Traumatic Auricular Haematoma (Cauliflower ear)
Traumatic auricular haematoma, commonly known as cauliflower ear, occurs when blood collects between the cartilage and the perichondrium of the outer ear following blunt trauma. This condition is often seen in contact sports such as wrestling, boxing, and rugby. If left untreated, the haematoma can lead to permanent deformity of the ear, resulting in the characteristic "cauliflower" appearance.
👂 About
- Auricular haematoma is a preventable cause of ear deformity.
- Also known as "Cauliflower ear" due to its characteristic thickened, irregular appearance.
⚠️ Causes
- Contact Sports: Wrestling, boxing, rugby, MMA – repeated friction or blunt trauma to the ear.
- Accidents: Falls, MVAs, or direct trauma to the ear.
- Physical Altercations: Punches or blows to the side of the head/face.
🧬 Aetiology
- Haematoma forms between the perichondrium and cartilage.
- This disrupts blood supply ➝ cartilage necrosis ➝ fibrous overgrowth ➝ permanent deformity ("cauliflower ear").
🩺 Clinical Features
- Swelling: Fluctuant swelling on the pinna, tender and discoloured.
- Pain: Worsened by pressure or manipulation.
- Fluctuance: Soft and compressible in early stages.
- Loss of Normal Contour: Landmarks (helix, antihelix) obscured.
- Deformity: Chronic cases become thickened, firm, and nodular (classic "cauliflower ear").
🔎 Investigations
- Usually a clinical diagnosis.
- Ultrasound or MRI may be used in atypical cases to assess extent or exclude associated pathology.
🛠️ Management
- Prompt drainage of haematoma: Needle aspiration or incision & drainage (I&D).
- Compressive Dressing: Apply a firm pressure dressing or mould to prevent re-accumulation of blood and promote adherence of skin to cartilage.
- Antibiotics: Consider if incision is made, to reduce risk of perichondritis (often flucloxacillin or co-amoxiclav, depending on local policy).
- ENT Follow-Up: All patients should be reviewed for recurrence, infection, or inadequate drainage.
🏃♂️ Prevention & Prognosis
- Use of protective headgear/ear guards in contact sports is highly effective in prevention.
- Prognosis is excellent if drained promptly. Untreated or recurrent haematomas ➝ cartilage necrosis ➝ permanent "cauliflower ear" deformity.
