Cauliflower ear on both sides. This can happen to people who have repeated trauma to their ears and do not have the hematomas drained properly. CamachoMD
Cauliflower ear on both sides. This can happen to people who have repeated trauma to their ears and do not have the hematomas drained properly.

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Summary for cauliflower ears:

Ear trauma can cause bleeding, a collection of blood and sometimes even a cauliflower ear.

A cauliflower ear can occur when there is trauma to the outer ear.

Typically, the trauma to the ear can cause a collection of blood under the skin, in one of three locations: 1) immediately under the skin, 2) under the skin and perichondrium, or 3) inside the ear cartilage itself.

Hematoma of the ear from trauma. ChicoMD.com
Hematoma of the ear from trauma.

If the auricular hematoma is not properly drained, or there is a repeated injury to the ear, then a cauliflower ear can start to form.

People who get cauliflower ear tend to be wrestlers, rugby players, mixed martial artists and those who play contact sports.

Prevention includes wearing the proper headgear that covers the ears, getting the proper medical care when there is a hematoma of the ear, and following the guidance given by the healthcare provider once a hematoma is drained.

Background for cauliflower ears:

What is a cauliflower ear?

A cauliflower ear is when the outer ear becomes firm and is thickened to the point that it no longer has the normal landmarks or the appearance of a normal ear.

Cauliflower ears tend to stick out, and they also tend to hang down to a level below their normal position (before the trauma).

The technical name for cauliflower ear is hyperchondroplasia auris traumatica – which roughly translates to a thickening of the cartilage of the outer ear that is due to trauma.[1]

Cauliflower ear side view. Note the loss of normal ear landmarks along with a narrowing of the external auditory canal. ChicoMD.com
Cauliflower ear side view. Note the loss of normal ear landmarks along with a narrowing of the external auditory canal.

What is the anatomy and physiology for cauliflower ears?

The typical history for cauliflower ears is that there is an acute trauma to the ear that causes a collection of blood under the skin, in one of three locations:

  • immediately under the skin;
  • under the skin and perichondrium; or
  • inside the ear cartilage itself.

Then, over time the ear remodels and as part of the remodeling, new cartilage and even bone start to form inside the outer ear.

A study on rabbits[2] found that ear changes can occur if the hematoma is not drained and they include:

  • by two weeks: the central part of the hematoma is starting to be absorbed within the cartilage vs between the cartilage and perichondrium/skin[2];
  • by three weeks: fibrous tissue starts to replace the hematoma[2];
  • by eight weeks: cartilage replaces the fibrous tissue[2]; and
  • by fourteen weeks: new bone formation can occur as cartilage producing cells change to bone producing cells.[2]

Another rabbit study found that changes leading to a cauliflower ear occurred when there was a collection of blood between the perichondrium and the cartilage, but not when there was a collection of blood between the skin and perichondrium.[3]

So, in order to help prevent cauliflower ears, it is important that medical care is sought out.

Once a patient has cauliflower ears, how are they treated?

Observation

If you do nothing, and the cauliflower ear is mature and is no longer growing, then it may stabilize at the current size.

If the cartilage and bone inside the cauliflower ear are causing a cosmetic problem that is bothersome, or there is a narrowing of the opening to the ear canal, then consider seeing a healthcare provider.

Typically, an ear, nose and throat surgeon or a plastic surgeon can help treat the cauliflower ear.

Cauliflower ear front view. Note the loss of normal ear landmarks. The ear is also protruding forward more than normal. ChicoMD.com
Cauliflower ear front view. Note the loss of normal ear landmarks. The ear is also protruding forward more than normal.

What are the surgical options for treating a cauliflower ear?

Surgery for cauliflower ear includes removal of the hardened segment of the cartilage and then re-sculpture a portion of the cartilage that is kept in the proper position.[4]

Another study describes using part of the excess cartilage to create a new outer rim when the outer rim is absent.[5]

Surgery may improve the appearance, but depending on the size and extent of the deformity, the ear might still look abnormally-shaped after healing from surgery.

What are the risks of cauliflower ear surgery?

The risks of any surgery include the risks of anesthesia, plus the risks of surgery to include (but not limited to):

  • bleeding;
  • infection;
  • failure to improve the cosmetic appearance;
  • risk of recurrence of the cauliflower ear; and
  • chronic ear pain.

What is the classification system used for cauliflower ears?

Dr. Yotsuyanagi and colleagues[6] have developed a classification system for cauliflower ears as follows:

Type I: deformity with no change or only a slight change to the outline of the ear[6];

  • Type IA: concha only[6];
  • Type IB: from antihelix to the helix[6];
  • Type IC: cartilage defect extends throughout the ear[6]; and
  • Type ID: cartilage defect with deformity of the skin[6];

Type II: cartilage defect with a substantial change in the outline of the ear[6]; and

  • Type IIA: with good structural integrity[6]; and
  • Type IIB: II with poor structural integrity[6].

Government Disclaimer: The views expressed in this website are those of the author(s) and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.

References:

1.            Unger, M., Hyperchondroplasia auris traumatica (cauliflower ear). Eye Ear Nose Throat Mon, 1947. 26(9): p. 482-5.

2.            Pandya, N.J., Experimental production of “cauliflower ear” in rabbits. Plast Reconstr Surg, 1973. 52(5): p. 534-7.

3.            Ohlsen, L., T. Skoog, and S.A. Sohn, The pathogenesis of cauliflower ear. An experimental study in rabbits. Scand J Plast Reconstr Surg, 1975. 9(1): p. 34-9.

4.            Vogelin, E., et al., Surgical correction of the cauliflower ear. Br J Plast Surg, 1998. 51(5): p. 359-62.

5.            Schonauer, F., et al., Redefinition of the helical rim in cauliflower-ear surgery. Br J Plast Surg, 2002. 55(1): p. 66-8.

6.            Yotsuyanagi, T., et al., Surgical correction of cauliflower ear. Br J Plast Surg, 2002. 55(5): p. 380-6.