Doctors Link Headphones, Earbuds, and Even Phone Calls to Rare but Serious Ear Injuries

A 33-year-old man in Riyadh, Saudi Arabia, fell asleep wearing headphones and woke up with an ear that swelled progressively over a week. Diagnosed with an auricular hematoma — a collection of blood beneath the skin of the outer ear — he required drainage three times. The authors of the June case report in the Journal of Surgical Case Reports, previously covered by Medical Daily, wrote that “to our knowledge, this is the first case to link headphone use to an auricular hematoma directly.”

This case adds to a small but growing medical literature. Pressure, heat, moisture, and even materials in ear tips have been associated in published studies and case reports with a range of ear problems, from outer-ear cartilage to deep canal skin.

The Outer Ear Can Bruise Without a Blow

Auricular hematomas are most commonly associated with boxing and wrestling, where a blow separates the tissue supplying the ear’s cartilage from the cartilage itself. If untreated, the accumulated blood can lead to the permanent deformity known as cauliflower ear.

The Riyadh patient’s experience illustrates how persistent the injury can be. Doctors drained about 2 cubic centimeters of blood-tinged fluid, placed a pressure bolster, and prescribed antibiotics, yet the swelling returned on day 2 and again on day 6. By day 10 only minimal ridge deformity remained, and the result held at one year. The authors attributed recurrences to residual space under the skin, inadequate early compression, and a week-long delay in seeking care.

They proposed that hours of steady pressure could produce the same separation as a blunt impact. A 2015 report from Turkey described a similar phenomenon with mobile phones: a 32-year-old man and a 23-year-old woman developed hematomas after daily phone calls of roughly four and three hours, respectively, without significant trauma. The man’s swelling recurred within two days of the first aspiration.

Both reports involve only a handful of patients and neither proves causation. They do indicate, however, that doctors evaluating an unexplained swollen ear have begun asking about headsets and phone use.

A Different Lump Inside the Cartilage

A second, lesser-known condition can resemble a hematoma. An auricular pseudocyst is typically a painless, fluid-filled swelling that forms within the cartilage rather than beneath it, usually appearing in the upper folds of the ear. It is called a pseudocyst because it lacks a true lining.

The cause is uncertain, but chronic low-grade friction and pressure are leading suspects. A 2020 clinical study of 30 men in Nepal, all daily motorbike commuters, listed hard pillows, helmets, and earphones or headphones among possible predisposing factors. Seventy percent resolved after a single drainage and steroid injection.

During the COVID-19 pandemic, the Spanish dermatology journal Actas Dermo-Sifiliográficas reported a 35-year-old man who developed pseudocysts on both ears after wearing masks with ear loops for more than eight hours daily. Switching to masks with looser loops led to clearance within two months, with no recurrence over six months of follow-up. Untreated pseudocysts can cause lasting deformity.

Earbud Tips May Trigger Allergies in the Canal

In-ear devices raise separate concerns. Otitis externa — inflammation of the ear canal often called swimmer’s ear — thrives on moisture and irritated skin. The CDC notes that water left in the canal can degrade protective wax and skin, and snug earbuds can trap heat and moisture.

Researchers at West China Hospital of Sichuan University tested whether allergy also plays a role. In a case-control study published in 2025 in JAAD International, 75 participants were patch-tested on their backs with pieces from five common earphone and earplug models. Thirty-eight had otitis externa and 37 did not.

Eleven of the 38 with canal inflammation showed a positive or suspicious skin reaction, versus just 1 of the 37 without. Reactions were also more frequent among heavier users. The authors concluded that allergy to certain plastics may contribute to some ear canal inflammation or impede healing.

The study was small and does not establish that any product is unsafe for most people or that earbuds cause infections.

Signs Worth Taking Seriously

No U.S. health agency has issued guidance on sleeping with headphones or earbuds, and most users never develop these problems. The published cases do highlight symptoms warranting attention.

A tense, swollen, or painful outer ear should be evaluated promptly, as early drainage and compression reduce the risk of deformity. Self-drainage should be avoided. Persistent itching, flaking, pain, or discharge from the ear canal — especially symptoms that flare after earbud use — can signal infection or contact allergy; an ENT specialist or dermatologist can test for either.

For habitual overnight listeners, the common thread in these reports is sustained pressure, heat, and moisture on tissue that normally gets a rest.

Key Questions Answered

Can sleeping in headphones really injure the ear? One published case and a similar phone-related report suggest prolonged pressure can cause an auricular hematoma, but these are rare and the link is not proven.

What is the difference between an ear hematoma and a pseudocyst? A hematoma is blood collecting beneath the tissue covering cartilage and is often painful; a pseudocyst is usually painless fluid forming within the cartilage itself.

Can people be allergic to their earbuds? Some can. In a 75-person study, 11 of 38 people with ear canal inflammation reacted to common ear tip or plug materials, compared with 1 of 37 without inflammation.

What symptoms should prompt a doctor visit? A swollen or painful outer ear, or persistent itching, pain, flaking, or discharge in the canal, should be evaluated rather than treated at home.

Is it safe to keep using earbuds? Most people use them without issues. Anyone with recurring irritation should consult a clinician about infection, moisture, or possible allergy to tip material.

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