Treatments: Auricular Hematoma (Cauliflower Ear)

This page describes how an auricular hematoma is drained and treated to prevent a lasting cauliflower ear deformity.

An auricular hematoma is most common after blunt or shearing injury to the outer ear, such as a blow in wrestling, boxing, rugby or mixed martial arts. This page covers how it is treated and what patients can generally expect. The condition itself is described on the auricular hematoma conditions page.

Why Treatment and Timing Matter

The cartilage that gives the ear its shape has no blood vessels of its own. It is fed by the thin layer of tissue wrapped around it (the perichondrium). When blood collects between this layer and the cartilage, it lifts the covering away and cuts off the cartilage's nutrient supply.

If the blood is not removed, two problems can follow:

• The cartilage can be damaged and the body can lay down new, disorganized scar-cartilage. This produces the permanent lumpy, thickened "cauliflower ear" deformity.

• The ear can become infected (a condition called perichondritis), which in severe cases leads to further tissue loss.

For these reasons, a soft, fluid-filled hematoma is generally drained, and the sooner the better. Treatment is typically offered when the hematoma is found within about 7 days of the injury. Leaving it untreated carries a real risk of lasting deformity.

Numbing the Ear First

Before the ear is drained, the area is numbed with a local anesthetic injection around the ear (an "auricular block"), so the procedure itself is generally not painful.

Removing the Blood (Drainage)

There are two main ways to remove the collected blood:

• Needle aspiration: a needle is used to draw out the blood. It is quick and simple, but the blood is more likely to come back, especially with larger or older collections.

• Incision and drainage: a small cut is made to let the blood out, the space is cleaned out thoroughly and any clot is removed. This is generally more reliable, particularly for larger hematomas, clots that have begun to solidify or collections that have already come back after aspiration.

The choice depends on the size and firmness of the hematoma and how long it has been present. What to expect after an evacuation is described on the hematoma evacuation recovery page.

Keeping the Blood From Coming Back (Compression)

Removing the blood leaves an empty space that tends to refill. The most important part of treatment is pressing the ear covering back down against the cartilage so this space closes. This is done in one of a few ways:

• A bolster dressing: small molded pads or rolls are placed on both sides of the ear and held firmly in place, often with stitches, to apply steady pressure.

• Quilting (through-and-through) sutures: stitches are passed through the ear to hold the layers together and close the space. Some recent data suggest this technique may have a lower rate of the blood returning than bolster dressings alone, though high-quality head-to-head studies are still limited.

Whichever method is used, the compression stays in place for several days while the ear heals.

Antibiotics

Because of the risk of infection in injured cartilage, a course of antibiotics (commonly 7 to 10 days) is often prescribed after drainage. The antibiotic is chosen to cover the bacteria most likely to infect ear cartilage.

Follow-Up and Aftercare

• A re-check is typically arranged soon after the procedure, often within 24 to 48 hours, to make sure the blood has not reaccumulated.

• The dressing is kept dry and left in place as instructed until it is removed at a follow-up visit.

• Contact sports are generally avoided for at least about 2 weeks to let the ear heal and to prevent re-injury.

• Increasing pain, swelling, redness, warmth, pus or fever are reasons for an earlier visit, as these can be signs of infection.

If the Blood Comes Back

Reaccumulation is the most common problem after treatment. If it happens, the ear is drained again and re-dressed. Repeated or stubborn collections may be managed with incision and drainage rather than another simple needle draining.

If a Cauliflower Ear Has Already Formed

Once the firm, scarred deformity of a true cauliflower ear has set in, draining alone will not correct it. Correcting an established deformity requires a surgical procedure to remove the overgrown scar-cartilage and reshape the ear, described on the ear shape correction (otoplasty) page.

Prevention

For those who take part in wrestling, grappling or similar sports, well-fitted protective headgear lowers the chance of these injuries. Prompt evaluation of any new ear swelling after a blow is the single best way to avoid a permanent deformity.