Cauliflower Ear

Overview

Cauliflower ear is a deformity of the outer ear that gives it a bumpy, swollen, folded appearance resembling a cauliflower. It develops after an injury causes blood to pool between the ear's cartilage and the layer that nourishes it (the perichondrium).

If this blood collection is not drained promptly, the cartilage is cut off from its blood supply and the tissue heals into thickened, irregular scar. It is common in contact sports such as wrestling, boxing, and rugby. The good news is that the deformity can usually be prevented with quick treatment of the initial injury.

Symptoms

The early, treatable stage looks very different from the final deformity. Signs include:

• Pain, swelling, and bruising of the outer ear after a blow
• A soft, tense, fluid-filled lump where blood has collected
• Redness and warmth in the early stage
• Loss of the ear's normal ridges and folds

If untreated, over days to weeks the swelling firms up and the ear becomes lumpy, pale, thickened, and permanently misshapen. Recognizing and treating the early swelling is what prevents the lasting deformity.

Causes

Cauliflower ear is caused by blunt trauma to the outer ear, such as:

• A direct blow or repeated friction in contact and combat sports
• A fall or accident that strikes the ear
• An injury that causes blood to collect under the skin of the ear (an auricular hematoma)

The ear's cartilage has no blood supply of its own and depends on the overlying perichondrium. When blood pools between them, it separates the cartilage from its nourishment, and the resulting scarring produces the deformity.

Risk Factors

• Participation in wrestling, boxing, mixed martial arts, rugby, and similar sports
• Not wearing protective headgear during these activities
• Repeated minor injuries to the ear
• Delay in treating an ear hematoma after injury

Diagnosis

Cauliflower ear and the hematoma that precedes it are usually diagnosed by examination alone. A doctor inspects and gently feels the ear, noting the fluid collection in the early stage or the firm, lumpy thickening in the established deformity. Imaging is rarely needed, but it may be used if there is concern about an associated injury, such as after significant head trauma.

Treatment

Treatment depends on how soon the injury is seen.

• Early drainage: If treated quickly, a doctor drains the collected blood with a needle or small incision, then applies a compression dressing to keep the cartilage and skin pressed together while it heals. Prompt drainage usually prevents deformity.
• Compression and follow-up: Bolster dressings or splints hold the area firmly; re-accumulation of blood is common, so follow-up is important.
• Surgery for established deformity: Once cauliflower ear has formed and hardened, only surgical reshaping can improve the appearance, and results vary.
• Antibiotics: May be given to reduce the risk of infection of the cartilage.

The key message is that acting fast on the initial swelling is far more effective than treating the finished deformity.

Prevention

• Wear well-fitting protective headgear for wrestling, boxing, and similar sports
• Treat any ear swelling after injury promptly rather than waiting
• See a doctor within hours to a day of an ear injury that causes a soft, tense lump
• Follow instructions to keep compression dressings in place during healing

When to See a Doctor

See a doctor as soon as possible, ideally within a day, if your outer ear becomes swollen, bruised, and develops a soft, tense lump after a blow. Early drainage can prevent permanent deformity.

Seek prompt care if the ear becomes increasingly red, warm, very painful, or you develop a fever, which can signal an infection of the cartilage that needs urgent treatment. After a significant head injury, seek emergency evaluation.

Related Topics

Frequently Asked Questions

References

1. MedlinePlus, U.S. National Library of Medicine. Ear injuries and hematoma.
2. American Academy of Otolaryngology–Head and Neck Surgery.
3. Mayo Clinic. Cuts and injuries of the ear.
4. Centers for Disease Control and Prevention (CDC). Sports injury prevention.