• Assaf S.

Cauliflower Ear in Jiu Jitsu

Updated: Apr 18, 2020

What is cauliflower ear, how to avoid it, and what to do if my ear is irritated or swollen after training.


What Causes Cauliflower Ear?

Cauliflower ear is cosmetic disfigurement of the ear which is quite common in contact sports including rugby, football, wrestling, boxing, and many martial arts [1]. Jiu jitsu is no different in that sense, almost anyone who practice jiu jitsu long enough has deformity of the (outer) ear of some level. Cauliflower ear is typically a secondary trauma which causes a “perichondrial hematoma” or “auricular hematoma.” In most cases, the damage is caused by blunt force trauma to the ear – generally a hit or strike. An auricular hematoma can also occur when skin is pulled away from the cartilage which can be caused by shearing of the ear, when trying to escape a headlock, cross-face or submissions such as kata-gatame, guillotines, or triangles. The second kind of damage is more likely to occur in the gi game where high friction is involved.


20+ years of bjj training – check, bjj black belt – check, cauliflower ear – check [Image courtesy of Anselmo Oliveira]
20+ years of bjj training – check, bjj black belt – check, cauliflower ear – check [Image courtesy of Anselmo Oliveira]

Why Does Cauliflower Ear Form?

After trauma to the ear, blood vessels that supply blood to the ear cartilage can tear and blood begins to accumulate between the cartilage and the “perichondrium,” a dense layer of fibrous connective tissue that covers the cartilage. The perichondrium is important for transporting blood and nutrients to the cartilage [1]. These pools of blood cut off blood supply to the ear cartilage or can significantly reduce blood flow. This leads to infection and death of the affected portion of the tissue. Without the supportive tissue, new fibrous tissue can form around the affected area which result in the bumpy or lumpy cauliflower texture and deformed look.


What Can I Expect if I Develop an Auricular Hematoma?

If you develop an auricular hematoma you may experience severe pain, redness, and swelling. Early treatment can help prevent permanent deformity. If inadequately treated and cauliflower ear develops, plastic surgery is your only option to fix the unsightly appearance. This may also keep you out off the mat for a considerable amount of time while you heal.


How Do I Treat Cauliflower Ear?


Option 1 – Leave It

Some guys choose not to take any action and just let the ear harden and develop the cauliflower texture since the common belief is that cauliflower ears are less vulnerable to recurrent damage. This might be reasonable but there is no scientific proof to support this theory. This practice is also not recommended because of the complications of inadequately treated cauliflower ear can lead to hearing loss and increased risk of repeated ear infections, not to mention that you can forget about wearing those cool ear buds you had your eyes on.


Option 2 – Self-Drain the Auricular Hematoma

It is important to note that just draining the hematoma (the blood pool) which is common practice among jiu jitsu practitioners is usually not effective since blood might continue to pool in the damaged area. If you choose to do self-drain, you’ll need to use a low gauge needle to drain the hematoma several times a day for anywhere from 3 to 14 days. The need for frequent drainage may be a burden and might increase your risk of developing an infection. Make sure you keep the area sterile before and after the process.


If you self-drain, firmly press down on the ear after draining it with compression pads or compressed cotton and reinforce it with medical tape for a few days. Best way to keep up the pressure is to wrap gauze on the ear and around your head. You can even purchase set of magnets that compress the ear from both sides. Whichever you choose, putting pressure on the damaged area is necessary otherwise fluids are likely to re-accumulate and all effort might be in vain.


After the procedure, the ear should be kept dry and clean until the area is healed, usually this takes about a week. Training while the ear is healing is highly not recommended – even with ear guards.

Dr. Joseph Spinell pointed out that the longer the blood pools the more it will coagulate. Once the blood coagulates needle drainage will become irrelevant and will not result in decompression. This results in a short window of time (1-2 days) for needle aspiration. If you do choose to self-drain the hematoma you must act quick. If you wait too long, it will be necessary to see an ENT specialist. This will most likely require cleaning out the hematoma with the use of scalpel as well as aspiration. This will be discussed more in the sequel.


Self-draining a hematoma is not recommended. This is a medical procedure, and it should be carried out by trained medical physician.


Here is an example of how it is done in home environment. Please note that this is done by medical doctor on medical doctor. Again, we do not recommend this practice.



Option 3 – Seek Medical Attention

As previously stated, time is of the essence when treating damaged ear. It is recommended to see an ENT specialist right away. If you take blood-thinning medications, it is even more important to see a doctor as soon as possible. The doctor will probably use local anesthetics, open the ear, remove the hematoma, and then suture it together with compression pads for about a week [2]. Antibiotics are most likely to be prescribed as well.


The end result of the common medical procedure for auricular hematoma. After draining the damaged ear two compression pads are sutured from both sides of the ear to keep the damaged area pressed. [Image curtesy of Jody Bond]
The end result of the common medical procedure for auricular hematoma. After draining the damaged ear two compression pads are sutured from both sides of the ear to keep the damaged area pressed. [Image curtesy of Jody Bond]

How to Avoid Cauliflower Ear

The common opinion is that some people are more susceptible to auricular hematoma than others. We think there is some truth to this since many practitioners report experiencing more than one incidence of injury. We recommend taking precautions to avoid this unnecessary injury.


1. If your ears are sensitive or you experience pain when training, these are warning signs and it is recommended to put a little bit of Vaseline on your ear before training, especially before rolling.


2. Ear guards are the best way to protect your ears. It might feel cumbersome and uncomfortable at first (it can make you hot as hell and some people report claustrophobic feelings while wearing it), but you will get used to it quickly. There are several types of ear guards, some are more suitable to jiu jitsu than others. Note: that wearing ear guards does not guarantee full protection – auricular hematoma may occur even when protective ear guards are used.



References

[1] Ghanem T, Rasamny JK, Park SS. Rethinking auricular trauma. Laryngoscope. 2005 Jul;115(7):1251-5. [https://www.ncbi.nlm.nih.gov/pubmed/15995516]

[2] Krogmann RJ, King KC. Auricular Hematoma. [Updated 2019 Jun 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK531499/



Disclaimer

The information provided in the articles on the site is anecdotal, based on our own or others' experience. The article here or any other piece of information on the site should not be viewed as a recommendation - neither medical nor professional. The site, its operators, or the authors of the articles therein will not be held liable for any damage you incur if you follow the suggestions set forth therein. In any case and need you should consult a suitable physician or appropriate professional or your personal trainer.



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