Cauliflower ear, formally known as an auricular hematoma, is a deformity of the outer ear resulting from blunt trauma. This condition is most often associated with contact sports like wrestling, boxing, and rugby. Despite the change in appearance, the condition usually does not affect a person’s ability to hear. The structures responsible for processing sound remain functional, meaning hearing is preserved.
The Anatomy of Cauliflower Ear Formation
The outer ear, or pinna, consists primarily of elastic cartilage covered by skin and a membrane called the perichondrium. The perichondrium is the sole source of oxygen and nutrients for the underlying cartilage. Blunt force or repeated trauma causes the skin and perichondrium to separate from the cartilage, creating a pocket.
This pocket fills with blood, forming an auricular hematoma. The blood collection separates the cartilage from its nutrient supply, leading to tissue death. If the hematoma is not promptly drained and the perichondrium reattached, the body attempts to heal by forming disorganized scar tissue and new cartilage (neocartilage). This process results in the permanent, lumpy, and thickened appearance that resembles a cauliflower.
Why Sound Transmission Remains Intact
Hearing is preserved because cauliflower ear affects only the pinna, which is part of the outer ear. The pinna functions primarily as a sound-gathering dish, collecting sound waves and funneling them down the external auditory canal toward the eardrum.
The mechanical process of hearing occurs deeper inside the head, far removed from the site of the injury. Sound waves are converted to vibrations by the tympanic membrane (eardrum) in the middle ear. These vibrations are amplified by the ossicles and transmitted into the fluid-filled cochlea of the inner ear. The cochlea and the auditory nerve are safely protected within the skull and are not damaged by the superficial trauma that causes the external deformity.
When Hearing Loss Does Occur
While the inner hearing mechanisms are protected, hearing loss can develop in specific, less common circumstances. This loss is conductive, meaning sound waves are prevented from traveling to the eardrum. Severe, chronic trauma can lead to extensive scar tissue that physically narrows or completely blocks the external auditory meatus (ear canal).
In the acute phase, a large, untreated hematoma or significant swelling can temporarily close the ear canal, causing a muffled sensation. Trauma can also lead to perichondritis, a secondary cartilage infection that causes intense swelling and temporary blockage. Once the swelling or infection is resolved, or if the physical obstruction is surgically corrected, hearing typically returns to normal because the inner ear components were never damaged.
Preventing and Treating the Condition
Cauliflower ear is preventable if the initial auricular hematoma is treated quickly and correctly. Treatment must be sought immediately following the injury, ideally within 48 to 72 hours, before the blood clot organizes into scar tissue. The procedure involves draining the collected blood using needle aspiration or a small incision.
After draining the hematoma, a compressive dressing or splint must be applied for five to seven days. This compression presses the separated perichondrium back against the cartilage, allowing it to reattach and restore the blood supply. Without this step, the pocket will refill, and the deformity will develop. Long-term prevention involves wearing appropriate protective headgear, such as wrestling ear guards, during contact sports.