Cauliflower Ear

  • Medical Author:
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

What is cauliflower ear?

  • Cauliflower ear is an acquired deformity of the outer ear. It is usually due to blunt trauma to the ear.
  • When the cartilage of the ear is injured by trauma or inflammation, the blood supply from the skin is disrupted, often forming a large pocket of blood, called a hematoma. As the injury to the ear heals it 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, therefore, cauliflower ear is also sometimes called boxer's ear or wrestler's ear.
  • In 2014, UFC fighter Leslie Smith's cauliflower ear exploded after a direct hit from opponent Jessica Eye, causing the fight to stop. The fighter had an existing cauliflower ear that was intermittently being drained of fluid before the fight, but the ear was further damaged by the intense blow, causing it to bleed profusely.

What causes cauliflower ear?

The ear is vulnerable to blunt trauma. 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, causing cauliflower ear.

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 blood from injury or inflammation, or infection), the cartilage is deprived of important nutrients. Ultimately, the cartilage dies and the risk of infection is increased.

Untreated, the ear cartilage contracts on itself forming a shriveled up outer ear, known as the cauliflower ear deformity. Once cartilage death and scarring (fibrosis) occurs, the resulting deformity is generally permanent. The ear may also appear pale, due to loss of blood supply. In some cases, cosmetic procedures may improve the appearance of the ear.

Cartilage damage may also result from piercing the upper ear in the cartilage. Piercing can lead to a type of ear cartilage infection called auricular perichondritis, which can result in cauliflower ear. An even more rare cause of cauliflower ear is from the inflammation of cartilage in relapsing polychondritis.

Picture of a normal ear, and cauliflower ear
Picture of a normal ear, and cauliflower ear
Trauma and First Aid Quiz: Test Your Medical IQ

Ear Anatomy

The anatomy of the ear can be a little confusing, especially since the ear is responsible not only for hearing, but also for balance.

There are three components to the ear: the outer ear, the middle ear and the inner ear. All three are involved in hearing but only the inner ear is responsible for balance.

What are the symptoms of cauliflower ear?

Because cauliflower ear is usually due to trauma, the symptoms depend on the severity of the trauma to the ear.

Common symptoms of acute cauliflower ear

  • Pain
  • Swelling
  • Bruising
  • Deformity of the curvature of the ear

Severe symptoms of cauliflower ear

If the damage from the trauma is severe and medical attention should be sought immediately. Once scarring and deformity of the cartilage occurs, there may be no symptoms.

What is the treatment for cauliflower ear?

The goals of treatment are to prevent permanent damage to the cartilage by draining blood from the hematoma, treating any infection, and reducing inflammation in order to re-establish the connection of the skin to the underlying cartilage. Antibiotics are prescribed to prevent infection.

Patients may be referred to an ear, nose, and throat doctor (otolaryngologist) or plastic surgeon to treat this deformity and assure proper healing.

Cauliflower ear repair consists of 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.

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 or plastic surgeon) for definitive care as soon as possible after the injury.

Medically reviewed by Avrom Simon, MD; Board Certified Preventative Medicine with Subspecialty in Occupational Medicine

REFERENCE: Hanif, J. et al. "High" ear piercing and the rising incidence of perichondritis of the pinna. BMJ 2001. 322 : 906 doi: 10.1136/bmj.322.7291.906

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Reviewed on 3/3/2016
References
Medically reviewed by Avrom Simon, MD; Board Certified Preventative Medicine with Subspecialty in Occupational Medicine

REFERENCE: Hanif, J. et al. "High" ear piercing and the rising incidence of perichondritis of the pinna. BMJ 2001. 322 : 906 doi: 10.1136/bmj.322.7291.906

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