Cauliflower ear, medically termed an auricular hematoma, is a permanent deformity of the outer ear most frequently seen in athletes who participate in high-contact sports like wrestling, boxing, and rugby. The condition develops after blunt trauma causes a collection of blood to pool beneath the skin. The injury hurts intensely when it first occurs because of the pressure buildup. Once the deformity has fully set and hardened, however, the area is typically no longer painful.
How the Injury Occurs
The injury begins with a direct blow or repetitive shearing force to the outer ear. The skin is tightly attached to the underlying cartilage, which is covered by the perichondrium, the sole source of blood and nutrients for the cartilage structure.
Trauma causes the skin and perichondrium to separate, tearing small blood vessels and creating a space where blood accumulates (a subperichondrial hematoma). This pooled blood blocks the supply of nutrients to the cartilage. If the hematoma is not promptly removed, the deprived cartilage tissue begins to die (necrosis). The body replaces this dead cartilage with disorganized scar tissue, resulting in the characteristic shriveled, cauliflower-like appearance.
Acute Pain and Long-Term Sensation
The acute phase, immediately following trauma and hematoma formation, is characterized by significant pain and tenderness. This intense, throbbing discomfort is caused by the pressure of accumulating blood and fluid pushing against the ear’s sensitive structures. The ear will appear red and swollen, and the pressure feels like a painful fullness.
If untreated, the liquid hematoma begins to calcify and scar tissue forms, creating the permanent deformity. Once the ear has hardened into the “cauliflower” shape, the acute pain subsides completely. The permanently deformed tissue becomes firm, numb, and painless to the touch, though the area can remain sensitive to direct pressure or friction from objects like headphones or a pillow.
Immediate Treatment and Recovery
The window for effective treatment is narrow, ideally within six hours of the injury, to prevent permanent deformity and relieve acute pain. Medical intervention focuses on evacuating the pooled blood to restore contact between the perichondrium and the cartilage. A healthcare provider will use a large-bore needle for aspiration or perform a small incision to drain the hematoma completely.
Immediately following drainage, a compression bolster dressing is applied to the ear. This dressing is essential, as it prevents the space from refilling with blood or fluid and holds the skin and perichondrium firmly against the cartilage. The compression minimizes the risk of cartilage death and is a direct way to alleviate the painful pressure. The dressing is typically kept in place for five to seven days and may be secured with sutures. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) can manage remaining pain and reduce inflammation, and patients are usually prescribed antibiotics to prevent infection.
Avoiding the Deformity
The most effective way to avoid cauliflower ear is through prevention. Athletes in high-risk sports must consistently wear appropriate protective headgear during all training and competition. This includes wrestling headgear (ear guards) and rugby scrum caps, which shield the outer ear from blunt force and friction.
The headgear works by distributing the force of impact over a wider area, preventing the shearing injury that separates the perichondrium. Prompt recognition of the injury is also crucial. If trauma occurs, the athlete should immediately stop the activity, apply ice to reduce swelling, and seek medical attention for potential drainage.