Home Science Biology Cauliflower Ear 101: Cause, Treatment and Prevention

Cauliflower Ear 101: Cause, Treatment and Prevention

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Opinions about cauliflower ear are as divided as opinions on nationwide healthcare. Is it good, bad or just ugly?

Cauliflower ear is a complication arising from a prolonged hematoma to the ear. This occurs when the outside of the ear suffers trauma causing blood clots or other fluid to collect under the perichondrium, which is the connective tissue surrounding the cartilage of the ear.

The type of trauma that is conducive to fluid collection is typical in combat sports. It can be caused by a punch or kick to the ear or a submission hold that presses tightly against the ear. Head pressure against the cage, mat or from takedowns can also cause cauliflower ear.

When fluid fills in the ear the cartilage from the overlying perichondrium is separated from its nutrient supplies, causing it to die, resulting in the formation of fibrous tissue in the overlying skin. As a result, the outer ear becomes permanently swollen and deformed, resembling a cauliflower floret.

Depending on a fighter’s mindset, the development of cauliflower ear can be considered a badge of honor or a catalyst for unwanted attention. Either way, it is painful and has long-term complications.


Complications from Cauliflower Ear

  1. Hearing Impairment
  2.  Difficulty Sleeping
  3. Headaches
  4. Ringing in the Ear (tinnitus)
  5. Blurred Vision
  6. Cosmetic Deformity
  7. General Pain in Ear


The goals of treatment is to drain blood or fluid from the hematoma, treat any infection, and reduce inflammation in order to re-establish the connection of the skin to the underlying cartilage. This usually requires draining accumulated blood or fluid through an incision in the ear and applying a compressive dressing to sandwich the two sides of the skin against the cartilage. Antibiotics are recommended to prevent infection. Sometimes the incision needed will be large enough to constitute stitches and special bandaging.

Although the success rate is much higher if treatment is conducted by an actual physician, many competitors choose to take matters into their own hands. Although this is the most common method used for at home draining, SciFighting does NOT recommend self-treatment.


1. Clean the ear and surround area. This includes in the ear, surrounding skin and hair.

2. Sterilize the incision site. Using a surgical scrub such as chlohexadine and rubbing alcohol followed by betadine is ideal, although most households may only have access to rubbing alcohol. Use the rubbing alcohol swab or prep pad and let it sit for about 20-30 seconds.

3. Entering from the front of the ear, insert the syringe at an angle into the area that is swollen. Gently pull back the plunger of the syringe to initiate extraction of the fluid. If the syringe fills up, do not empty and reuse. Get another sterile syringe and needle.

(A note about needles:  Sterile needles and syringes typically require a prescription to acquire.  Another reason why SciFighting strongly recommends you seek a professionals assistance for this sort of treatment.  That being said, the gauge of the needle will impact the level of pain and also residual bleeding from the extraction.  For example an 18 gauge needle will have a wider diameter and will result in both a faster extraction of fluid and a larger amount of pain where as a 24 gauge needle will incur less pain but will require much more force on the plunger to extract the fluid.)

4. Re-sterilize the ear (specifically where the needle was inserted) with alcohol after it is drained.

This entire process is undoubtedly painful and may have to be repeated multiple times. It is not uncommon for fluid to fill the ear again before the connective tissue has had time to heal. A compression bandage may have to be applied to hold the cartilage together. Again, this is just a brief overview of the basic procedure. There are numerous videos and online forums with additional details and recommendations for those who wish to attempt this on their own.

Infamous Ears

The most notorious cauliflower ears belong to former UFC Champion (and actor) Randy Couture, who was also an All-American wrestler before his cage days. His ears are so obvious that Couture has a whole scene about them in his dialogue for the movie “The Expendables.” His character in the movie is extremely sensitive to any references about his ears and feels the need to repeatedly explain their appearance.


“We all know I wrestled in college. A common injury associated with that sport is trauma to the ear. A clot, if left unattended causes a contraction of the cartilage and forms cauliflower ears.”- Randy Couture in The Expendables.

Other fighters with pretty gnarly lobes include, but are not limited to the following;

  • Frank Trigg
  • BJ Penn
  • Frankie Edgar
  • Antonio Rodrigo Nogueira
  • Matt Hughes
  • Kazushi Sakuraba


The best way to prevent cauliflower ear is to wear headgear. Wrestling headgear can be worn in most grappling sports. For punching and kicking sports, sparring headgear is recommended. Many competitors feel that it is a disadvantage to have the additional equipment, but in order to avoid the discomfort and complications of cauliflower ear, this is the way to go. Another thing to consider is checking your ego at the door and tapping when caught in a bad position that could result in the ear to fold or endure heavy pressure. Holding out may seem like a good idea during a fight but may look different when the needle goes in.