Auricular Hematoma in Athletes: Treatment and Risks of Neglect
DOI:
https://doi.org/10.12775/QS.2025.41.59993Keywords
auricular hematoma, cauliflower ear, wrestler's ear, otohematoma, auricular hematoma complications, recurrent auricular hematomaAbstract
Introduction: Auricular hematoma is most often caused by direct blunt trauma to the outer ear and is frequently seen in individuals who engage in full-contact sports such as boxing, wrestling, and rugby. This condition occurs when blood accumulates between the cartilage and skin, resulting in pressure that compresses the perichondrium, leading to ischemia. If untreated, it can cause infections, perichondritis, necrosis, and permanent deformity, commonly referred to as "cauliflower ear". Standard treatment includes hematoma evacuation and the application of pressure dressings or sutures. However, alternative methods and modifications of standard approaches are currently under investigation.
Aim of the Study: The aim of this study is to evaluate the current understanding of auricular hematoma and cauliflower ear in athletes, with an emphasis on new treatment approaches, prevention and the potential complications associated with untreated cases.
Materials and Methods: A review of research literature was conducted through databases such as PubMed, Google Scholar, ResearchGate, and the Cochrane Library.
Conclusion: Auricular hematoma is a prevalent injury in contact sports, requiring prompt and effective treatment to prevent complications. New evidence indicates that untreated auricular hematoma may lead to complications such as hearing loss and infections. Recent advancements in drainage techniques, surgical approaches, and non-invasive approaches offer promising management options. However, current research is limited by small sample sizes, underscoring the need for larger clinical trials and long-term studies.
References
1. Gastoł B, Mikołap K, Staroń A, Kras M, Karkos P, Kuśmierczyk K, et al. Comparison of the incidence and causes of injuries in stand-up and ground combat-sport fighters – a narrative review. Quality in Sport. 2024.18:53419.
https://doi.org/10.12775/QS.2024.18.53419
2. Schuller DE, Dankle SK, Martin M, Strauss RH. Auricular Injury and the Use of Headgear in Wrestlers From the Departments of Otolaryngology. Arch Otolaryngol Head Neck Surg.1989;115: 714–717.
https://doi.org/10.1001/archotol.1989.01860300068019
3. Manninen IK, Blomgren K, Elokiuru R, Lehto M, Mäkinen LK, Klockars T. Cauliflower ear among Finnish high-level male wrestlers and judokas is prevalent and symptomatic deformity. Scand J Med Sci Sports. 2019 Dec 1;29(12): 1952-1956.
https://doi.org/10.1111/sms.13530
4. Nitsch A, Marx H, Fischer CS, Bakir S, Ekkernkamp A, Wassilew GI, et al. Prevalence of cauliflower ear in high level judoka. Sci Rep. 2023 Dec 1;13(1).
https://doi.org/10.1038/s41598-023-42635-8
5. Ohldn L, Skoog T, Sohn SA. The pathogenesis of cauliflower ear. An experimental study in rabbits. Scand J Plast Reconstr Surg. 1975;9(1):34-39.
https://doi.org/10.3109/02844317509022854
6. Pandya NJ. Experimental production of "cauliflower ear" in rabbits. Plast Reconstr Surg. 1973 Nov;52(5):534–537.
https://doi.org/10.1097/00006534-197311000-00010
7. Vogelin E, Grobbelaar AO, Chana JS, Gault DT. Surgical correction of the cauliflower ear. Br J Plast Surg.1998. 51(5): 359-362.
https://doi.org/10.1054/bjps.1997.0033
8. Haik J, Givol O, Kornhaber R, Cleary M, Ofir H, Harats M. Cauliflower ear - A minimally invasive treatment method in a wrestling athlete: A case report. Int Med Case Rep J. 2018;11:5-7
https://doi.org/10.2147/IMCRJ.S152145
9. Noormohammadpour P, Rostami M, Nourian R, et al. Association Between Hearing Loss And Cauliflower Ear in Wrestlers, a Case Control Study Employing Hearing Tests. Asian J Sports Med. 2015;6(2):e25786.
https://doi.org/10.5812/asjsm.6(2)2015.25786
10. Hunter A, Frias JL, Gillessen-Kaesbach G, Hughes H, Jones KL, Wilson L. Elements of morphology: Standard terminology for the ear. Am J Med Genet A. 2009;149(1):40–60.
https://doi.org/10.1002/ajmg.a.32599
11. Greywoode JD, Pribitkin EA, Krein H. Management of auricular hematoma and the cauliflower ear. Facial Plastic Surgery. 2010;26(6):451-455
https://doi.org/10.1055/s-0030-1267719
12. Dudás B. Human Histology Academic Press. 2023: 49–71.
https://doi.org/10.1016/B978-0-323-91891-6.50014-3
13. Ma X, Dai X, Zhang D, Xiong Z, Wang B, Li J, et al. A Subunit-Based Concept for Preoperative Design of the Cauliflower Ear. Journal of Craniofacial Surgery. 2024;35(8): 2492–2496
https://doi.org/10.1097/SCS.0000000000010634
14. Mashiko T, Minabe T, Shiokawa I, Mineda K, Yoshimura K. Heterotopic ossification in cauliflower ear. J Plast Reconstr Aesthet Surg. 2014;67(3):e93-e94
https://doi.org/10.1016/j.bjps.2013.10.015
15. Summers A. Managing auricular haematoma to prevent “cauliflower ear.” Emergency Nurse. RCN Publishing Company Ltd. 2012; 20: 28–30.
16. Gooch MD. Preventing Cauliflower Ear. Adv Emerg Nurs J. 2020;42(3): 204–209.
17. Dalal PJ, Purkey MR, Price CPE, Sidle DM. Risk factors for auricular hematoma and recurrence after drainage. Laryngoscope. 2020;130(3):628–631.
https://doi.org/10.1002/lary.28310
18. Butt WE. Auricular Heamatoma- Treatment Options. Aust NZJ Surg. 1987; 57: 391–392.
19. Schuller DE, Dankle SD, Strauss RH. A technique to treat wrestlers' auricular hematoma without interrupting training or competition. Arch Otolaryngol Head Neck Surg. 1989;115(2):202-206.
20. Stuteville OH, Janda C, Pandya NJ. Treating the injured ear to prevent a "cauliflower ear." Plast Reconstr Surg. 1969;44(3):310-312.
21. Gernon WH. The care and management of acute hematoma of the external ear. Laryngoscope. 1980;90:881-885.
22. Koopmann C, Coulthard S. Management of hematomas of the auricle. Laryngoscope. 1979; 89: 1172-1174
23. Sbaihat AS, Khatatbeh WJ. Treatment of auricular hematoma using dental rolls splints. J R Med Sci. 2011;18(2):22-25.
24. Haik J, Givol O, Kornhaber R, Cleary M, Ofir H, Harats M. Cauliflower ear - A minimally invasive treatment method in a wrestling athlete: A case report. Int Med Case Rep J. 2018; 11:5–7.
https://doi.org/10.2147/IMCRJ.S152145
25. Ang WW, Foley G, Laycock J, McKay-Davies I. Ear magnetic discs to prevent cauliflower ear: a case gone wrong. BMJ Case Rep. 2022;15(11): e250864.
https://doi.org/10.1136/bcr-2022-250864
26. Bull PD, Lancer JM. Treatment of auricular haematoma by suction drainage. Clin Otolaryngol. 1984;(9):355–60.
27. Eliachar I, Golz A, Joachims HZ, Goldsher M. Continuous portable vacuum drainage of auricular hematomas. Am J Otolaryngol. 1983;4(2):141-143
28. Vuyk HD, Bakkers EJ. Absorbable mattress sutures in the management of auricular hematoma. Laryngoscope. 1991;101(10):1124-1126.
https://doi.org/10.1288/00005537-199110000-00015
29. Kakarala K, Kieff DA. Bolsterless management for recurrent auricular hematoma. Laryngoscope. 2012;122(6):1235–7.
https://doi.org/10.1002/lary.23288
30. Kirdak VR, Chintale SG, Shaikh K, Jatale S. Our experience of auricular hematoma treatment in wrestlers. International Journal of Otorhinolaryngology and Head and Neck Surgery. 2018;4(2):440.
https://doi.org/10.18203/issn.2454-5929.ijohns20180704.
31. Lamb MM, Mims MM, Clark JM. “Hole-Punch” Technique for Recurrent Auricular Hematomas. Laryngoscope. 2023;133(4):814–7.
https://doi.org/10.1002/lary.30298
32. Mohamad SH, Barnes M, Jones S, Mahendran S. A new technique using fibrin glue in the management of auricular hematoma. Clin J Sport Med. 2014;24(6):e65-e67.
https://doi.org/10.1097/JSM.0000000000000095
33. Kubota T, Ohta N, Fukase S, Kon Y, Aoyagi M. Treatment of auricular hematoma by OK-432. Otolaryngology - Head and Neck Surgery. 2010:142(6):863–866.
https://doi.org/10.1016/j.otohns.2010.03.006
34. Ohta N, Fukase S, Kusano Y, Saito Y, Tateda Y, Ishida Y, et al. Treatment of auricular hematomas by OK-432: How and why it works. Otology and Neurotology. 2019;40(8):E820–823.
https://doi.org/10.1097/MAO.0000000000002336
35. Im GJ, Chae SW, Choi J, Kim YS, Kim WJ, Jung HH. Intralesional steroid injection for the management of otohematoma. Otolaryngology - Head and Neck Surgery. 2008: 139(1):115–119.
https://doi.org/10.1016/j.otohns.2008.01.006
36. Talaat M, Azab S, Kamel T. Treatment of auricular hematoma using button technique. ORL J Otorhinolaryngol Relat Spec. 1985;47(4):186-188.
https://doi.org/10.1159/000275768
37. Rah YC, Park MH. Use of silastic sheets with mattress-fashion sutures for the treatment of auricular hematoma. Laryngoscope. 2015; 125(3):730–732.
https://doi.org/10.1002/lary.24976
38. Henderson JM, Salama AR, Blanchaert RH Jr. Management of auricular hematoma using a thermoplastic splint. Arch Otolaryngol Head Neck Surg. 2000;126(7):888-890.
https://doi.org/10.1001/archotol.126.7.888
39. Grosse SJ, & LJM. Treating Auricular Hematoma Success With a Swimmer’s Nose Clip. The Physician and Sportsmedicine. 199; 19(10), 98–102.
40. Khan A, Kwiatkowski T. A novel technique: Use of finger splint as compression device for post auricular hematoma drainage. Am J Emerg Med. 2022;56:286-287
https://doi.org/10.1016/j.ajem.2021.07.023
41. Choung YH, Park K, Choung PH, Oh JH. Simple compressive method for treatment of auricular haematoma using dental silicone material. J Laryngol Otol. 2005;119(1):27-31.
https://doi.org/10.1258/0022215053222932
42. Yotsuyanagi T, Yamashita K, Urushidate S, Yokoi K, Sawada Y, Miyazaki S. Surgical correction of cauliflower ear. Br J Plast Surg. 2002;55(5):380-386
https://doi.org/10.1054/bjps.2002.3854
43. Putri IL, Bogari M, Khoirunnisa A, Dhafin FR, Kuswanto D. Surgery of Severe Cauliflower Ear Deformity. Plast Reconstr Surg Glob Open. 2023;11(4):e4953.
https://doi.org/10.1097/GOX.0000000000004953
44. D’Ascanio L, Gostoli E, Ricci G, De Luca P, Latini G, Brenner MJ, et al. Modified Valente Technique for Cauliflower Ear: Outcomes in Children at Two-Year Follow-Up: New Surgical Technique for Cauliflower Ear. Aesthetic Plast Surg. 2024; 48(10):1906–1913.
https://doi.org/10.1007/s00266-024-03914-5
45. Hao S, Angster K, Hubbard F, Greywoode J, Vakharia KT. Ear Scaffold Reconstruction Using Ultrasonic Aspirator for Cauliflower Ear. The Cleft Palate Craniofacial Journal. 2018;55(4):619–21.
https://doi.org/10.1177/1055665617732787
46. Noormohammadpour P, Rostami M, Nourian R, et al. Association Between Hearing Loss And Cauliflower Ear in Wrestlers, a Case Control Study Employing Hearing Tests. Asian J Sports Med. 2015;6(2):e25786.
https://doi.org/10.5812/asjsm.6(2)2015.25786
47. Özal N, Çetin Kara H, Çögen T, Özdoğan HA. Effect of External Ear Deformity on Hearing in Wrestlers. Am J Audiol. 2024;33(3):863-873.
https://doi.org/10.1044/2024_AJA-23-00277
48. Hirt Z, Stephen L, Liu J, Barnett J, Lee AH. Perception of cauliflower ear amongst combat sport athletes. Am J Otolaryngol. 2024;45(4):104293.
https://doi.org/10.1016/j.amjoto.2024.104293
49. Schuller DE, Dankle SK, Martin M, Strauss RH. Auricular injury and the use of headgear in wrestlers. Arch Otolaryngol Head Neck Surg. 1989;115(6):714-717.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Julia Kiełbratowska , Wiktoria Pietruszka, Przemysław Klasicki, Maria Potrykus, Agata Krupa, Maciej Mozer, Jan Mateńko, Anna Krawczyk, Michał Pałuchowski, Wiktor Możarowski

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 29
Number of citations: 0