Cauliflower ear, medically known as auricular hematoma, is a deformity of the outer ear caused by blunt force trauma. It results in a disfigured, lumpy appearance. This medical condition requires prompt attention to prevent permanent structural changes. While often associated with specific athletic activities, anyone can develop it following an ear injury.
The Mechanism of Formation
Cauliflower ear develops when direct trauma to the outer ear causes the skin and its underlying perichondrium to separate from the ear’s cartilage. The perichondrium is a layer of connective tissue that provides the primary blood supply and nutrients to the cartilage, which is avascular. When this separation occurs, blood accumulates in the newly formed space, creating an auricular hematoma. This pooled blood then acts as a barrier, disrupting the flow of essential nutrients from the perichondrium to the cartilage.
Without this nourishment, the deprived cartilage begins to die, a process called necrosis. As the body attempts to heal, new, disorganized cartilage and scar tissue form in the affected area. This irregular growth leads to the thickened, lumpy, and shriveled appearance of cauliflower ear. Repeated trauma can exacerbate this process, contributing to more severe deformities.
Identifying the Condition
Initially, an auricular hematoma presents as a swollen, bruised, and tender area on the outer ear. The affected part may feel like a fluid-filled pocket. Pain and throbbing are common symptoms accompanying this initial swelling.
If untreated, the fluid within the hematoma can clot and harden within approximately 7 to 10 days, leading to permanent changes. The ear’s contours become distorted, developing a hard, lumpy texture. In more severe instances, swelling might affect the ear canal, potentially leading to temporary or permanent hearing impairment. Other symptoms can include:
Ringing in the ear (tinnitus)
Headaches
Blurred vision
Facial swelling
Prevention and Management
Preventing cauliflower ear involves protecting the ears from blunt force trauma. For individuals participating in contact sports such as wrestling, boxing, rugby, or martial arts, wearing appropriate, well-fitted protective headgear is the most effective measure. This headgear helps absorb impacts and reduce the shearing forces that can cause the skin and perichondrium to separate from the cartilage.
If an auricular hematoma occurs, immediate medical attention is important to prevent permanent deformity. Healthcare providers typically treat the condition by draining the accumulated blood, either through needle aspiration or a small incision. Following drainage, compression is applied to the ear, often using a dressing, dental rolls, or custom molds, to re-establish contact between the skin and cartilage and prevent blood re-accumulation. Antibiotics are frequently prescribed to prevent infection, as the injured ear is more susceptible. Prompt treatment, ideally within six hours of the injury, is necessary for a successful outcome and to avoid lasting disfigurement.