The Cauliflower Ear in Wrestling

The cauliflower ear is a classic injury in wrestling and martial arts, which have become more popular of late. It's not just a minor injury. Here we'll tell you about how it can happen.
The Cauliflower Ear in Wrestling

Last update: 20 December, 2020

The technical name for a cauliflower ear is an auricular hematoma. In plain words, you could say that it’s an accumulation of blood in the outer ear due to blunt force trauma. It’s not an injury relating to the inner ear or the ear canal.

This injury is characteristic of martial arts and contact sports, where we could include boxing and wrestling. If you look it up, you can even find representations of the cauliflower ear from antiquity, when artists depicted Greek and Roman pugilists and wrestlers.

What causes a cauliflower ear?

The basic cause of cauliflower ear formation is trauma to the ear. It can even just be one single blow, hard enough to create a hematoma. Or it may be several blows over time to the same spot. A hematoma can form in the part of the ear that has cartilage underneath the skin’s surface.

When the ear suffers a blow, cartilage cells detach from the tissue that contains the area’s blood vessels. The separated cells run out of nutrients and oxygen, causing them to die.

At the injury spot, the ear starts to swell, and blood pools under the skin from the broken blood vessels. The dead cells form fibrous tissue under the skin and appear swollen and deformed, similar to the appearance of a cauliflower.

Different results for each person

Not all wrestlers or athletes develop cauliflower ear in the same way. According to a study published in Otology and Neurotology, genetic factors and training factors can influence the risk of developing the condition.

A boxer getting hit in the face.

With regards to genetics and hereditary factors, these can influence the cartilage’s development, and make it weaker or stronger. Genetics can also increase the probability of diseases that affect these tissues. This is the case with chondromalacia, which is the softening of cartilage tissues. It’s not always serious but can lead to chondritis in some cases, a more serious condition.

Remember that the outer part of your ear is made up of the same type of cells that are in your knees, or the tip of your nose. This cartilage is flexible. However, it’s not exactly the same for everyone.

Along with the cartilage cells, some other substances and fibers bring together the tissues. The most important protein in cartilage is collagen, which can also be affected by genetic disorders.

On the other hand, training methods are also an important factor in understanding why some fighters are predisposed to developing cauliflower ear while others aren’t. Previous injuries, with constant damage to the outer ear cartilage as well as accumulation of small hematomas, make the athlete more susceptible to injury from new traumas.

Treatment for cauliflower ear

Once an auricular hematoma has formed, treatment options revolve around draining off accumulated blood. Of course, this option only applies when the injury is recent, not months afterward. If not, the liquid will harden which impedes suction.

The most common techniques are simple suction, incisions, and fenestration. In the first, the doctor will insert a small needle to drain the accumulated blood into a syringe. The second technique is when the doctor makes an incision so that the blood drains on its own, without the need for suction.

The last option, fenestration, is a little more complex. It’s a minor surgical procedure. The aim is to separate the edges of a bone or cartilage from the rest of the tissue. With a cauliflower ear, the goal is to restore circulation to the damaged part of the ear.

Despite these treatment options, the results aren’t always satisfactory. A deformation can appear anyway, even if a doctor treats the hematoma immediately. On the upside, if treatment is immediate, the risk of complications is minimal. This is especially important to avoid perichondritis, which is inflammation of the tissues connecting to the cartilage.

A man suffering from ear pain.

Can you prevent a cauliflower ear?

Prevention of a cauliflower ear is difficult since the causes are basically an ingrained part of many martial arts and contact sports. Due to the traumas to the ears that are frequent in these sports, it’s almost impossible to stop an injury from happening.

The use of helmets and headgear seems to be the only viable option. Of course, helmets aren’t allowed in certain categories of boxing or wrestling. The very rules of these games impede adequate protection for the participants.

During their training sessions, at least, athletes can take care. It’s also good to educate yourself on this injury if you’re going to be in harm’s way. That way you can recognize the signs and get it looked at in time if it happens to you. Early drainage is preferable to having to have corrective surgery if it becomes chronic or if your ear canal gets obstructed.

It might interest you...
What are the Boxing Categories?
Fit PeopleRead it in Fit People
What are the Boxing Categories?

In boxing matches, boxers fight against opponents who are in the same weight class. By doing this, boxing categories eliminate certain advantages



  • Mudry, Albert, and Wolfgang Pirsig. “Auricular hematoma and cauliflower deformation of the ear: from art to medicine.” Otology & Neurotology 30.1 (2009): 116-120.
  • Giffin, Charles S. “Wrestler’s ear: pathophysiology and treatment.” Annals of plastic surgery 28.2 (1992): 131-139.
  • Greywoode, Jewel D., Edmund A. Pribitkin, and Howard Krein. “Management of auricular hematoma and the cauliflower ear.” Facial Plastic Surgery 26.06 (2010): 451-455.
  • Yotsuyanagi, Takatoshi, et al. “Surgical correction of cauliflower ear.” British journal of plastic surgery 55.5 (2002): 380-386.
  • Hassan, Mahmudul, and Aftab U. Ahmed. “Management of Haematoma Auris by Minimal Access Surgery and Steroid Injection.” Bangladesh Journal of Otorhinolaryngology 23.1 (2017): 83-87.