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Cauliflower ear |
| Cauliflower ear Classification and external resources |
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| Cauliflower Ear as Seen in an Elderly Male | |
| ICD-10 | M95.1 |
| ICD-9 | 738.7 |
Cauliflower ear (also hematoma auris or perichondrial hematoma) is a condition most common among Judo players, amateur wrestlers, professional wrestlers, rugby players, mixed martial artists, and boxers. If the external portion of the ear suffers a blow, a blood clot or other fluid may collect under the perichondrium. This separates the cartilage from the overlying perichondrium that is its source of nutrients, causing the cartilage to die. This leads to a formation of fibrous tissue in the overlying skin. When this happens, the outer ear becomes permanently swollen and deformed, thus resembling a cauliflower.
Headgear that protects the ears is worn in wrestling and rugby (where it is called a "scrum cap"), many martial arts, and other contact sports to help prevent this condition. For some wrestlers and fighters, however, a cauliflower ear is considered a badge of courage [1].
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When fluid collection in the outer ear occurs, it is important to contact a doctor immediately and have it treated. The doctor will evacuate the fluid and apply a compressing tie to the outer ear to reconnect the perichondrium and the cartilage. The compressing tie must be left in place for some time, generally 10 days, to prevent the fluid from building up again. Another treatment involves the use of leeches to drain blood, reduce internal pressure, and promote bleeding.
The outer ear is prone to infections, so antibiotics are usually prescribed. If the pressure is left alone without medical intervention, the ear can suffer very serious damage. Pressure can build up and eventually rupture the ear drum. When this occurs, the ear may further wrinkle, and can become slightly pale; hence the common term "cauliflower ear". Should the ear drum rupture, the only treatment option is to heal the existing wound with stitches. Even with treatment, significant hearing loss may occur. Today, cosmetic procedures are available which can greatly improve the appearance of the ear, even though internal damage will persist.
An extensive literature and serious science on haematoma auris developed between the 1860s and the turn of the century. It was defined as "An effusion of blood or of bloody serum between the cartilage of the ear and its perichondrium, occurring in certain forms of insanity and sometimes among the sane". Alienists (psychiatrists) argued ardently that it was a symptom of insanity and had nothing to do with mechanical causes. Some thought it was involved in all types of insanity, while others thought it to be worse ’in those forms of insanity in which the mental excitement runs high for any length of time’. It was thought to affect the left ear more often than the right. Psychiatrists advanced various theories linking it to abnormalities of bone, blood, brain in the insane. Others argued that it resulted from an interaction between nervous system degeneration in the insane, and mechanical causes such as the insane hitting themselves or being boxed around the ear by asylum staff (and it was pointed out that this might be the easier explanation for the higher prevalence in the left ear, since most staff were right-handed, rather than convoluted arguments linking it to the origin of the left common carotid artery). It was also noted that it could occur to a lesser extent in sportsmen due to an interaction between mechanical blows and the heat and excitement of physical combat. By the end of the First World War the topic disappeared from the medical press and the experts moved onto new fashions. Its mainstream acceptance as a psychiatric symptom has been said to have relevance to scientific and conceptual concerns over psychiatric diagnosis today.[2]
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