Perichondrial hematoma or “cauliflower ear” occurs when trauma affecting the ear does not heal properly. This causes the ear to change shape, becoming bumpy and disfigured, eventually resembling a cauliflower head. Because the condition primarily affects people participating in wrestling and similar sports, it is sometimes referred to as “wrestler’s ear.”
Direct trauma to the ear, such as from a punch or excessive pressure from a headlock, creates a hematoma, the collection of blood outside the blood vessels. Without treatment, the hematoma heals improperly and cauliflower ear develops. Occasionally, infections from ear piercings can cause cauliflower ear, as well. Relapsing polychondritis, a rare rheumatologic disorder in which inflammation destroys cartilage in the ears and nose, may also be responsible.
How Cauliflower Ear Develops
The skin on the outer ear adheres tightly to the perichondrium, a dense layer of tissue that supplies the area with blood. Because there is virtually no subcutaneous fat to protect the ear from trauma, the perichondrium is relatively susceptible to damage. Blood accumulates between the perichondrium and ear cartilage, forming an auricular hematoma. This blocks blood flow to the cartilage, causing unusual fibrosis and cartilage formation that eventually leads to cauliflower ear.
Both cauliflower ear and the hematomas that cause it are potentially dangerous. Infections of the cartilage and the surrounding tissue — chondritis and perichondritis — are the most common complications. Necrosis of the cartilage and the surrounding tissue is also possible. Cauliflower ear can also involve a loss of structural integrity in the ear. Some experts believe cauliflower ear can lead to hearing loss.
Understanding the warning signs of cauliflower ear allow a person to seek treatment before their ear changes shape. Pain, redness, bruising, and swelling are some of the earliest signs of a hematoma. Some people report headaches, vision issues, and facial swelling before developing the condition.
Participating in activities like combat sports or martial arts dramatically increases the chance of developing cauliflower ear. This also applies to activities where a person may spend a significant amount of time with their head against the ground, such as wrestling. Full-contact sports like rugby also tend to have a high risk of cauliflower ear.
Diagnosing cauliflower ear is a straightforward process in most cases. A doctor typically begins by asking about events leading up to the injury. They will physically examine the area to test for tenderness, bruising, and changes in shape. In most cases, a doctor does not need to use medical imaging. However, imaging may be necessary to rule out other issues if the ear has not yet developed the recognizable cauliflower shape.
Classification of Cauliflower Ear
To make sure a person receives the best treatment possible for cauliflower ear, some doctors have begun using a classification system. They first determine how much the ear has changed shape and then examining the extent of the damage.Type 1: Minimal shape changes, no or slight changes to the ear’s outline
- Type 1A: Shape change in the concha
- Type 1B: Shape change from the helix to the antihelix
- Type 1C: Shape changes throughout the outer ear
Type 2: Substantial shape changes of the ear’s outline
- Type 2A: Structural integrity of the ear is intact
- Type 2B: Loss of ear structural integrity
Treatments for cauliflower ear can vary depending on the extent of the damage and where the changes occur. Drainage of a hematoma can prevent these visible issues. After drainage, pressure on the ear may help the skin and cartilage reconnect. Cosmetic procedures can return the shape of the ear if prevention isn’t possible. Because infections often develop alongside cauliflower ear, doctors usually prescribe antibiotics in addition to other treatments.
Protective equipment like headgear, ear guards, and scrum caps can help prevent trauma that causes cauliflower ear. Equipment that is too small or tight may contribute to cauliflower ear, however, so athletes should wear only appropriately-sized pieces. Special ear splints protect against the condition by placing pressure on the ears to keep them from filling with blood. Medications like blood thinners can also increase the risk of conditions like cauliflower ear.
Medical recognition of cauliflower ear dates back hundreds of years. Records, statues, and artwork of Ancient Greek athletes often depict the condition. It was also a widespread issue in 19th-century opium dens in China. Opium users would often sleep on hard wooden boards or rough earth for long periods, leading to ear trauma and cauliflower ear.