Buzz
Cauliflower ear, also known as an auricular hematoma, is an injury to the ear resulting in internal bleeding and inflammation. The upper part of the ear becomes swollen, resembling a cauliflower. This injury is commonly seen in sports such as wrestling, mixed martial arts, rugby, boxing, and water polo. Prompt treatment is crucial to prevent permanent disfigurement, with the primary goal being to reduce swelling and drain the accumulated blood. Drainage procedures should be performed by medical professionals, except in emergency situations.
Procedures
Commencing Immediate Treatment
Apply cold compress. Following an ear injury causing swelling, immediately cease activity and apply a cold compress to reduce inflammation and alleviate pain. Cold therapy helps restrict blood flow to the space between the skin and cartilage of the upper ear. Apply the cold compress for 10-minute intervals, repeating every hour for three to four hours post-injury.
- Wrap the ice or cold pack in a thin cloth to prevent frostbite or skin irritation.
- An alternative is to use a small bag of frozen vegetables or fruits to reduce ear swelling.
Apply a head wrap to compress the affected ear. Besides using ice on your swollen ear, wrap a Tensor or Ace bandage around your head to exert pressure on your ear. Combining cold therapy with compression is the most effective way to reduce swelling in almost all musculoskeletal injuries. Applying pressure can help stop internal bleeding faster, thus lessening the severity of the cauliflower ear.
- You can also use a long strip of gauze or an elastic exercise band to press the ice against your ear.
- Consider wedging some gauze in front of and behind your ear before wrapping it with a stretchy bandage to increase pressure.
- Ensure that the bandage is not wrapped too tightly to avoid headaches, dizziness, or cutting off circulation, as adequate blood flow is necessary to remove excess fluid. Also, avoid wrapping it in a way that obstructs your vision or affects hearing in your unaffected ear.
- Remove the bandage every hour to allow your ear to rest.
Use anti-inflammatory drugs. Another method to reduce swelling and pain associated with cauliflower ear is to take over-the-counter anti-inflammatory drugs such as ibuprofen (Advil), aspirin, or naproxen (Aleve). Take them immediately after the injury for optimal results. Combine them with cold therapy and compression as well.
- Pain relievers like acetaminophen (Tylenol) help alleviate pain but do not reduce swelling.
- Aspirin and ibuprofen may exacerbate internal bleeding, so consult your doctor before taking anti-inflammatory drugs.
- Limit the use of anti-inflammatory drugs to two weeks to minimize side effects such as stomach and kidney irritation. A few days of medication is typically sufficient for cauliflower ear.
Home Remedies for Draining Cauliflower Ear
Assess the risks. While it is possible to drain a mild cauliflower ear at home, especially if you have some medical training, doing so significantly increases the risk of infection and subsequent complications. Only attempt to drain a cauliflower ear if you cannot see a doctor or medical professional within two to three days.
- Moreover, only try draining your ear if the injury is mild with moderate swelling and no torn skin.
- If you have a cell phone, call emergency services for helpful advice and support.
Sanitize your hands and/or wear gloves. Before addressing your cauliflower ear, ensure that your hands are clean by washing them with warm water and regular soap for approximately 30 seconds, then dry them with paper towels. If available, wear latex surgical gloves after washing your hands, although it is not essential. Clean or gloved hands significantly reduce the risk of bacterial contamination of the ear injury and subsequent infection.
- Alternatively, if soap and water are not available, sanitize your hands with alcohol-based hand sanitizer.
- In emergency situations, alcohol or baby wipes can also be used to clean your hands.
- Apply rubbing alcohol generously to cover all crevices, both inside and outside the upper half of your ear.
- For disinfection, alcohol swabs or alcohol-based sanitizing lotion applied with a clean Q-tip are also effective.
- Apply ice for 10 – 15 minutes before puncturing your ear to numb the pain, as ice acts as a natural anesthetic.
Puncture the hematoma with a needle and syringe. If unavailable, purchase a new 20-gauge 1-inch needle with at least a 3-milliliter (0.10 fl oz) syringe attached to pierce the hematoma, the large blood-filled pocket. Although not the smallest, a 20-gauge needle is ideal for suctioning thick, coagulated blood from a cauliflower ear.
- The 3 mL syringe capacity ensures complete fluid suction, while the 1-inch needle length prevents excessive ear puncturing and cartilage damage.
- Pierce only the swollen area of the mid-to-upper ear deep enough to insert the needle tip. Avoid excessive insertion to prevent further damage.
Extract blood and other fluids. After piercing the skin of your cauliflower ear, slowly draw the syringe plunger to extract blood, pus, and inflammatory fluid. Continue until the plunger cannot be pulled back further or until the area appears fully drained and deflated.
- Gently squeeze the affected ear area while draining to facilitate fluid movement towards the needle tip and out of the ear. Hold the needle as steady as possible to prevent internal ear micro-cuts.
- If pus is present, the fluid may appear milky red; fresh injuries may yield bright red fluid.
- Withdraw the needle slowly and steadily to minimize puncture wound size. Excessive needle movement can cause skin tearing.
Re-sterilize the area. After draining remaining fluid from your ear, disinfect the puncture wound using additional rubbing alcohol, tea tree oil, or alcohol-based sanitizer applied to a clean cotton ball, swab, or soft tissue. As the ear is vulnerable to infection at this stage, thorough disinfection is crucial.
- Although the skin may still appear wrinkled, it typically heals and flattens over time if adequately drained.
- If necessary, allow the puncture to 'weep' for a few minutes, indicating minor ongoing blood leakage.
Apply pressure to control bleeding. If blood continues to trickle or drip from your ear, apply gentle pressure with clean gauze or tissue for several minutes to stop bleeding and promote clotting. Consider bandaging the area after bleeding stops to prevent infection.
- Change the bandage daily or when it becomes wet to maintain cleanliness and prevent infection.
Receiving Professional Attention
Undergo Draining and Compression. Although needle drainage is still practiced, it's not favored due to potential recurrence. Nevertheless, your physician might opt for it, following similar steps as recommended above. Following drainage, a specialized compression wrap is applied to prevent further pooling of blood in the injured ear.
- The primary difference between self-drainage and professional drainage lies in the use of local or topical anesthesia by the physician, rendering the procedure almost painless.
- Application of pressure with a tight bandage aids in reconnecting any torn skin to the underlying ear cartilage.
- Expect the application of gauze to both the front and back of your ear before wrapping it with sterile bandages.
Inquire About Draining and Splinting. This method resembles needle drainage and compression, but instead of a compression wrap, a physician inserts a special splint to maintain constant pressure on the wound for complete drainage.
- Splinting may involve sutures passed through the ear to hold a special gauze in place.
- Alternatively, the splint may be made from pediplast or silicone and molded to fit your ear.
- If a splint is used, your ear requires reassessment by your physician after one week. Sutures are typically removed after two weeks unless there are signs of redness or tenderness. A molded splint may remain in place for a longer duration.
Opt for Incision to Drain Your Ear. The most recommended method for draining a cauliflower ear involves a small incision made with a scalpel. This procedure completely removes the blood, significantly reducing the risk of hematoma recurrence compared to needle drainage. Incision also facilitates the removal of thickly coagulated or clotted blood from the ear.
- This procedure is usually performed by a plastic surgeon or an otolaryngologist (ear, nose, and throat specialist).
- With the incision technique, the wound must be closed with a few stitches, which will either dissolve or be removed approximately a week later.
- The stitches ensure that the detached skin over the cartilage remains in place, allowing proper reattachment to occur.
Pointers
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Besides swelling, other typical symptoms of cauliflower ear are: pain, redness, bruising, and alteration in the shape of the ear.
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Ensure your ear stays dry. It's essential to keep the affected ear dry for the initial day following the drainage procedure.
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Avoid bathing or swimming for the first 24 hours after draining a cauliflower ear.
Cautions
- If you suspect an infection, notify your doctor immediately. A serious infection necessitates treatment by a surgeon through open drainage and intravenous antibiotics. Indications of infection include headache, fever, redness, tenderness, pus drainage, swelling, increased pain, or altered hearing.
- It's strongly recommended to have your ear drained by a professional rather than attempting it yourself. The procedure will be safer and more effective if performed by a skilled individual.
- Seek treatment within the first 24 to 48 hours. During the initial injury phase, the cauliflower ear will be soft and filled with fluid. It's crucial to drain the fluid within this timeframe as it will begin to harden afterward. Once hardened, plastic surgery is required to correct the deformity.
- The trauma causing the cauliflower ear may have also affected your eardrum (tympanum) or other hearing-related structures. Consult your doctor to have your eardrum evaluated and to undergo a hearing test.
Essentials
- Ice pack
- Elastic gauze bandages
- 23-gauge syringe, 3-ml, with 1-inch needle
- Disposable gloves
- Tea tree oil
- Tweezers
- Sterile cotton balls
- Antibacterial ointment
- Athletic foam
