What is Cauliflower Ear?
The deformation of the ear, known as cauliflower ear, can be traced back to Roman and Greek history. Accounts from those periods are filled with descriptions of wrestlers and boxers with ear deformities. Intriguingly, the term “earmark” was coined back then because wrestlers could be recognized by their uniquely shaped ears.
Doctors have been aware of this affliction for a long time. Although there are descriptions of such cases in the writings of ancient Greek physician Hippocrates, formal research into the disease didn’t start until the mid-1800s. At that time, it was thought that a cauliflower ear could be caused by something other than physical trauma. This hypothesis came from observing older people or individuals with mental health conditions.
However, our understanding of cauliflower ear has evolved over the 20th century. We now link this condition to an abnormal and excessive inflammatory response to either a hematoma (blood clot) or an abscess in the ear. Regardless of how it’s caused, many people find cauliflower ear unsightly and inconvenient, especially as it can interfere with wearing earphones. Therefore, preventing and treating cauliflower ear is a key part of the job for emergency health workers and surgical specialists.
The outer ear has several layers crucial for its function and protection. The skin of the outer ear not only covers the ear canal and the auricle (the visible part of the ear), but also contains important structures like hair follicles and glands. These structures defend against environmental factors and help regulate temperature. The outer layer of skin, or epidermis, creates a barrier against germs and keeps water from escaping. Underneath the epidermis, there’s the dermis, which is filled with blood vessels, nerves, and connective tissue. These provide structural support and supply nutrients to the layers above.
The auricle’s main structure is elastic cartilage. This gives the ear its shape and flexibility. Cartilage cells, or chondrocytes, reside in a mix of collagen and elastic fibers. Because cartilage doesn’t contain blood vessels, a layer of fibrous tissue known as the perichondrium wraps around it, offering support, supplying oxygen and nutrients, and aiding in cartilage repair and growth. The perichondrium also anchors the skin above, maintaining the ear’s integrity.
The outer ear’s special anatomic features include the inside layer, which is thin and closely attached to the perichondrium, while the outside layer is thicker and has a muscle layer. The auricle can still be affected by environmental factors and trauma, despite these protective layers. Any disruption to the structure can lead to complications like the cauliflower ear deformity.
What Causes Cauliflower Ear?
Cauliflower ear is a condition that changes the shape of the ear, typically caused by a blood collection (hematoma) in the ear due to a blunt force. It’s often seen in people who undergo a lot of ear trauma, such as wrestlers or boxers, particularly when the blows are tangential or shearing, rather than directly applied.
This hematoma separates the outer skin of the ear, also called the perichondrium, from the cartilage underneath, which cuts off the blood supply to the cartilage. If these hematomas aren’t treated, it can lead to decay of tissue (necrosis), infections, or the cauliflower ear deformity, which is when the ear looks like a cauliflower due to the growth of abnormal cartilage tissue and fibrosis – a sort of scar tissue.
There are also other less common conditions that can cause a cauliflower ear deformity, like relapsing polychondritis, a rare inflammatory condition, leprosy, a chronic infection, and phaeohyphomycosis, which is a type of fungal infection. However, blunt force trauma is the most common cause.
Risk Factors and Frequency for Cauliflower Ear
The exact number of people in the general public who have a condition known as “cauliflower ear” is unknown, as it hasn’t been recorded in any medical writings. However, several studies have looked at how often this condition occurs in different groups of athletes. In general, the more competitive you are in high-risk sports such as wrestling, boxing, martial arts, or rugby, the greater your risk of developing cauliflower ear. Older athletes who continue to compete also have a higher chance of getting cauliflower ear than younger competitors.
- A study found that 96% of Finnish martial artists who were national champions had a form of ear damage known as auricular hematoma, and 84% of men in this group had cauliflower ear.
- Another study from Germany found that 55.5% of high-level judo practitioners had cauliflower ears.
- According to these studies, male athletes are more likely than female athletes to develop this condition and its more severe deformities.
Signs and Symptoms of Cauliflower Ear
People with cauliflower ears usually have a noticeable deformity in the cartilage of the ear. This change can interfere with hearing and cause other difficulties, like wearing glasses or helmets. Some people may even feel discomfort, causing challenges when sleeping on the side with the problematic ear.
In the early stages, the ear might feel soft and sensitive due to the presence of blood or fluid. As time goes by, the affected area becomes harder and more misshapen due to the excessive growth of fibrous cartilage. This area may still feel uncomfortable.
Many mention a history of recurrent trauma to the problematic ear, usually associated with contact sports like wrestling, boxing, rugby, or mixed martial arts. Not everyone remembers having a bruise or hematoma before the deformity. Piercing the cartilage of the ear might also lead to cauliflower ear due to blood accumulation or a subsequent infection. If the fluid collection is not fully drained or if there’s a recurrence, fibrous cartilage might overgrow. If there is no reported trauma or infection, other potential diagnoses should be considered. Particularly, children and older individuals might be vulnerable to non-accidental trauma.
Sometimes, cauliflower ear might look similar to auricular keloids. Keloids also tend to occur at the site of an ear piercing, but unlike cauliflower ear, they may not always be preceded by a hematoma or infection. Keloids are also often found on the earlobe. However, unlike keloids, cauliflower ear involves cartilage deformation.
When examining a cauliflower ear, medical professionals will first visually check for swelling, deformity, and discoloration. Afterwards, they gently touch the affected area to check for tenderness, firmness, and any irregularities in texture. They’ll also look inside the ear canal for any obstructions that might impact hearing or signs of swelling or deformity. Further evaluation via otoscopy may be required to check for the involvement of the eardrum and middle ear.
The skin over a cauliflower ear generally appears normal. However, if there are signs of pigmentation abnormalities, redness, or ulceration, additional tests must be carried out to rule out any tumors. The area might feel firm, and there might not be much tenderness. The lesion itself might obstruct the ear canal and cause hearing issues.
Since cauliflower ears are usually linked to head trauma, health professionals should also rule out other problems related to head trauma such as hearing loss and signs of traumatic brain injury. Further evaluation, such as hearing tests or a computed tomography scan of the head might be necessary if any specific impairments are found.
Testing for Cauliflower Ear
Cauliflower ear can be identified just by looking at it, without the need for any specific tests or imaging procedures. However, if there are signs of brain injury due to repeated head trauma, brain imaging may be necessary. Also, if the skin over the cauliflower ear looks unusual and the patient has a higher risk for skin cancers – due to factors like ongoing sun exposure, a family history of skin cancer, or a weakened immune system – a skin biopsy might be needed.
Treatment Options for Cauliflower Ear
Cauliflower ear can be prevented by wearing protective headgear during contact sports, which can significantly reduce ear injuries leading to this condition. Early detection and prompt treatment of the ear swelling that precedes cauliflower ear are key to prevention. If caught within six hours of the injury, the swelling can typically be drained with a needle. If the injury is not discovered within this timeframe, a small incision may be made near the swelling to help remove it. Alternatively, if it has been approximately a week since the injury, the clot causing the swelling can be reabsorbed and the swelling can be drained with a needle. After the removal of the swelling, pressure should be applied to the treated area for roughly a week and the patient might receive preventive antibiotics. During this time, the naturally occurring tissues in the ear can heal, reattach, and restore proper blood flow. However, without proper pressure application, bleeding may continue and cause further complications. Various methods of applying pressure have been suggested, and one called the bolsterless suture even allows athletes to return to normal activities faster.
If a patient seeks treatment outside of the ideal timeframe for draining the swelling or has stopped participating in the activity that led to cauliflower ear, surgery may be the best option to correct the deformity. The type of surgical treatment depends on the severity and location of the deformity. In mild cases, the altered ear cartilage may be reshaped or removed to restore the normal ear appearance. Access to the affected cartilage can be achieved through various small cuts made close to the swelling and the cartilage can be reshaped using various medical instruments. For severe deformities, techniques typically used for repairing a congenitally small or absent external ear (a condition known as microtia) may be employed. Following surgery, a special dressing and a be worn to prevent additional swelling and help manage potential swelling due to the surgery. Regular check-ups during the first year post-surgery are necessary to keep an eye on any potential complications and to facilitate prompt treatment as needed.
What else can Cauliflower Ear be?
If you have unusual changes to your ear shape, it could be due to several reasons:
- Abscess (a swollen pocket of pus)
- Chondritis (inflammation of the ear’s cartilage)
- Chondrodermatitis (bumps on the ear caused by pressure or sun exposure)
- Chondroma (cartilage growth)
- Chondrosarcoma (a rare type of cancer involving cartilage)
- Dermatofibroma (benign skin growth)
- Ear canal cancer (squamous cell carcinoma)
- Injury to the ear canal
- Exostosis (abnormal bone growth in the ear canal)
- Foreign object stuck in your ear
- Hemangioma (a birthmark that shows up at birth or in the first or second week of life)
- Hematoma (a solid swelling of clotted blood within the tissues)
- Keloid (an overgrowth of scar tissue)
- Osteoma (a new piece of bone growing on another piece of bone)
- Pseudocyst of the auricle (fluid-filled sac on the ear)
- Seroma (collection of serous fluid in a pocket under the skin)
- Skin cancer such as:
- basal cell carcinoma
- squamous cell carcinoma
- non-pigmented melanoma
- Merkel cell carcinoma
- dermatofibrosarcoma (a rare type of cancer that forms in the deep layers of skin)
A detailed medical check-up and diagnostic tests are crucial to distinguish these conditions from “cauliflower ear”, a deformity caused by trauma. Proper diagnosis is key to choosing the right treatment.
What to expect with Cauliflower Ear
Early treatment of a condition called auricular hematoma, which includes draining the fluid and applying pressure, can significantly decrease the chance of developing a “cauliflower ear”, or at least reduce the severity of this deformity. Cauliflower ears that have been present for a long time can result in less satisfying cosmetic results, particularly if the person continues to participate in activities that can cause trauma to the ear.
Prevention is always better. This can be achieved with the use of protective headgear or by quickly draining any hematomas that may develop. If someone continues to take part in activities such as boxing or wrestling, they risk making the cauliflower ear worse. Also, surgical correction can become more difficult if the deformation is severe.
Therefore, it’s best to consider intervening after ceasing activities that cause trauma to the ear. This will help to avoid the need for numerous surgeries.
Possible Complications When Diagnosed with Cauliflower Ear
Most issues with cauliflower ear mostly deal with how it looks, but there could be rare instances where it causes pain or affects your ability to hear properly. After surgery to fix the deformity, it may reoccur because of scar tissue tightening, which is why regular check-ups for up to a year are really important. Immediate recognition and treatment with core drugs and splinting are key.
The following complications may occur:
- Aesthetic issues
- Pain
- Obstruction of the external auditory canal (hearing problems)
- Recurrence of deformity due to scar tissue tightening
- Requirement of regular check-ups post-surgery
- Need for immediate treatment with drugs and splinting
Preventing Cauliflower Ear
In simple terms, to prevent “cauliflower ear”, protective measures should be taken during activities that may cause a high risk of ear injury. This includes wearing helmets or protective headgear with ear protections during contact sports. It’s also crucial to educate athletes about the risks of ear injuries and the importance of using protective equipment consistently. Methods to lessen direct harm to the ear can also help in preventing the formation of blood clot-like structures within the ear.
On the other hand, if an injury has already occurred, early detection and quick management of these blood clots, known medically as “auricular hematoma”, can help in preventing cauliflower ear from developing. Healthcare providers should be well-informed to recognize the signs of hematoma, and patients are advised to seek medical help immediately after an ear injury. Swiftly draining the hematoma is crucial to prevent the formation of hard tissue, with follow-up care involving monitoring for any recurrence and ensuring proper care of the wound.
