A cauliflower ear results from an injury to the external ear cartilage. Typically, the cartilage has been fractured (broken) and bleeding has occurred within the tissue covering the cartilage. The blood lifts the lining away from the injured cartilage and creates a pocket of fluid called an auricular hematoma. The word auricular refers to the external ear, and the word hematoma means a mass of clotted blood. Unfortunately, the cartilage in the ear does not have a blood supply of its own and it relies upon the lining tissue, called perichondrium, to provide nourishment. If the hematoma is not immediately drained and the fractured cartilage repositioned, the cartilage may die. Over time, the dead cartilage and the hematoma are reabsorbed by the body and the remainder of the ear shrivels up like a dried prune, losing its original shape.
Most auricular hematomas and cauliflower deformities occur in contact sports that involve hitting, kicking or grabbing the head, such as boxing, wrestling, mixed martial arts, and water polo. Protective headgear is available for all of these sports, but it is not consistently worn during practice and competition. It is not uncommon for coaches and experienced athletes to look upon these injuries as battle scars. Continued pressure from parents and physicians is necessary to mandate the use of protective headgear in our children to reduce the risk of these injuries.