Cauliflower ear is a result of trauma to the ear and is most common in individuals who box, wrestle, practice martial arts or play contact sports like rugby union. This is what is known as an acquired injury, as it is not a congenital condition, and is due to a sustained injury. Cauliflower ear forms when the ear is struck and the underlying blood vessels are torn or ruptured. As the ear heals, the blood can pool in the ear and this will start to swell as the blood supply is cut off.
As a result, the cartilage of the ear can become deformed due to it folding in on itself. Additionally, since the blood supply is compromised, there is potential for infection and tissue death that also further the deformation of the ear. As a result of the tissue death, potential infection and loss of blood supply to certain parts of the ear, scar tissue or fibrosis can develop, leading to the appearance of cauliflower, hence the name cauliflower ear.
In addition to the more common cause of cauliflower ear, other events and conditions can lead to cauliflower ear. A condition called auricular perichondritis can also lead to the development of cauliflower ear. Piercing of the cartilage of the upper ear, ear surgery or any other type of piercing trauma can cause this infection. Additionally, a medical condition known as relapsing polychondritis, which is a disorder of the cartilage, can also lead to cauliflower ear.
While cauliflower ear is the culmination of sequelae of events, there are a few symptoms to look out for after trauma to the ear. One indicator of perichondrial hematoma is swelling in the ear. Swelling in the pinna, or exterior of the ear can indicate the presence of a hematoma as the pooling of blood would distort the skin around the ear. In addition, after a strike or other trauma to the ear, bruising may occur, indicating potential damage to the deeper blood vessels that could lead to a perichondrial hematoma. Additionally, paying close attention to any change in the shape of the ear is important as this could indicate the future development of cauliflower ear.
In addition to the aforementioned symptoms, more severe ones may present as well. Facial swelling and severe bleeding may also occur. If more severe symptoms are present, immediate medical attention is essential to prevent severe complications.
In the case of infections, redness and discharge can also be indicative of conditions that lead to cauliflower ear. It is important to immediately identify potential symptoms of infection after piercing or piercing damage to the cartilage of the upper ear to help prevent the development of infectious causative factors of cauliflower ear.
If cauliflower ear goes untreated, there are a number of complications that can occur. Issues such as tinnitus, or ringing in the ear may occur as well as a headache and blurred vision. Hearing loss may also occur and could be permanent if left an attended for an extended period of time. In addition, permanent ear deformity may happen if cauliflower ear is not drained and treated in a timely manner.
Acute treatment is important to prevent potential permanent sequelae from the auricular hematoma. Applying ice or a cold compress immediately will help with swelling and inflammation. In addition, antibiotics may be used in the case of auricular perichondritis and as a prophylactic measure against infection even in the absence of an already developed infection. Most prominently, drainage is the main method of treatment and may be undertaken in a number of ways.
There are a few ways in which cauliflower ear may be drained. With the most common method as of late, the physician will sterilize the injured area with iodine or similar agent and then administer a local anesthetic, which will most likely be lidocaine. Then, an incision will be made at the injury site and the skin will be separated from the cartilage so that suction can be applied to thoroughly remove the blood. Prior to closure, the area will be cleaned with a saline solution. After this, a compressive dressing is applied to both sides of the ear to help drain the blood from the hematoma and prevent deformity of the cartilage.
In some cases, there may be a small drain left in the incision to allow further drainage after the patient is discharged. Given that there would still be an open wound after this, prophylactic antibiotics are given to prevent infection.
Another method that is used, albeit not as often, is to perform a needle aspiration. While needle aspiration is effective in draining the hematoma, there is an opportunity for the blood to reaccumulate in the future as the aspiration may not be as effective as making an incision to drain from the area of injury. With a needle aspiration, the area is sterilized and a local anesthetic may be applied as with the incisional method and an 18 or 20-gauge needle is used to puncture the fullest area of the hematoma, and the blood is drawn out. Compression dressing is also applied in this method as well. In both procedures, compression dressings are necessary as the pressure will help prevent blood from reaccumulating in the injured area.
In some cases, both methods may be undertaken. This may occur if there is a particularly large auricular hematoma and presence of blood in the injured area.
Prevention of cauliflower ear can range from taking measures prior to trauma to decrease the chances of sustaining an auricular hematoma to being proactive after trauma occurs to prevent the sequelae leading to cauliflower ear.
When engaging in contact sports or any other form of activity where trauma to the ear is common, wearing protective headgear is essential in mitigating the damage that can impact the ear. If damage to the ear is sustained, taking note of any bruising, swelling, redness or punctures and getting immediate medical attention is important in helping prevent and auricular hematoma.
When getting a piercing in the upper cartilage of the ear, ensure that the person performing it is experienced and takes all hygienic measures to drastically reduce the risk of developing an infection such as auricular perichondritis, which can lead to cauliflower ear.
While the complications of cauliflower ear can be severe and limiting, with successful drainage and treatment, the risk of developing complications can be greatly reduced.