Cauliflower Ear

Here is a picture of a normal ear and a cauliflower ear.

Cauliflower ear is an acquired deformity of the outer ear. It is usually due to blunt trauma to the ear. When the cartilage of the ear is injured by trauma or inflammation, the blood supply from the skin is disrupted, often forming a large pocket of blood, called a hematoma. As the injury to the ear heals it can shrivel up and fold in on itself and appear pale, giving it a cauliflower-like appearance, hence the term cauliflower ear.

Wrestling, rugby, football and boxing are all contact sports that can cause cauliflower ear. Therefore, cauliflower ear is also sometimes called boxer's ear or wrestler's ear.

Cauliflower ear is common in sports that involve regular physical contact or impact on the ear. Grappling sports (such as wrestling, jiujitsu, judo and sambo) as well as striking sports (such as boxing, karate and taekwondo), which involve repetitive hits from punches, kicks and other strikes, can directly injure the ear cartilage. This can progress to cauliflower ear. Contact sports such as rugby, hockey and water polo also have a high risk of causing ear injuries due to the rough nature of these games and the close contact among players.

To reduce the risk of long-term deformity, players in these activities must wear protective gear and seek medical assistance immediately after they sustain ear injuries.

Here are some statistics on the incidence of cauliflower ear among various sports populations:

• Wrestling: A study reported a prevalence of 52 percent among collegiate wrestlers in the United States.
• Rugby: A study conducted by the University of Pretoria in South Africa found that 25 percent of rugby players in the study developed cauliflower ear.
• Judo: A study conducted on world-level judokas showed a prevalence of cauliflower ear of 55.5 percent, with 32.4 percent unilateral and 67.6 percent bilateral deformities.
• Martial arts: A study of Finnish martial artists at the national champion level described a prevalence of auricular hematoma of 96 percent, with cauliflower ear seen in 84 percent of men.

The ear is vulnerable to blunt trauma. When the ear is struck and a blood clot develops under the skin, or the skin is sheared from the cartilage, the connection of the skin to the cartilage is disrupted, causing the cauliflower ear.

The cartilage of the ear has no other blood supply except that supplied by the overlying skin’s blood sypply. When the skin is pulled from the cartilage, and/or separated from the cartilage by blood collections (as with accumulated blood from injury or inflammation, or infection), the cartilage is deprived of important nutrients. Ultimately, the cartilage dies and the risk of infection is increased.

Untreated, the ear cartilage contracts on itself forming a shriveled-up outer ear, known as the cauliflower ear deformity. Once cartilage death and scarring (fibrosis) occur, the resulting deformity is generally permanent. The ear may also appear pale, due to loss of blood supply. In some cases, cosmetic procedures may improve the appearance of the ear.

Cartilage damage may also result from piercing the upper ear in the cartilage. Piercing can lead to a type of ear cartilage infection called auricular perichondritis, which can result in a cauliflower ear. An even more rare cause of the condition is the inflammation of the cartilage in relapsing polychondritis.

Because cauliflower ear is usually due to trauma, the symptoms depend on the severity of the trauma to the ear.

Common symptoms of the acute condition include:

• Pain
• Swelling
• Bruising
• Deformity of the curvature of the ear

Severe symptoms of the condition include:

• Loss of hearing
• Ringing in the ear (tinnitus)
• Headaches
• Blurred vision
• Facial swelling
• Severe bleeding

If the damage from the trauma is severe and medical attention should be sought immediately. Once scarring and deformity of the cartilage occur, there may be no symptoms.

The goals of treatment are to prevent permanent damage to the cartilage by draining blood from the hematoma, treating any infection, and reducing inflammation to re-establish the connection of the skin to the underlying cartilage. Antibiotics are prescribed to prevent infection.

Patients may be referred to an ear, nose, and throat doctor (otolaryngologist) or plastic surgeon to treat this deformity and assure proper healing.

Repair of the ear condition consists of draining accumulated blood (the hematoma) through an incision in the ear and applying a compressive dressing to sandwich the two sides of the skin against the cartilage.

Ear surgery, also known as otoplasty, is done to correct cauliflower ear resulting from untreated ear injuries. This surgical procedure usually involves repairing the damaged cartilage and skin to enhance the look and function of the ear. During otoplasty, a surgeon may remove scar tissue and restore the ear's natural shape. The recovery period varies from person to person. Patients are routinely encouraged to seek postoperative care to ensure optimal healing and reduce the chance of recurrence.

How to drain cauliflower ear at home

It is critical to note that draining cauliflower ear should only be attempted under medical supervision to avoid problems such as infection or poor healing. Using makeshift tools or attempting DIY methods to drain cauliflower ear can be dangerous, resulting in infection, additional injury and structural damage to the ear.

Draining cauliflower ear without a syringe or any other medical equipment at home is not recommended. It can be risky and result in infection. If you feel you have cauliflower ear, you should get expert medical help as soon as possible. Doctors are trained to perform drainage safely and effectively, using sterile procedures and local anesthetics to minimize discomfort and problems.

How long does it take for cauliflower ear to harden?

Cauliflower ear hardens fast if not treated promptly. The transition from hematoma into solid fibrous tissue can begin within 24 to 48 hours after injury. After about a week, the hematoma hardens enough so that simple drainage is no longer effective, requiring more invasive operations to repair the deformity. Early intervention is crucial to prevent this hardening and preserving the ear's natural shape.

When is it too late to drain a cauliflower ear?

It is usually advised to drain a cauliflower ear as quickly as possible, preferably within the first few hours after the injury occurs. The effectiveness of draining decreases significantly if it is done after 24 hours because the blood begins to clot, and the fluid becomes more difficult to extract. After injury, your body may begin to form scar tissue, which can harden, making it more challenging to restore the ear’s original form with simple draining alone. After around 7 days, the hematoma usually begins to harden, requiring surgical intervention rather than simple drainage to repair the deformity. Early treatment not only helps maintain the look of the ear but also reduces long-term consequences, such as persistent discomfort, infection and hearing loss.

When treated aggressively and promptly, cauliflower ear deformity is unlikely. Any delay in diagnosis leads to more difficulty in managing the problem, increased chances for insufficient blood supply to the ear cartilage, and escalated risk of deformity.

Can cauliflower ear go away?

Cauliflower ear does not improve without proper treatment, especially if the problem has progressed to the point of necrosis, where the ear cartilage cells begin to die. If left untreated following injury, the blood and fluid collected within the ear can cause irreversible damage to the cartilage, resulting in cauliflower ear.

In the early stages, when a hematoma has just developed, quick drainage of the blood and the use of compression dressings may help avoid cauliflower ear. However, after the cartilage becomes necrotic and develops fibrous tissue, the deformity becomes permanent, especially without surgical intervention. Timely treatment can help minimize the risk of developing a permanent ear deformity and improve the chances of preserving the ear's natural appearance.

Protective headgear and helmets worn during sporting activities can help prevent this condition. Helmets can also protect from a serious head injury.

See a doctor (preferably an otolaryngologist or plastic surgeon) for definitive care as soon as possible after the injury.

Why do people get cauliflower ear?

People get cauliflower ear primarily due to blunt trauma or repeated friction to the outer ear. Blunt trauma to the ear can cause blood to pool between the skin and the cartilage, resulting in a hematoma. If left untreated, the hematoma can cause cartilage to die and deform. Repeated rubbing or friction against the ear, as seen in grappling sports, can cause the skin to split from the cartilage, resulting in scar tissue formation and eventual deformity. Failure to use appropriate protective equipment, such as helmets or ear protectors, during high-risk activities increases the risk of getting cauliflower ear. Some people may be more prone to developing cauliflower ear due to hereditary factors that affect the flexibility and durability of their ear cartilage.

Should I drain my cauliflower ear?

If you suspect that you have developed a cauliflower ear or experience it, seek immediate medical attention. You should not try to drain cauliflower ear yourself, as this can lead to infections or improper healing. A healthcare provider will examine your ear to assess the severity of the condition and determine the best course of treatment.

Can cauliflower ear be undone?

Early treatment of cauliflower ear can restore some deformity of the ear, but it is not possible to completely restore the ear to its original condition, especially if the cartilage is completely damaged. Usually, surgery is done to remove the scar tissue and reconstruct the damaged cartilage. Getting it treated immediately after injury before it hardens into the cauliflower form can give better results. It is best to speak with your healthcare provider who specializes in ear issues to understand the available alternatives based on the severity of the situation.