Cauliflower ear is a deformity of the outer ear that often arises from trauma, particularly in contact sports. It develops when a collection of blood, known as a hematoma, forms between the cartilage of the ear and its overlying membrane. This separation disrupts the blood supply to the cartilage, initiating a process that can lead to the ear’s characteristic lumpy appearance.
What is Cauliflower Ear?
Cauliflower ear begins with blunt force trauma to the outer ear, which can rupture small blood vessels. This causes blood to pool between the ear’s cartilage and the perichondrium, the thin tissue layer that provides nutrients. This accumulation separates the perichondrium from the cartilage, depriving it of blood supply.
Without adequate blood flow and nutrients, the cartilage can begin to die, leading to inflammation and the growth of new, disorganized cartilage and scar tissue. This irregular tissue formation gives the ear its distinct, lumpy shape.
The Hardening Process and Timeline
If a hematoma is not promptly treated, the trapped blood begins to clot and organize within hours to a few days after the injury. This is followed by the formation of new, unorganized cartilage. This stage of fibrosis and new cartilage growth can become noticeable within one to two weeks.
The ear then gradually hardens as this new tissue matures and calcifies. This hardening can take several weeks to months, depending on the size of the initial hematoma and how an individual’s body heals. Once significant hardening and calcification occur, the changes to the ear’s shape are permanent without surgical intervention. The deformity can become permanent within approximately 7 to 10 days if left untreated.
Prevention and Early Intervention
Preventing cauliflower ear involves protective headgear during activities that carry a risk of ear trauma, such as wrestling, boxing, or rugby. Headgear, like wrestling headgear or scrum caps, can absorb direct impacts and protect the ear cartilage. This protective gear must fit snugly to prevent shifting during activity.
If an ear injury does occur, immediate medical attention is important to prevent hardening. A healthcare professional can drain the hematoma, ideally within six hours of the injury, before the blood clots and tissue death begins. After drainage, compression techniques, using pressure bandages or magnets, are applied to prevent the re-accumulation of blood and to help the perichondrium reattach to the cartilage. Antibiotics are prescribed to reduce infection risk following the drainage procedure.
Living with Hardened Cauliflower Ear and Treatment Options
Once cauliflower ear has fully hardened, it is primarily a cosmetic concern, though severe deformities can affect hearing or the ability to comfortably wear headphones or glasses. The hardened tissue will not resolve on its own.
For individuals seeking to change the appearance of a hardened cauliflower ear, surgical options are available. Procedures such as otoplasty or chondrocutaneous flap procedures involve removing excess cartilage and reshaping the ear to restore a more typical contour. These surgical corrections are elective and performed long after the ear has stabilized from the initial injury.