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  • Cauliflower ear, a deformity that results from blunt trauma, is common in people who participate in contact sports.
  • If the injuries aren’t addressed soon enough, otoplasty may be required to improve the ear’s appearance.
  • The best way to prevent cauliflower ear it is to wear protective headgear while participating in activities that put you at risk.

Cauliflower ear, as the name suggests, is a deformity where the ear resembles the outer portion of a cauliflower. Wrestlers and boxers are the most commonly afflicted by the condition given that they encounter regular head trauma. However, anyone who experiences injury or trauma to the ear may develop the condition.

When it comes to cauliflower ear, prevention is the best cure. If injury to the ear does occur, early recognition and treatment are the keys to preventing cauliflower ear from developing.

Although cauliflower ear is usually considered permanent, there are a few treatment options available to patients that can help normalize the appearance. In most cases, by the time cauliflower ear has developed, surgery is the only realistic corrective treatment left.

ear surgery

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Are You at Risk?

Descriptions of cauliflower ear can be found in literature and was represented in art dating as far back as ancient Greek and Roman times. Even the writings of Hippocrates, considered the father of medicine, contained case reports of patients with cauliflower ear. Much like today, those who participated in sports, such wrestling and boxing, were the most likely to suffer from the condition.

Some studies estimate that approximately 40% of wrestlers may be affected by auricular hematoma (the pooling of blood), which leads to cauliflower ear if left untreated. Anyone who experiences regular and repeated trauma to the ear is at risk for cauliflower ear, especially those who participate in contact sports such as wrestling, boxing, rugby, football, martial arts, mixed martial arts (MMA) and ultimate fighting (UFC).

Others who may be at risk of cauliflower ear include those who experience domestic abuse, especially children or the elderly. People who have had the cartilage of the ear pierced may also be at risk if the piercing becomes infected.

How to Recognize the Signs

Following trauma or injury to the ear, an auricular hematoma may form in and around the cartilage of the ear. If the hematoma is not promptly treated, the blood supply to the cartilage in the ear may get cut off, leading to inflammation and tissue death of the original cartilage.

Over time, fibrous tissue (scar tissue) and new cartilage may grow to replace the dead cartilage, resulting in a permanent deformity of the ear.

Outward signs of ear trauma that may indicate the need for evaluation by a physician, include redness, swelling and warmth, especially if accompanied by pain, hearing loss, tinnitus (ringing of the ears), vision changes, headache or migraine.

Treatment Options for Cauliflower Ear

Any trauma or injury to the ear should receive early medical attention and intervention to prevent the development of cauliflower ear. Immediate interventions can include:

Ice to Reduce swelling

Following an ear injury accompanied by any of the previously listed signs and symptoms, you should ice the ear for periods of 15-20 minutes at a time until you reach the emergency department, which should ideally happen within 6 hours of the initial trauma.

Head and Neck Examination

Any severe trauma to the external ear requires a thorough examination of the head and neck to rule out more severe intracranial injury. As part of this process, the physician will use an otoscope to check the inner structures of the ear, including the tympanic membrane (ear drum) to ensure that it is intact and not punctured.

Draining the Auricular Hematoma

In order to prevent tissue death of the ear cartilage, the physician will need to drain the auricular hematoma, using one of these two techniques:

  • Aspiration, if the hematoma is small or soft, can be done using an 18-gauge needle. Before draining, the physician will typically administer lidocaine and epinephrine to numb the area. After draining, the doctor will apply a compression dressing to facilitate healing and regrowth of healthy cartilage.
  • Surgical incision can be done if the hematoma is large or firm, or if it has been more than 6 hours since the initial injury. Surgical draining can be considerably more involved than aspiration and may require local or general anesthesia. The incision can typically be made and hidden in an inconspicuous part of the ear. Following surgical draining, stitches will be required in addition to compression dressing.


These will be prescribed orally in many cases to prevent infection. If no antibiotics are taken, it’s important to watch for any signs of infection, including pus near the site of injury, aspiration or incision.

The need for subsequent draining of an auricular hematoma is fairly common. So, it’s likely that patients will receive a referral to an otolaryngologist – also known as an ear, nose and throat (ENT) specialist – for continued management and to prevent development of cauliflower ear.


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Surgical Correction

For patients who did not receive proper treatment within the ideal time frame following an ear injury, otoplasty or plastic surgery on the ear may be the only option. The goal of otoplasty for cauliflower ear is to correct the deformity to whatever extent is possible and return the ear to a more normal appearance.

The surgeon can employ a number of techniques to improve the appearance of cauliflower ear, such as making small, concealed incisions; excising (or cutting out) the fibrous tissue; and resculpturing, recontouring and/or shaving the remaining cartilage.

How to Prevent Cauliflower Ear

As the saying goes, an ounce of prevention is worth a pound of cure. All the available literature stresses the importance of taking measures to prevent injuries that can lead to cauliflower ear.

If you participate in any type of contact sport where injuries to the ear are common, you should always wear properly-fitted protective headgear. Invest in adequate protective equipment while participating in activities that may put you at risk for ear injuries.

If you do experience an ear injury, early intervention is the next best strategy to prevent the development of cauliflower ear.

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