Cauliflower ear, or auricular hematoma, results from blunt trauma to the outer ear (auricle). This trauma causes blood to collect between the skin and the underlying cartilage, separating these layers. The ear cartilage receives nourishment from the overlying tissue layer, the perichondrium, which is disrupted by this blood collection. When this separation occurs, the cartilage is deprived of blood supply, which can lead to necrosis. Immediate professional medical intervention is required to prevent permanent structural changes to the ear.
Treatment Timeline
The timing of treatment prevents the irreversible deformity that gives the condition its name. When blood pools beneath the perichondrium, the body begins a destructive healing process resulting in fibrosis. This involves the organization of the blood clot and the formation of new, disorganized cartilage, leading to the characteristic lumpy, misshapen appearance of cauliflower ear.
The hematoma must be evacuated quickly, ideally within the first 48 to 72 hours following the injury. Beyond this timeframe, the clot starts to solidify and organize, making it far more difficult to drain completely with simple aspiration or incision. Delaying treatment also increases the risk of perichondritis, a severe infection of the ear cartilage that can accelerate tissue destruction. Prompt action is necessary to restore blood flow to the cartilage and minimize permanent damage.
Identifying the Right Medical Provider
The best place for drainage is a healthcare facility with staff experienced in minor surgical procedures. The primary recommendation is to seek an Otolaryngologist, or Ear, Nose, and Throat (ENT) specialist. These specialists possess the detailed anatomical knowledge required to perform the drainage effectively and apply the specialized compression needed to maintain the ear’s contour. Consulting a facial plastic surgeon is also recommended, as they are experts in preserving both function and aesthetic outcome.
For immediate assessment, an Emergency Department or an Urgent Care center is an appropriate starting point. While these facilities can perform initial drainage, particularly for fresh hematomas, they may lack the advanced compression materials or time for meticulous follow-up. Specialized sports medicine clinics that regularly treat athletes involved in contact sports are another viable option. If the hematoma is more than seven days old, it may have organized into solid scar tissue, requiring referral to an ENT or plastic surgeon for more complex surgical management.
The Drainage and Compression Procedure
The procedure begins with the application of local anesthesia. The provider selects either needle aspiration or incision and drainage, depending on the size and age of the blood collection. For small, fresh hematomas (less than 48 hours old), needle aspiration may be attempted, but incision and drainage is generally preferred due to its lower risk of reaccumulation.
During incision and drainage, a small cut is made along the natural curves of the ear to minimize visible scarring. The clotted and liquid blood is fully evacuated, and the pocket is irrigated with sterile saline to ensure all debris is removed. The most important step is the application of compression, which aims to close the “dead space” created by the hematoma and press the perichondrium back onto the cartilage. This compression may involve securing materials like dental rolls, cotton bolsters, or specialized splints to the ear using through-and-through sutures. This constant, even pressure prevents the space from refilling with blood or fluid.
Post-Procedure Care and Recurrence Prevention
After drainage and compression, the patient is responsible for aftercare. Oral antibiotics are frequently prescribed to guard against perichondritis, a serious infection that can rapidly destroy the cartilage. Patients must closely monitor the ear for signs of infection, such as increasing redness, warmth, fever, or pain that worsens after the initial procedure.
The compression dressing must be kept dry and intact for the period recommended by the physician, usually between five and seven days. It is necessary to avoid manipulating the dressing or sleeping directly on the affected ear to keep the perichondrium firmly against the cartilage. Follow-up appointments, often within 24 to 48 hours, are necessary to check for any reaccumulation of the hematoma, which can sometimes require a second drainage. Avoiding contact sports and any activity that risks further ear trauma is necessary for approximately 10 to 14 days.