Cauliflower Ear (Auricular Hematoma)


Overview

What is cauliflower ear?

Cauliflower ear, medically known as auricular hematoma, is a condition of the outer ear that can cause deformity to the external ear if left treated. The condition results in a distortion of the outer ear resulting in a deformity that looks like the outside of a “cauliflower” over time.

Who gets cauliflower ear?

Cauliflower ear is common in athletes who participate in sports in which there are repeated friction or blunt force trauma to the ears as in the sports of boxing, rugby, martial arts, water polo, and wrestling.




Causes

What causes cauliflower ear?

The outer ear is primarily made of elastic cartilage. This cartilage gives the outer ear its form, but also allows for the flexibility and movement. Because cartilage of the ear does not have its own blood supply, the cartilage is dependent on the blood flow from the attached skin to supply its nutrients.

There are two primary causes for cauliflower ear. The first is blunt force trauma (blow to the ear) that causes bleeding between the cartilage and skin. A hematoma forms between the cartilage and the skin compromising the blood flow to the cartilage.

The second cause is repeated friction injuries to the ear such as when a wrestler’s ear is compressed and rubbed against the mat by an opponent. With repeated friction forces, the skin and the cartilage can become separated causing bleeding between the skin and cartilage. The result is the same as in blunt force trauma with a hematoma forming between the cartilage and skin.

If left untreated, the hematoma forms a fibrosis (abnormal tissue) blocking the cartilage from the skin. This in turn causes death of the underlying cartilage tissue resulting in the “cauliflower ear” appearance.



Prevention

What can I do to prevent cauliflower ear?

Because cauliflower ear is primarily caused by repeated friction and trauma to the ear, the condition can be prevented through the use of protective head gear. Specialized ear protection is available for specific sports in which athletes are at risk for ear injuries including wrestling, water polo, and boxing.

It is important to make sure that the ear protection gear fit properly and that the chin strap is snug so that the head gear does not move during contact with another player. The ear cup should also be deep enough to ensure that the ear is not compressed when wearing the head gear. If the head gear is not properly fitted, the equipment itself could cause a hematoma.

Unfortunately, in some sports, head gear is required for competition but not for practices. Athletes will only wear the head gear during competition when it is required, but will go without protective head gear during practices.



Treatment

What is the treatment for cauliflower ear?

Once the earlobe has been injured, the ear should be packed with ice with moderate compression applied to the injured ear. If a hematoma has formed, the hematoma can be drained by a physician to avoid permanent deformity of the earlobe.

To drain the ear, the physician can use either a hollow-bore needle or make a small incision. Once the hematoma has been cleared, a compressive dressing is then applied and kept in place so that the skin can reattach to the cartilage of the ear.

The compressive dressing is left in place for three to five days and can be reapplied if necessary. To prevent infection, antibiotics may be given to the athlete after the procedure.

If the cauliflower ear has already formed and it is too late to drain the hematoma, a ear, nose, throat physician or plastic surgeon can be consulted to repair and restore the natural look of the ear. The surgeon can thin down the thickened cartilage and then reposition the skin over it.

Bandages may be worn for up to one week to control the bleeding and swelling. Any bruising and swelling from the procedures should dissipate within 10 to 14 days with the sutures removed after seven days.

When can I return to play?

The athlete can return to participation as soon as the athlete gets a medical release from his/her physician. Restricting an athlete’s participation is usually not necessary unless there are complications with the procedure.

If you suspect that you have cauliflower ear (auricular hematoma), it is critical to seek the urgent consultation of a local sports injuries doctor for appropriate care. To locate a top doctor or physical therapist in your area, please visit our Find a Sports Medicine Doctor or Physical Therapist Near You section.

More Information: Read about sports injury treatment using the P.R.I.C.E. principle - Protection, Rest, Icing, Compression, Elevation.

Related Articles

Concussions and the Effects on Athletes
Traumatic Brain Injury (TBI)
Subdural Hematoma
Orbital Blowout Fracture
Broken Nose (Nasal Fracture)
Broken Jaw (Mandibular Fracture)

References

Anderson, M., Hall, S., & Martin. M. (2009). Foundations of Athletic Training: Prevention, Assessment and Management. (4th Ed.). Lippincott Williams and Wilkins: Philadelphia, PA.

Irvin, R., Iversen, D. & Roy. S. (1998). Sports Medicine: Prevention, Assessment, Management, and Rehabilitation of Athletic Injuries. (2nd Ed.). Allyn & Bacon: Boston, MA.



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