Nasal continuous positive airway pressure (nCPAP) in preterm infants is closely linked to improvements in the primary management of respiratory failure. We report on a severe complication involving the external ear, which is usually covered by the fixing straps of the nCPAP application system. The very low birthweight infant (233/7 weeks' gestation) was treated with nCPAP for more than 2 months. At the age of 51 days, the child developed a fluctuating seroma of the right external ear. Applied surgical treatments including punctation and compression of the ear resulted in full recovery after 3 months. Due to shearing forces associated with straps used for attaching the nasal application system, the infant developed a severe auricular trauma. Ear trauma can be minimised by careful padding of these straps. Continuous monitoring of the nCPAP-system, including the straps, is required.