Cauliflower Ear

Medical Author: John P. Cunha, DO
Medical Editor: William C. Shiel, Jr., MD, FACP, FACR

• What is cauliflower ear?
• How is cauliflower ear treated?
• What is the prognosis for cauliflower ear?
• How can cauliflower ear be prevented?

What is cauliflower ear?

Cauliflower ear is an acquired deformity of the outer ear. In this injury, the ear can shrivel up and fold in on itself and appear pale, giving it a cauliflower-like appearance, hence the term cauliflower ear. Wrestlers, boxers and martial artists in particular are susceptible to this type of injury. When the ear is struck and a blood clot develops under the skin, or the skin is sheared from the cartilage, the connection of the skin to the cartilage is disrupted.

The ear is vulnerable to blunt trauma. The cartilage of the ear has no other blood supply except that supplied by the overlying skin. When the skin is pulled from the cartilage, and/or separated from the cartilage by blood (as with accumulated, localized blood from injury, called a hematoma) or infection, the cartilage is deprived of important nutrients. Ultimately, the cartilage dies and the risk of infection is increased.

Untreated, the ear cartilage begins to contract on itself forming a shriveled up outer ear classically known as the cauliflower ear deformity. Once there is cartilage death and scarring (fibrosis), the resulting deformity is very difficult to reconstruct. The ear may also appear pale, due to loss of blood supply. In some cases, cosmetic procedures may be able to improve appearance of the ear, but often the victim can be left with a permanent deformity.

Because the ear is vulnerable to infection, it's important to treat these hematomas, even if the patient is not concerned with the cosmetic appearance of the ear. If the ear drum is also injured (ruptured), the wound may be treated with stitches. However, significant hearing loss may still occur.

How is cauliflower ear treated?

The goals of treatment are to drain blood from the hematoma, treat any infection, and re-establish the connection of the skin to the underlying cartilage. Treatment usually requires draining accumulated blood (the hematoma) through an incision in the ear and applying a compressive dressing to sandwich the two sides of the skin against the cartilage. Antibiotics are given to prevent infection.

What is the prognosis for cauliflower ear?

When treated aggressively and promptly, cauliflower ear deformity is unlikely. Any delay in diagnosis leads to more difficulty in managing the problem, increased chances for insufficient blood supply to the ear cartilage, and escalated risk of deformity.

How can cauliflower ear be prevented?

Protective headgear and helmets worn during sporting activities can help prevent this condition. Helmets can also protect from serious head injury.

See a doctor (preferably an otolaryngologist-ear, nose and throat specialist or plastic surgeon) for definitive care as soon as possible after the injury.

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