Cauliflower ear, also known as perichondrial hematoma, is a swelling of the ear caused by a blood clot. This blood clot causes tissue damage that leads to a lumpy appearance that is said to resemble a cauliflower.
Typically, those at risk can prevent the sorts of injuries that lead to this condition by wearing protective headgear.
The ear is particularly vulnerable to this sort of injury because it protrudes from the head. The blood supply to the cartilage that supports the ear and keeps its shape is provided by the overlying skin. When this supply is interrupted, by either multiple clots or pressure caused by swelling, this cartilage may die off.
This can lead to the thickening and scarring of tissue in the ear and the formation of new cartilage.
Cauliflower ear typically occurs when blunt trauma affects the ear. The trauma leads to a series of small blood clots that block blood flow, leading to tissue damage. Sometimes, the injury pulls the cartilage away from the skin.
However, the condition can also occur due to an ear infection, particularly those caused by piercings in the upper portion of the ear. Up to 35 percent of piercings result in complications. In many cases, these complications will be minor, but in some, they can lead to more serious issues.
In both cases, tissue damage can be relatively minor, resulting in scar tissue. In others, the cartilage may die as it is starved of essential nutrients. The ear then folds over because it lacks the support supplied by the cartilage.
Any sport that can involve blunt-force trauma raises the risk of a cauliflower ear. These sports include martial arts, boxing, rugby, and wrestling. Often, a cauliflower ear is the result of repeated impacts to the side of the head. These impacts may be from a fist, a shoulder, or repeated contact with the ground (such as during a wrestling match).
In addition, fights can also result in similar injuries, as can accidents where the side of the head is injured. These accidents may include cycling accidents in which someone is not wearing a helmet, and vehicle accidents.
Other risk factors include piercings to the upper ear in particular. Because these piercings penetrate the ear and can be hard to keep clean, the risk of infection increases.
Such infections can cause the cartilage to separate, resulting in further complications. Of particular concern is the bacteria Pseudomonas aeruginosa, according to a study published in the Brazilian Journal of Otorhinolaryngology.
The most common initial symptoms of a cauliflower ear are:
- deformation of the shape of the ear
In some cases, severe symptoms may occur. These include:
- hearing loss
- ringing in the ear
- severe bleeding
- blurred vision
- facial swelling
Seek medical attention immediately for a hematoma, which is a large collection of blood outside of the blood vessels. The earlier a hematoma is treated, the less likely it is that it will progress to a cauliflower ear.
After a few days, the pain and swelling generally subside. Left untreated, the ear remains lumpy and the swelling gradually hardens over the course of 7 to 10 days. This can create a permanent change to the ear’s appearance. In some cases, the ear may flop over as the cartilage dies.
Initial treatment can prevent a cauliflower ear from forming. Ice packs to the ear for approximately 15-minute stretches several times per day may help to reduce swelling.
Rapid removal of fluid by a medical professional reduces the likelihood of clots forming. The fluid is usually drained using a wide-bore needle in a process called aspiration. This fluid may contain the blood clots, preventing further blockages.
The injury requires constant compression to stop it from filling up with fluid again. Compression also keeps the skin close to the cartilage so that it does not rip out additional blood vessels. People should rest from training and other situations where blunt-force trauma is likely to reoccur.
In cases where simple draining is not sufficient, a surgeon may suture a temporary drain onto the ear. This may not be practical for those who play sport professionally, as they must keep the drain clean to avoid infection. For most, however, this method is likely to be fine.
An alternative to the traditional compression bandage involves silicone molds. One mold fits in the ear, just like a traditional hearing aid, and another fits behind the ear. Together, they apply compression to the injury.
Those participating in sports can wear these molds under their headgear in order to reduce the risk of further injury. A case study in the British Journal of Sports Medicine described this treatment as being successful after a player with a newly developed cauliflower ear wore these molds for 10 days. The authors also noted that a hole in the in-ear mold would aid hearing. Because this is a new form of treatment, no long-term studies as to its effectiveness are available.
If a cauliflower ear is not treated quickly, there is potential for it to become permanent. The fluid that builds up hardens within 7 to 10 days, causing the cartilage to thicken and harden. After that occurs, the condition requires surgery to restore the ear.
Corrective surgery is called otoplasty. If it is completed within 30 days of the initial clot and formation, it involves cutting out the newly formed scar tissue and stitching the wound up. This typically takes place under local anesthetic and requires the patient to wear a headband for a few days following the surgery. People can usually resume contact sports 12 weeks after the operation.
In cases where the cartilage has hardened and the scar tissue has settled in, the surgeon must reconstruct the ear cartilage, particularly when the cartilage has died. This surgery typically takes longer and has a longer recovery time, as it can involve taking cartilage from the ribs to reconstruct the ear.
Preventing a cauliflower ear typically means avoiding sports where multiple impacts to the side of the head are likely. Participants in these sports may choose to wear helmets where possible, reducing the impact of blows to the ear.
A well-fitting helmet is crucial. One that is too loose can result in shifting, potentially making the problem worse. A loose helmet can also fall off at inopportune moments. Some rugby players wear a band around the ears, but their effectiveness is debatable.
In some sports, such as in high-level boxing and wrestling, this is not possible. For these sports, rapid treatment of blunt-force trauma to the ear can prevent a cauliflower ear from forming.
Untreated, a cauliflower ear is usually harmless. Those who leave it untreated generally do not experience ill effects.
Cauliflower ear can cause practical issues, such as difficulty wearing headphones and problems with wax removal from the ear. Consequently, those with a cauliflower ear may experience more ear infections than others.
When treated quickly, a cauliflower ear can be cured. This process often takes a couple of days. The longer the cauliflower ear is left to develop, the longer it takes to resolve, and it may require reconstructive surgery if left too long.