Cauliflower Ear: Prevention and Treatment

Ear Deformity Due To Trauma

MMA Fighter Rafael dos Anjos
MMA Fighter Rafael dos Anjos. Ronald Martinez/Getty Images

If you follow sports such as boxing or mixed martial arts (MMA), you've probably seen cauliflower ear on professional fighters whose ears appear lumpy and deformed. This condition is a result of repeated injury to the ear and while it is common in combat sports it can occur any time a person suffers significant trauma to the ear.

What Causes Cauliflower Ear?

Trauma to the outer ear, which is common in contact sports, can cause damage to cartilage and blood vessels.

This damage are can result in a hematoma (called an auricular hematoma, or subperichondrial hematoma), which is a collection of blood underneath the skin. For reasons that are not exactly clear the presence of a hematoma can actually stimulate new cartilage to grow. This new cartilage is typically asymmetrical and appears lumpy or deformed.

Another condition, called perichondritis, may also result in ear deformity. Perichondritis also occurs from injury to the ear and is common among athletes. The injury leads to an infection of the outer ear and in some cases deformity of the cartilage can occur. Perichondritis can be caused by an infection caused from ear piercings. If the infection causes perichondritis, your pierced ear can actually cause cauliflower ear.

Symptoms of Cauliflower Ear

Initial symptoms occur right after the ear is injured and include:

  • redness
  • swelling of the ear
  • bruising
  • ear pain
  • bleeding

If the area becomes infected the following symptoms may occur within days:

  • increased redness and pain
  • fever
  • drainage of pus or foul smelling liquid

If left untreated, eventual deformation of the ear cartilage will occur resulting in cauliflower ears.

Can Cauliflower Ear Be Prevented?

Preventing the injury in the first place is the first step in preventing cauliflower ear.

Wearing appropriate head gear while participating in combat sports or any sport in which an injury to this area may occur will decrease your risk of developing cauliflower ear.

Even if an injury does occur cauliflower ear may be prevented by seeking appropriate medical care immediately. However, many professional fighters or other athletes fail to take these opportunities. There is speculation that fighters do not seek adequate treatment to prevent cauliflower ear because they view the deformity as a so called badge of honor. However, many athletes may simply not realize the seriousness of the injury or do not know that cauliflower can be prevented with adequate treatment.

If you suffer trauma to the outer portion of your ear it is important to see a doctor as soon as possible. Once an auricular hematoma occurs, draining of the hematoma and proper measures to prevent it from returning can prevent the development of cauliflower ear.

Treatment of Cauliflower Ear

Early treatment of the initial injury will decrease your chance of developing cauliflower ear.

Even if you do not think that the injury is serious it should be evaluated by a doctor as soon as possible. If there is a hematoma present the doctor will most likely drain the hematoma in order to restore proper blood flow. This in and of itself may not be enough, however, since there is a high incidence of the hematoma reforming. To prevent the hematoma from coming back special stitches may be used or your doctor may choose to use a special bandage called a pressure dressing. Some doctors will initiate antibiotics to prevent perichondritis. Your physician will most likely want to monitor the injury closely in case the hematoma returns.

You should never try to drain an aural hematoma yourself due to the risk of infection and the likelihood that the hematoma will return.

If perichondritis occurs, it can usually be cured with oral antibiotics. In severe cases intravenous antibiotics may be necessary or even surgery to drain pockets of pus and infectious debris from the wound.

If cauliflower ear does occur, sometimes ear deformities can be repaired or improved with cosmetic surgery. Professional athletes may wish to wait until they have retired from sports before undergoing this procedure, however, since their is a high incidence of recurrence, especially among professional fighters. While there are different surgical methods for repairing cauliflower ear most involve removing the deformed part of the ear and using skin grafts to repair the shape and appearance of the ear. Another method involves trying to simply reduce the size of the deformity, smooth it out and then stretch the skin back over the ear. This procedure can be costly and may not qualify for insurance coverage since it is cosmetic. The surgery is usually performed under anesthesia but may be done as an outpatient surgery (also called same day surgery).


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Hanif, J, Frosh, A, Marnane, C, Ghufoor, K, Rivron & Sandhu, G. (2001). “High” ear piercing and the rising incidence of perichondritis of the pinna. BMJ. 322(7291): 906–907.

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Yotsuyanagi, Yamashita, K., Urushidate, S., Yokoi, K., Sawada, Y., & Miyazaki, S. (2002). Surgical correction of cauliflower ear. Br J Plast Surg. 55(5):380-6.

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