic
Auricular hematoma	Contact sports⁴	Yes	Pain due to initial trauma	Adequate ear protection, compression sutures, I&D	Dissection causes devitalization and fibrosis, which leads to cauliflower ear.	26,27,28
Eardrum perforations	Deep sea diving , Water skiing	Yes	Otalgia, otorrhea, tinnitus, and vertigo	Observation, tympanoplasty	Can result in sensorineural hearing loss	21
Pseudocyst of the auricle	Rugby	Yes	Usually painless and unilateral	Chemical irritation to enhance adhesiveness, partial removal of the cartilage Compression to minimize recurrence	Yellow aspirate Histology shows cystic space without epithelial lining	1,3,6-8,11,13

1. Abbreviations: bid, twice daily; °F , degrees Fahrenheit; g, grams; I&D, incision and drainage; mg, milligrams; NSAIDs, nonsteroidal anti-inflammatory drugs; P., Pseudomonas; S., Staphylococcus; SPF, Sun protective factor; tx, treatment

2. Includes triathlons, cycling, baseball, softball, and golf

3. Primary infection is treated with 200 mg of oral acyclovir 5 times daily for 10 days, 400 mg of oral acyclovir 3 times daily for 10 days, 250 mg of oral famciclovir 3 times daily for 7-10 days, or 1000 mg of oral valacyclovir twice daily for 10 days. Recurrent infection is treated with 400 mg of oral acyclovir 3 times daily for 5 days, 125 mg of oral famciclovir twice daily for 5 days, or 500 mg of oral valacyclovir twice daily for 5 days

4. Includes boxing, rugby, and wrestling.