Auricular hematoma (AH), an otologic emergency requiring prompt intervention to prevent complications like cauliflower ear, is traditionally associated with trauma. This single-center retrospective study (2014-2024) analyzed 40 patients (40% pediatric, 60% adult) to characterize AH etiology, treatment outcomes, and recurrence risk factors. Data included demographics, etiology, time to presentation, treatment modalities (incision and drainage [I&D], needle aspiration [NA], bolster dressings), and six-month outcomes. Statistical analyses employed chi-square and t-tests (significance: p < 0.05). Notably, 55% of cases were spontaneous, contrasting prior trauma-focused literature. Pediatric involvement (40%) highlighted underrecognized demographics. Traumatic etiologies included sports injuries (25%), falls/accidents (7.5%), assault (7.5%), and rare postoperative/self-harm cases (2.5% each). Early presentation (<12 hours) correlated with lower recurrence (14% vs. 50%, p = 0.005). I&D demonstrated superior efficacy to NA, with recurrence rates of 11% vs. 47% (p = 0.03). Bolster dressings reduced recurrence (9% vs. 55%, p < 0.01) and improved cosmetic satisfaction (mean score 8.5 vs. 6.2, p = 0.03). Otolaryngology consultation significantly lowered recurrence (14% vs. 67%, p < 0.01). Comparative analysis with Dalal et al. (2019) emphasized shared findings on I&D and bolster superiority but diverged in etiology: our cohort's spontaneous/pediatric predominance versus their trauma-focused adult population. This study underscores the importance of early intervention, specialist involvement, and I&D with bolster dressings to minimize recurrence and optimize aesthetics. The high spontaneous incidence suggests population-specific risk factors, advocating tailored protocols for diverse groups, including children. These findings challenge traditional AH paradigms, urging broader etiological consideration in clinical practice.