- What is Cauliflower ear?
- How is Cauliflower ear formed?
- What Causes Cauliflower Ear?
- Close contact sports
- Ear piercing
- Other Causes
- Cauliflower Ear in animals:
- Symptoms of Cauliflower Ear
- How to prevent cauliflower ear:
- Safety precautions:
- Early treatment of hematoma:
- Treatment goal
- Needle Aspiration:
- Treatment of Cauliflower Ear
- Complication of Cauliflower Ear
What is Cauliflower ear?
It’s not uncommon to see someone in our daily life with a funny looking ear which is lumpy, shriveled, appears as if the ear has folded on itself and reminds you of a cauliflower.
This swollen deformity of ear is called Cauliflower ear. It usually results due to blunt injury to the ear, side of the face or head and occurs as a complication of unresolved blood clot (hematoma) which is known as Hematoma auris/ perichondrial hematoma /traumatic auricular hematoma. [1, 2]
How is Cauliflower ear formed?
Ear is made up of cartilage which gives the firm shape to it and is covered by a layer of tissue called perichondrium. Cartilage does not have blood supply and it receives oxygen and nutrients from blood vessels supplying the overlying skin and the perichondrium. When there is a blow to the external ear, the blood from the blood vessels of skin and perichondrium leaks inside and forms a blood clot between the cartilage and perichondrium.
Thus the cartilage does not get the nutrients and begin to die and the skin overlying the dead cartilage turns into a scar. This scarring and collapse of the cartilage causes the shriveled bumpy look of the cauliflower ear.
Thus any accumulation of blood or fluid and any other causes that separate the cartilage and perichondrium leading to the death of the cartilage will cause cauliflower ear. Not all injuries to ear cause cauliflower ear. When the clot is small, it may get resolved spontaneously. [2, 3]
Picture1: Ear cartilage
Image Source: pinna.hawkelibrary.com
What Causes Cauliflower Ear?
Close contact sports
Cauliflower ear is more common among people taking part in contact sports like wrestling , boxing, rugby, soccer, mixed martial arts etc. in which there are more chances of taking a blow to the head. This funny looking deformity is considered as a badge of honor by these sportsmen.
It is so prevalent among wrestlers and boxers that some of the great muscle men like Randy couture – athlete, actor and 5 times UFC title winner, have taken their Cauliflower ear as one of the identity mark. Hence it is rightly named as Wrestlers ear or Boxers ear. [4, 5]
Picture 2: Randy Couture – Cauliflower ear
Image source: imawrestler.com
In recent days, ear piercing has become a cult thing. When ear piercing is done in the upper ear without proper aseptic precaution and using unsterilized instruments, it leads to infection of the cartilage. This infection causes fluid collection between the cartilage and skin that causes death of the cartilage and thus leads to formation of the cauliflower ear. 
Picture 3: Fluid collections due to ear infection caused by ear piercing
- Relapsing perichondritis
Cauliflower Ear in animals:
Cauliflower ear can develop in any animal. It is most commonly seen in pets like dogs and cats , especially dogs like Setters, Basset Hounds with long and sloppy ears which happens to lodge infectious mites and parasites. It causes pain and the animal shakes its head frequently and paws its ear. It can be prevented by maintaining good ear hygiene of the pets by blow drying the ear and moisturizing with mineral oil. 
Picture 4: Cauliflower ear in dog
Image source: http://www.mnmidwestpugrescue.com/Resources/Pictures/Bad_Ear.jpg
Symptoms of Cauliflower Ear
- Swelling of ear
- Loss of curvature and concavity of the ear
When there is a severe blow to the ear, it may be associated with
- Hearing loss
- Ringing sound in the ear (tinnitus)
- Blurring of vision.
After 7 – 10 days, if the blood clot does not resolves, the deformity progresses to permanent cauliflower ear. It has unsightly look and cause discomfort when lying on the affected side. [3, 4, 8]
How to prevent cauliflower ear:
It’s safer to avoid dangerous sports or getting into a fight. If you are so much fascinated by the contact sports, follow the rules properly. Use protective headgear and helmets at all the times and make sure it is a perfect fit because tight headgears themselves can damage the blood supply to ear and the loose headgears don’t serve their purpose well 
Early treatment of hematoma:
Even if you have got your ear injured, no need to worry. Cauliflower ear can be prevented even after a blunt trauma if the blood clot or the fluid is removed sooner. The methods used for early treatment of hematoma are
- Needle Aspiration
- Incision and drainage
The idea behind all these techniques is to remove the blood clot or fluid that has built up between the cartilage and perichondrium. Then both of them are opposed against each other tightly like a sandwich to restore the nutrient supply to the cartilage and to prevent the repeated collection of fluid between them. 
Aspiration is done for the prompt evacuation of the fluid or clot and is necessary to prevent permanent damage.
Aspiration should be tried only if the injury is less than 7 days old because the granulation tissue will be formed after 7 days in the process of healing. This makes needle aspiration highly unsuccessful. Nowadays, needle aspiration has been replaced by incision and drainage due to the high chance of repeated accumulation of fluid in aspiration which requires more than one session of needle aspiration. [1, 7, 8]
Incision and drainage
Picture 5: Incision
Image Source: drmkotb.com
Picture 6: Drainage
Image Source: medscape.com
Picture 7: compression packing
Image Source: medscape.com
Picture 8: silicone ear splint
After incision and drainage, check it every 24 hours for the next few days for fluid collection, bleeding or infection. When either of these two techniques are carried out successfully soon after the injury, cauliflower ear will not develop. But once the deformity sets in, and then it is permanent. 
Treatment of Cauliflower Ear
Symptomatic treatment for the discomfort and pain – Keep ice packs for 15 minutes with 15 minutes break. Don’t keep the ice directly over the skin as this it can cause skin damage. Use a cloth or towel. Pain relievers like NSAIDs can be used. 
As Cauliflower ear is a permanent deformity, Surgery is the only choice to restore the normal shape of ear. The surgery involves removal of the dead cartilage and suturing the skin to original shape. The surgery is done by plastic surgeons and is a bit controversial regarding its outcome and review.
Complication of Cauliflower Ear
When the cauliflower ear gets infected, the infection causes inflammation of the perichondrium – perichondritis. In most severe condition, the infection may extend to middle ear and then to brain. 
So, when you get an injury in your ear, keep an ice pack and get it checked by a doctor immediately.
- D.L.Dhingra 5/e pg 125