Treatment and Prevention of Cauliflower Ear

Cauliflower ear is a condition that affects fighters in boxing and other combat sports, wrestling, and rugby. While it’s not a life-threatening condition, cauliflower ear can be very painful and cause deformities in the ear that impact physical and mental health.

So, what is cauliflower ear, and how can it be prevented? Get the run-down on cauliflower ear here.

What is Cauliflower Ear?

Cauliflower ear is the common name given to a type of hematoma that occurs in the cartilage of the ear. The medical name for cauliflower ear is a perichondrial hematoma. When a forceful impact is made with the ear, blood rushing to the area causes a perichondrial hematoma, similar to how a black eye is formed.

What Causes Cauliflower Ear?

The ear is made up of cartilage, skin, muscle, and perichondrium. Blood is supplied to the cartilage via the perichondrium, a type of tough tissue covering cartilage in the body. When damage occurs, the perichondrium separates from the cartilage underneath, with blood rushing into the void.

When blood rushes into this space and does not drain, it can cause necrosis of the existing cartilage in the area. This leads to a new layer of cartilage being formed, which contracts and scars, ultimately leading to the deformed shape seen in the case of cauliflower ear.

How do you Get Cauliflower Ear?

A perichondrial haematoma is caused in a similar way to other haematomas; blood rushes into the space from broken capillaries caused by an impact. However, while other haematomas like black eyes drain and heal, the physiology of the ear means cauliflower ear causes a hematoma that can’t drain away.

Because of this, close contact sports and combat sports are primary sports offenders that cause cauliflower ear. Here are some sports in which haematomas are more common:

• Boxing and martial arts
• Wrestling
• Rugby

But playing sports isn’t the only way people get perichondrial haematomas.

How Does Cauliflower Ear Happen Outside of Sports?

• Physical altercations in which you receive a blow to the ear
• Accidents such as road traffic accidents
• Piercings to the ear cartilage that become infected

How do Rugby Players Get Cauliflower Ears?

Cauliflower ear rugby injuries might not be the first thing people think of when it comes to perichondrial haematomas, but this is one of the most common sports in which they occur. Scrums and rucks can easily result in blunt trauma to the ear, as can tackling on the field.

With cauliflower ear such a commonplace injury for certain sports, many people wonder does cauliflower ear go away on its own or can cauliflower ear be fixed easily? For people wondering how long cauliflower ear lasts, the effects are permanent until you have it treated by a professional. Cauliflower ear won’t go away on its own, but it is easy to treat.

Cauliflower Ear Prevention

Cauliflower ear can only be resolved by a healthcare professional, and even after surgery, you could risk having permanent scarring or a change in the natural shape of your ear. Cauliflower ear can also return, so you should keep an eye on it even if it’s been treated.

Because of this, and as with most sports injuries, the best way to deal with cauliflower ear is through prevention. So, how do you prevent cauliflower ear?

Headgear to Prevent Cauliflower Ear

Do scrum caps and headgear prevent cauliflower ear? Wearing well-made, properly fitted headgear is the number one way to protect yourself from developing cauliflower ear (aside from altogether avoiding the sport). The protective structure of a head cap or head guard absorbs the direct impact of a blow, protecting the delicate cartilage in the ears.

When buying a head guard, factors include the level of coverage and fitting adjustability. The best headgear to prevent cauliflower ear should be well-fitting so it doesn’t slip out of place during activity. It should feature an adjustable velcro strap and lacing to fit it closely to the shape of your head.

A study published in the British Medical Journal on a comparison of branded rugby head guards on their effectiveness in reducing the impact on the head found that Canterbury Ventilator was the most effective head guard, decreasing the force of impact by 47%. The XBlades Elite was another effective head guard, with an impact force reduction of 27%.

Read more about headgear in our article about boxing safety equipment.

How to Prevent Cauliflower Ear Without Headgear

Can you prevent cauliflower ear without a head guard? It’s possible, but this is usually less effective. However, if you don’t want to wear a head guard or can’t for some reason, there are some things you can do.

For cauliflower ear prevention, rugby and combat sports players need to monitor how their ears feel during a game or a fight and what happens to them.

If you need to know how to prevent cauliflower ear after injury, time is critical as you’ll want to prevent as much blood rushing to the area as possible. If your ears start to hurt or you’re aware of a hard blow to that area, stop and apply an ice pack to the site. Ice the area for 15-minute intervals and use an icebag wrapped in a cloth.

Rest your ear and refrain from the activity for a couple of days. This may help you see off a perichondrial haematoma as the blood vessels flooding the area with blood are constricted and prevented from bleeding into the space.

What is Cauliflower Ear Treatment?

1. What to do With Cauliflower Ear Immediately After Injury

Applying ice after a blow to your ear is vital to reduce blood flow into the area. This will help you reduce the pain you feel and decrease the size of the haematoma that develops. Ice the area for 15 minutes at a time, and do not apply an icebag directly to the skin.

Use an instant ice pack if you’re on the field, in the ring, or just don’t have access to a freezer.

2. How to Treat Cauliflower Ear: Drainage

Arrange an appointment with your doctor as soon as you can. Your doctor will most likely advise you to have the area drained. This can happen in two ways:

1. By incision: making a small cut in the affected area with a scalpel and draining the fluid out. The cut will be minimal and likely won’t need to be stitched.
2. By aspiration: inserting a needle into the area and drawing the blood out with a syringe.

What to do After Draining Cauliflower Ear

After drainage, your doctor will apply a compression dressing to ensure no more blood flows into the space and that your ear heals in a natural shape. They may also prescribe you antibiotics to fight infection. Ask your doctor when you can return to the activities you were doing that caused the injury and follow their guidance.

3. Can you Treat Cauliflower Ear with Surgery?

A cauliflower ear left untreated can get worse and more challenging to resolve. The cartilage that dies (becomes necrotic) in the area will thicken, and it’ll be difficult to drain the site, so you may need cauliflower ear surgery; this is called otoplasty.

In cauliflower ear surgery, your doctor makes a small incision behind your ear to expose the cartilage and removes some of it or uses stitches to reshape it. You may be given a general or local anaesthetic for this.

Cauliflower ear is one of a host of common injuries seen in rugby. Read our article How to Treat Common Rugby Injuries to find out more.

Sports First Aid Kits

While cauliflower ear needs treatment by a trained professional, many injuries occur on the field or in the ring that can and need to be tended to immediately by the appointed first aider. Make sure you’re always ready to treat an injury with a sports first aid kit. Sterosport Sports First Aid Kits are:

• Designed in partnership with sports teams and leagues
• Made on the recommendations of sports injury therapists
• Made to meet sports national governing body requirements
• Come with a free refill of pitchside essentials

For trained sports physios, we also offer pitchside sports medical kits and junior sports team first aid kits for trained sports physios and for minors.

Take a look at our articles for more information on boxing and rugby first aid kit requirements and what training you need to complete to keep your team safe.

• Rugby First Aid Kits: Complete Guidance for Rugby Union and Rugby League
• The Definitive Rugby First Aid Kit Contents List
• Rugby First Aid Courses: Everything You Need to Know
• Recommended First Aid Courses for Sport
• 8 Essential Safety Tips for Boxing
• Boxing First Aid Kit Contents List
• Essential Boxing Safety Equipment

Rugby national governing bodies in the UK, England Rugby and Rugby Football League, have released their latest mandatory medical equipment lists. These determine what is required of all elite teams when training and playing on the pitch. Read our article Rugby Union and Rugby League Mandatory Medical Equipment 2023 Update and What to Buy to find out what you need.

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