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Cauliflower Ear

A cauliflower ear is an acquired deformity of the pinna which most commonly occurs as a result of acute external trauma to the ear due to contact sports.


Presentation

Symptoms depend upon the severity of injury. The anterior part of the ear is more commonly involved as compared to posterior ear. The symptoms include severe swelling along with bluish discoloration of the ear due to bruise formation. Deformity of the pinna is apparent and its normal curvature is distorted. There may be sharp and severe pain in the ear.

In some cases, the patient may complain of tinnitus (ringing in the ear). If the impact is severe enough, there may be associated loss of hearing due to damage to the tympanic membrane or even the ossicular framework of the ear. In some cases, the patients may have headache and blurred vision (due to diplopia). This is due to accompanying injuries to the orbital area.

Relapsing Polychondritis
  • Finally, a diagnosis of relapsing polychondritis with several unusual features was made. Overlap with Takayasu's arteritis and granulomatosis with polyangitis, which has been reported rarely in the literature, cannot be excluded.[ncbi.nlm.nih.gov]
  • An even more rare cause of cauliflower ear is from the inflammation of cartilage in relapsing polychondritis.[medicinenet.com]
  • Relapsing polychondritis This is a rare cause of cauliflower ear in which repeated inflammation and healing of all the cartilaginous tissues in the body, including the auricular cartilage occurs. of cauliflower ear, in which repeated inflammation and[symptoma.com]
  • polychondritis (RP), a rare rheumatologic disorder in which recurrent episodes of inflammation result in destruction of cartilage of the ears and nose.[en.wikipedia.org]
Gangrene
  • We report a young female who presented with saddle-nose and bilateral cauliflower ear deformities along with pyoderma gangrenosum-like ulcers, digital gangrene and pulselessness.[ncbi.nlm.nih.gov]
  • Successful treatment Although the diagnosis remained unclear, doctors were forced to amputate the woman's gangrenous toes and fingers.[dailymail.co.uk]
Localized Pain
  • Prompt medical care should be sought be sportsmen if even the minor trauma to the ear causes localized pain or ringing sensation in the ears.[symptoma.com]
Saddle Nose
  • We report a young female who presented with saddle-nose and bilateral cauliflower ear deformities along with pyoderma gangrenosum-like ulcers, digital gangrene and pulselessness.[ncbi.nlm.nih.gov]
  • She also started to develop 'saddle nose' and cauliflower ear, as well as gangrene on her toes and fingers. Saddle nose is the collapse of its bridge.[dailymail.co.uk]
Regurgitation
  • Subsequently, she was found to have bilateral conductive hearing loss, a corneal opacity, mild aortic regurgitation and radiological evidence of cavitary changes in lungs and aortoarteritis.[ncbi.nlm.nih.gov]
Large Ears
  • Personally I am less than thrilled by the possibility of acquiring a giant lumps on either side of my head because I’ve always had large ears.[grapplearts.com]
Diplopia
  • In some cases, the patients may have headache and blurred vision (due to diplopia). This is due to accompanying injuries to the orbital area.[symptoma.com]
Corneal Opacity
  • Subsequently, she was found to have bilateral conductive hearing loss, a corneal opacity, mild aortic regurgitation and radiological evidence of cavitary changes in lungs and aortoarteritis.[ncbi.nlm.nih.gov]
Confusion
  • Picture of a normal ear, and cauliflower ear Ear Anatomy The anatomy of the ear can be a little confusing, especially since the ear is responsible not only for hearing, but also for balance.[medicinenet.com]
  • This is where Health Care Providers are confused and ignorant of this sport. Compression can be obtained via various means, but each method has its advantages and disadvantages.[thematdoc.com]
Amnesia
  • Should that happen, look out for certain red flags that indicate a more severe underlying issue: Head injuries – loss of consciousness, amnesia before or after event, persistent headache, vomiting.[jiujitsumedic.wordpress.com]

Workup

Clinical presentation is usually enough to confirm a diagnosis. • Otoscopy is done to examine any injury to the internal components of the ear and the ear canal.

Treatment

The treatment of cauliflower ear consists of the following [3][4].

  • Analgesics such as non-steroidal antiinflammatory drugs (NSAIDs) are administered to reduce pain and inflammation.
  • Antibiotics are given to prevent the development of secondary bacterial infections.
  • Incision and drainage of the hematomas that are larger than 2 cm in diameter is required. This is done under local anesthesia and should ideally be done within 24 to 48 hours of the injury.
  • Intravascular catheterization may be performed as an alternative to incisional drainage [5].
  • Needle aspiration (with 18 gauge or larger needle) is done for the small hematomas that are less than 2 cm in diameter.
  • Splinting may also be done to prevent hematoma formation in the future [6].
  • Suturing is essential if there are lacerations on the ear.
  • Compression and packing of the ear is done to avoid the re-accumulation of blood.
  • Open reduction of the cartilaginous framework of the ear can be performed to cause repositioning of the displaced cartilage [7][8].
  • Complete examination of the ears, nose and throat should be done to rule out the complication of hearing loss.
  • Plastic surgery may be needed for cosmetic benefit [9][10].

Prognosis

Through immediate care and treatment, cauliflower ear can be prevented altogether. Delay in the treatment increase the risk of permanent deformity and damage. Although inflammation and swelling can be completely cured, the deformity may persist and plastic procedures are resorted to for its treatment.

Permanent hearing loss is another of the permanent complications of cauliflower ear. It is not a life-threatening condition. Complete resolution of the hematoma occurs usually within a week and the player can return to sports, once cured.

Etiology

Auricular hematoma

Cauliflower ear is an acquired deformity of the ear. Blunt trauma to the ears as a result of impact by an external force, for example, sports injuries in close contact sports as in boxers, wrestlers or martial arts fighters causes perichondrial injury as well as hematoma formation; thus, giving rise to cauliflower ear. Incomplete drainage of the auricular hematoma can also lead to recurrence and permanent disfiguration.

Auricular polychondritis

Piercing injuries in the upper part of the auricular cartilage cause acute inflammation of the perichondrium (perichondritis). The resulting edema and swelling can also lead to cauliflower type external ear deformity. Acquired infections secondary to hematoma formation or those acquired after ear piercing, can also be the cause of auricular perichondritis.

Relapsing polychondritis

This is a rare cause of cauliflower ear in which repeated inflammation and healing of all the cartilaginous tissues in the body, including the auricular cartilage occurs. of cauliflower ear, in which repeated inflammation and healing of all the cartilaginous tissues in the body, including the auricular cartilage occurs.

Epidemiology

Cauliflower ear comprises 1.7% to 24.6% of the total number of the wrestling injuries. The incidence is higher in men due to more involvement in sports.

Sex distribution
Age distribution

Pathophysiology

When bunt force is applied to the ear, skin gets avulsed from the underlying perichondrium and perichondrial blood vessels rupture. Blood effuses out and accumulates beneath the perichondrium (layer of cells surrounding the cartilage). This results in auricular hematoma or a fluid filled cyst formation in the subperichondrial space.

If not immediately drained and treated, the hematoma presses on the intact blood vessels, cutting off the blood and nutrient supply to the underlying cartilage. Alternatively, calcification may also occur. The cartilage, deprived of the blood and nutrients, undergoes fibrosis. Necrosis ensues. The shriveled up cartilage presents externally as a permanently swollen mass causing the ear to resemble a cauliflower.

Prevention

  • Protective head gear must be worn by the wrestlers and boxers to prevent the sports injuries.
  • Children must be encouraged to wear helmets while engaging in sports like rugby or biking.
  • Care must be exercised while getting the ear pierced to avoid piercing the cartilaginous part.
  • Prompt medical care should be sought be sportsmen if even the minor trauma to the ear causes localized pain or ringing sensation in the ears.
  • Wrapping, as a result of injury, should be done in such a way as to leave the ear exposed, to avoid secondary infections.
  • In case of ear injury, players should avoid further sports activity until the condition is fully resolved to prevent further injury to the ear.

Summary

Permanent swelling of the ear resulting in gross deformity resembling a cauliflower is known as cauliflower ear or hematoma auris [1]. Most commonly, it occurs as a result of acute external trauma to the ear as in boxers and wrestlers. This is why it has come to be known as boxer’s ear or wrestlers’ ear [2].

Hematoma formation as a result of injury to the cartilaginous part of the ear is the underlying cause. The ear becomes lumpy in appearance, resembling a cauliflower, hence the name.

Patient Information

When blunt force injury to the ear is left untreated for long, the ear assumes a lumpy shape resembling a cauliflower; this condition is termed as “cauliflower ear”. This usually happens in close contact sports like boxing or wrestling, where the risk of blows to the ear is relatively high.

Ear swells up immediately. Bruising appears. Other signs include ringing sensation in the ears, severe pain the ear, bluish discoloration. Hearing may also be affected. Immediate medical help should be sought in such cases so that the condition can be prevented from persisting. If treatment is delayed, the deformity becomes permanent and can then only be corrected through surgery. Snugly fitting, properly padded head gear should be worn by wrestlers, boxers, rugby players and other people engaged in close contact sports to avoid injuries to the ear. With proper care, the condition can be prevented.

References

Article

  1. Unger M. Hyperchondroplasia auris traumatica (cauliflower ear). Eye, ear, nose & throat monthly. Sep 1947;26(9):482-485.
  2. Giffin CS. The wrestler's ear (acute auricular hematoma). Archives of otolaryngology. Mar 1985;111(3):161-164.
  3. Greywoode JD, Pribitkin EA, Krein H. Management of auricular hematoma and the cauliflower ear. Facial plastic surgery : FPS. Dec 2010;26(6):451-455.
  4. Gernon WH. The care and management of acute hematoma of the external ear. The Laryngoscope. May 1980;90(5 Pt 1):881-885.
  5. Misaki K, Muramatsu N, Nitta H. Endovascular treatment for traumatic ear bleeding associated with acute epidural hematoma. Neurologia medico-chirurgica. May 2008;48(5):208-210.
  6. Stuteville OH, Janda C, Pandya NJ. Treating the injured ear to prevent a "cauliflower ear". Plastic and reconstructive surgery. Sep 1969;44(3):310-312.
  7. Yotsuyanagi T, Yamashita K, Urushidate S, Yokoi K, Sawada Y, Miyazaki S. Surgical correction of cauliflower ear. British journal of plastic surgery. Jul 2002;55(5):380-386.
  8. Vogelin E, Grobbelaar AO, Chana JS, Gault DT. Surgical correction of the cauliflower ear. British journal of plastic surgery. Jul 1998;51(5):359-362.
  9. Gross CG. Treating "cauliflower ear" with silicone mold. The American journal of sports medicine. Jan-Feb 1978;6(1):4-5.
  10. Roy WE. Plastic for repairing auricular hematoma. Journal of the American Veterinary Medical Association. Feb 1 1962;140:250.

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Last updated: 2019-06-28 12:11