Cauliflower ear

By Terry Zeigler, EdD, ATC 

Last Updated on October 17, 2023 by SportsMD Editors


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 of cauliflower ear 

cauliflower earThe outer ear is primarily made of elastic cartilage. This cartilage gives the outer ear its form, but also allows for 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 for 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 headgear. 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 fits properly and that the chin strap is snug so that the headgear 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 headgear. If the headgear is not properly fitted, the equipment itself could cause a hematoma.

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


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, an 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.


Returning to sports

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.


Recent news about Cauliflower Ear: Northern Ireland dental technician believes she may have found a way to prevent the rugby player’s curse – cauliflower ear. Brenda Phillips from Lisburn has invented a silicone ear guard to prevent injury and protect cartilage. The invention is … ‘Cauliflower ear’ tackled by silicone ear guard – BBC News

Getting a Second Opinion

A second opinion should be considered when deciding on a high-risk procedure like surgery or you want another opinion on your treatment options.  It will also provide you with peace of mind.  Multiple studies make a case for getting additional medical opinions.

In 2017, a Mayo Clinic study showed that 21% of patients who sought a second opinion left with a completely new diagnosis, and 66% were deemed partly correct, but refined or redefined by the second doctor.

You can ask your primary care doctor for another doctor to consider for a second opinion or ask your family and friends for suggestions.  Another option is to use a Telemedicine Second Opinion service from a local health center or a Virtual Care Service.


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