This is why rugby players get cauliflower ear

This is why rugby players get cauliflower ear

The Six Nations is about to begin and that means you will see a lot of cauliflower ears on your TV screen.

But what exactly is a cauliflower ear and why do rugby players tend to get them?

Much like wrestling, rugby is a contact sport where players can sometimes be involved in violent collisions with opponents. And in the midst of all those scrums and rucks, players can sustain injuries to the ear.

Graham Rowntree.
Quite a few rugby players, like Graham Rowntree, have cauliflower ears (Rebecca Naden/PA)


Cauliflower ear is caused by blunt trauma to the organ, leading to a deformity of the ear.

The medical term for the injury is auricular hematoma – where the anterior auricle, that is the outer ear, swells and reddens as a result of the accumulation of blood between the cartilage and the tissue surrounding it.

If neglected, auricular hematoma can result in deformities of the outer ear, ie, cauliflower ear.

Ear anatomy.
The outer ear is made up of cartilage, connective tissue and skin (Thinkstock)


The outer ear is made up of a framework of cartilage that forms its ear-like shape. Surrounding the cartilage is a dense layer of connective tissue known as the perichondrium, followed by loose connective tissue – and skin on the outer layer.

The cartilage has no direct blood supply to it (which is also one of the reasons why your earlobes turn cold quite quickly when you go outside in the winter) and is entirely dependent on the perichondrium for its blood supply and consequently nutrients.

When a rugby player experiences trauma to the auricle, the blow can cause the connective tissue, the skin and the cartilage to bundle up.

Paul Gustard.
Cauliflower ear, like Paul Gustard’s, can be caused by blunt force trauma to the auricle (Mike Egerton/EMPICS Sport)


If the impact is strong, it can cause damage to perichondrial blood vessels, resulting in bleeding occurring in an enclosed space where the blood is trapped. The medical term for this is hematoma.

The hematoma ends up working against the body by acting as a physical barrier between the cartilage and its perichondrial blood supply. With no access to sufficient fresh blood, the cartilage starts to die.

It then thickens and scars while new cartilage starts to form. This process of healing and regeneration is chaotic, leading to uneven cartilage formation and ear deformity.

Scrums can lead to injuries among rugby players (Niall Carson/PA)


To treat this, doctors have to ease the blockage so that blood can again flow to the affected tissues.

They do this by making a small incision and draining the built-up blood or removing a clot to prevent further bleeding. The doctor might need to reconnect tissues using stitches and apply a special bandage to put pressure on the area.

This pressure dressing may need to stay in place for several days to allow for the cut to heal.

Sometimes players wear headgear to protect their ears from injury. Pictured, Kelly Brown (Joe Giddens/PA)


Hematomas that are larger than two centimetres or have been around for more than 48 hours will need to be drained with a scalpel instead of a regular needle.

As well as disfigurement, other symptoms of cauliflower ear include ear pain, bruising and swelling. Sometimes, the swelling can spread to the face.

More severe symptoms include hearing loss, tinnitus, bleeding from the ear, headaches and inner ear pain.

If treated aggressively and promptly, a deformity is unlikely to happen. In extreme cases, doctors may refer to plastic surgeons to repair the damage.