A single injury may contribute to changes in the ear’s appearance, sometimes leading to a condition known as cauliflower ear. This condition, caused by trauma or repeated impacts, alters the ear's shape but can often be prevented and managed with proper care.
If left untreated, cauliflower ear may lead to changes in ear shape and, in some cases, affect hearing. Some athletes view this as a sign of experience in their sport.
This article examines cauliflower ear, its causes, symptoms, pervasiveness in some sports, treatments, and short-term prevention and long-term treatment.
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Understanding Cauliflower Ear
Cauliflower ear, also known as hematoma auris, is a condition resulting from trauma to the external part of the ear. This trauma causes fluid, or blood, to collect under the perichondrium, a connective tissue layer covering the ear's cartilage.
The external ear becomes permanently misshapen and swollen and resembles cauliflower, hence the name.
The skin covering the ear carries blood to the cartilage underneath, which gives the ear its shape. With enough trauma, the skin can separate from the cartilage, disrupting the blood supply and resulting in a hematoma.
As the injury heals, the ear folds in on itself and grows new cartilage to protect the injured area, giving it a shriveled, cauliflower-like appearance.
This can happen from repeated trauma, striking, rubbing, and forceful friction to the ear and is, therefore, most commonly seen in contact sports athletes such as boxers, wrestlers, martial artists, and rugby players.
While a single injury may contribute to changes in ear structure, repeated trauma is the more common cause. Identifying early signs may help manage symptoms and reduce the likelihood of long-term complications.
Causes and Risk Factors
There are several causes of cauliflower ear, but the primary cause is blunt force trauma or repeated friction trauma (Figure 4). While trauma from accidents, such as vehicle collisions, can contribute, sports-related injuries are the leading cause:
Direct blows to the ear, common in:
- Boxing
- Karate
- Kickboxing
- Rugby
Friction trauma, common in:
- Wrestling. This deformity is sometimes referred to as "wrestler's ear."
- Mixed Martial Arts
- Jujitsu
- Rugby
- Judo
In rare occasions, the deformity can be caused by an untreated infection resulting from:
- Home ear piercings
- Infected cuts or scrapes
- Piercings made with unsterilized equipment
Prevention Strategies
Since cauliflower ear results from repetitive trauma, various measures can reduce the risk of developing this condition.
Full, over-the-ear headgear is commonly recommended to reduce the risk of ear injuries. Organizations such as the Association of Ringside Physicians (ARP), USA Wrestling, and USA Rugby acknowledge its potential benefits.
However, a study showed these guards are seen as uncomfortable and are widely not used unless mandated in a competition.
This is important because:
- Organizations such as the North American Grapplers Association (NAGA) write that headgear use is the only way to ensure safety from cauliflower ear. Still, it does not require [Rulebook PG 29] the gear to be worn in youth or adult competitions.
- USA Wrestling removed the requirement for ear protection in 2016, making ear protection a recommendation rather than a requirement.
- USA Rugby does not currently mandate ear protection, although some professional leagues require it.
- Ear Guards are a newer, smaller device affixed to the ear as a cushion, usually via magnets. However, their efficacy in preventing cauliflower ear has not been determined.
Training Safety
Using proper technique is vital in preventing cauliflower ear.
Some techniques, such as headlocks or cross-face grabs, can increase the risk of this deformity as they rely on direct friction against the ear for effectiveness.
Proper coaching and education of athletes in administering these techniques can minimize friction and decrease the likelihood of injury.
Immediate first aid may help manage ear injuries and reduce the likelihood of long-term changes in ear shape.
Acute injury treatment includes:
- Icing the ear to reduce swelling.
- Having a medical professional drain the blood and liquid from the ear within a few hours of injury.
- Compression bandages keep pressure on the injury and prevent further blood from filling the injured area.
Athletes and coaches should seek medical attention for ear injuries rather than attempting drainage themselves, as improper techniques may increase the risk of infection or complications.
Recognizing Early Signs of Cauliflower Ear
Athletes and their coaches must learn to recognize the early signs of cauliflower ear to ensure rapid treatment and prevention of further damage.
The early signs of cauliflower ear are:
- Swelling where the ear appears swollen and puffy
- Redness
- Bruising, especially in the outer ear
- Pain
- Tenderness in the area around the ear
Other, more severe symptoms include:
- A change in the shape of the ear
- Discoloration of the outer ear
- Ear bleeding
- Headaches
- Tinnitus (ringing in your ears)
- Hearing loss
- Swelling in the face
- Blurry vision
Treatment Options for Cauliflower Ear
Non-surgical treatments for cauliflower ear include:
- Drainage
- Compression
- Full-head wraps or ear compression devices
Drainage should only be performed by a medical professional to reduce the risk of infection and complications.
Surgical treatments include:
- Reconstructing the ear cartilage
- Ultrasonic aspiration to reform and mold damaged cartilage
- Other methods of rebuilding a damaged ear
Recovery from surgery can take four to eight weeks, depending on the severity of the injury and the type of surgery.
As with any medical procedure, patients should closely follow the guidelines and suggestions of their surgeon and medical team.
Long-Term Implications
If left untreated, cauliflower ear may lead to:
- Long-term changes in ear appearance
- Damage to ear cartilage
- Potential effects on hearing
- Discomfort or persistent pain
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Key Takeaways
- Cauliflower ear, hematoma auris, is a deformity of the ear resulting from injury, including blows to the ear and friction injuries. It can result from individual or repeated injuries.
- It is most common in combat athletics, such as wrestling, judo, mixed martial arts, jujitsu, boxing, and rugby, but it is not only a problem for athletes.
- Wearing headgear and ear protection is the best way to avoid injury.
- Treatment options for cauliflower ear may include medical drainage, compression, cold therapy, or, in some cases, surgical interventions.
- If untreated, cauliflower ear can cause permanent disfigurement, hearing loss, and chronic pain.
- Athletes, coaches, and parents should pay close attention to ear injuries to treat them rapidly and correctly.
- Athletes should be encouraged to wear headgear and ear protection even when their sport's governing body does not mandate it.
- Some jiu-jitsu athletes associate cauliflower ear with experience in the sport. However, healthcare professionals note that it results from repeated trauma and may lead to complications if not addressed.
- As always, patients should have frank and open discussions with their physicians and medical teams to ensure proper treatment and care for any injury.
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