Cauliflower Ear

How cauliflower ear forms

The outer ear (pinna) is made of cartilage covered by a thin layer called the perichondrium, which supplies the cartilage with nutrients and blood. The skin on the front of the ear is tightly attached.

A blow or shearing force can tear the small blood vessels and lift the perichondrium off the cartilage. Blood collects in the gap, forming an auricular hematoma. Without a blood supply, the cartilage starts to die within days. The body responds by laying down new, disorganized cartilage and scar tissue, producing the hard, bumpy, folded shape that looks like a cauliflower. Repeated injuries make it worse.

Who gets it

• wrestlers, judo and Brazilian jiu-jitsu practitioners, and mixed martial artists
• boxers and kickboxers
• rugby forwards
• anyone after a fall, assault or direct blow to the ear, sometimes with a head injury
• people on blood thinners, who bleed more easily

Symptoms

Early (hours to days after injury)

• swelling on the front of the upper ear, usually in the hollow above the canal
• a soft, fluid-filled feel
• loss of the normal folds and ridges of the ear
• pain, tenderness and sometimes bruising

Late (established cauliflower ear)

• a firm, pale, lumpy, thickened ear
• distorted shape
• sometimes a narrowed ear canal, which can lead to blockage, infections or reduced hearing; a cut through the ear is covered under open wound of the ear

Treatment

Early treatment: drain the blood

Getting the blood out and keeping the space closed is the key to preventing deformity. A doctor, often in urgent care, the ER or an ENT clinic, will:

1. Numb the ear with local anesthetic.
2. Drain the hematoma by needle aspiration or a small incision. Incision is often preferred for larger or older collections because it lets clotted blood out.
3. Apply pressure to stop blood reaccumulating: a molded dressing, dental rolls or splints stitched through the ear (bolsters), or a custom compression device. This stays on for several days to a week.
4. Check the ear within 24 hours and again over the following days, because hematomas often recur.
5. Give antibiotics in some cases, especially after an incision or bolster, to prevent perichondritis.

Athletes usually need to avoid contact training until the ear has healed, often 1 to 2 weeks, and should wear headgear when they return.

Do not drain it yourself

Some athletes drain their own ears with syringes. This risks infection of the cartilage (perichondritis), which can destroy cartilage and cause worse deformity than the hematoma. Without proper compression afterward, blood usually returns.

Established cauliflower ear

Once the cartilage has scarred, it cannot be reversed with drainage. Surgical otoplasty removes excess scar tissue and reshapes the cartilage. It is usually performed by an ENT or plastic surgeon, and athletes are generally advised to wait until they have stopped contact sports.

Complications

• permanent deformity
• recurrence after drainage
• infection of the cartilage (perichondritis)
• narrowing of the ear canal, causing ear infections such as otitis externa or hearing loss

Prevention

• Wear properly fitted protective headgear in wrestling and grappling. Many school and college wrestling programs require it.
• Get every ear swelling treated early, the same day if possible.
• Avoid repeated trauma to an ear that has recently been injured.

Frequently asked questions

What causes cauliflower ear?

Cauliflower ear is caused by a blow or shearing force to the outer ear that leads to a blood collection between the cartilage and its covering. The blood cuts off the cartilage's nutrient supply, and the cartilage scars and thickens into a lumpy shape.

Can cauliflower ear be reversed?

Early swelling can be drained to prevent permanent deformity, ideally within 24 to 48 hours. Once the cartilage has hardened and scarred, it cannot be reversed by draining. Surgery (otoplasty) can reshape the ear.

How soon should cauliflower ear be drained?

As soon as possible, ideally within 24 to 48 hours of the injury and before about 7 days. After that, the blood begins to clot and organize, and the chance of preventing deformity drops.

Can you get cauliflower ear without fighting?

Yes. Any blunt injury to the ear can cause it, including falls, sports such as rugby, assaults and accidents. People taking blood thinners are at higher risk after even a minor blow.