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Protective Gear and Cauliflower Ear: Prevention and Treatment in Combat Sports

Gear and Equipment

The contentsof this article are for informational purposes only.  The contents are notintended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the adviceof your physician or other qualified health provider with any questions you mayhave regarding a medical condition. 

Cauliflower ear, also known as wrestler's ear or perichondrial hematoma, particularly common in martial arts, is a deformity of the outer ear. This condition arises from a blunt trauma or repeated impact to the ear, often experienced in contact sports like wrestling, boxing, judo, Brazilian jiu-jitsu, and mixed martial arts (MMA). In these sports, the athletes often engage in close contact, with frequent clenching and grappling maneuvers. During these interactions, the ears can be subject to a lot of friction and pressure, as they are rubbed against either the opponent's body or the mat. When the ear is struck and a blood clot develops under the skin, or the skin is sheared from the cartilage, the disrupted blood flow can cause the cartilage to die.

As the ear heals, it can become swollen and deformed, resembling the lumpy surface of a cauliflower, hence the name. The condition can also cause pain, bruising, and swelling in its acute phase. If not treated promptly, usually by draining the blood and sometimes requiring more extensive medical intervention, the cartilage can heal in a deformed shape.

MMA fighters with cauliflower ers
UFC fighters: Ronaldo Souza, Nate Diaz, Demian Maia

Cauliflower ear from medical perspective

Cauliflower ear, medically known as perichondrial hematoma, is a deformity of the outer ear that occurs due to a direct blow or repeated trauma.

The condition begins with a trauma to the ear. This can be a single severe blow or repeated impacts over time. In response to the injury, blood vessels in the ear can rupture. The rupture of these vessels leads to the accumulation of blood and fluid under the skin of the ear, specifically between the cartilage and the perichondrium (the layer of tissue that surrounds the cartilage). This is known as a hematoma.The buildup of blood (hematoma) can disrupt the normal blood flow to the cartilage. Cartilage, which gives the ear its shape and structure, is a unique tissue that relies heavily on the overlying skin for its blood supply.In response to the injury and hematoma, the body initiates an inflammatory response. As part of the healing process, the ear can become swollen and painful.If the hematoma is not drained or if the injury and subsequent hematomas recur, the disrupted blood supply can lead to the death of cartilage. The body then attempts to heal the area by replacing the damaged cartilage with fibrocartilage, a denser and more fibrous type of tissue.The new fibrocartilage often results in a lumpy or misshapen appearance, resembling a cauliflower, hence the name "cauliflower ear." The ear can become thickened and deformed, and in severe cases, this can lead to complications such as infection, chronic pain, or even hearing loss.

Types of movements and holds in grappling that lead to ear trauma.

In grappling martial arts, certain movements and holds are more likely to lead to ear trauma, contributing to conditions like cauliflower ear. These activities typically involve close physical contact and pressure, which can cause injury to the ears. Here are some common movements and holds that can lead to ear trauma:

  1. Takedowns: During takedowns, athletes often forcefully bring their opponents to the ground. The ears can get compressed or rubbed aggressively against the opponent's body or the mat, leading to trauma.
  2. Clinches: In clinching, athletes grapple at close quarters, usually to set up throws or takedowns. The ears can be squeezed between the heads of the competitors, causing friction and pressure.
  3. Ground Fighting: Much of grappling occurs on the ground, where athletes attempt to gain advantageous positions. The ears can get crushed or rubbed against the mat or the opponent's body.
  4. Scrambles: These are fast, often chaotic situations where athletes struggle for position. Quick, unpredictable movements can lead to accidental impacts to the ear.
  5. Headlocks and Neck Cranks: Holds like headlocks or techniques that apply pressure to the neck and head can also put stress on the ears.
  6. Guard Position: In sports like Brazilian jiu-jitsu, positions like the guard, where one athlete wraps their legs around an opponent, often involve the head being pressed against the opponent's body, putting pressure on the ears.
  7. Strikes to the Head: While not as common in traditional grappling sports, some hybrid martial arts that incorporate grappling may include strikes, which can impact the ears.
  8. Chokes: Some chokes involve wrapping an arm around the opponent's neck, with the forearm or bicep pressing against the ears.
  9. Escape Attempts: Trying to escape from holds or pins can involve vigorous head movement, which can lead to the ears rubbing or hitting against the opponent or the mat.
  10. Head Pressure: Applying direct head pressure to control an opponent is a common tactic. This can squeeze the ears between the heads of the two athletes.

These movements and holds can lead to acute trauma or cumulative damage over time, resulting in conditions like cauliflower ear. It's important for athletes in these sports to be aware of these risks and to consider protective measures like wearing headgear.

Treatment and Management

Treating cauliflower ear depends on how soon the patient sees a doctor and how severe the ear damage is. It's important to know that you can often prevent cauliflower ear by wearing ear protection during contact sports. This kind of gear helps avoid the kind of damage that leads to cauliflower ear. Studies have shown that wearing headgear in sports like wrestling can reduce ear injuries by about half.

If someone gets a bad hit to the head that hurts their outer ear, they need a full check-up. This includes looking inside the ears, testing their nerves, and making sure their brain is okay. If there are any signs of brain injury, a CT scan might be needed.

The best way to handle cauliflower ear is to stop it before it starts. If you get to a doctor quickly, within six hours after hurting your ear, they can usually treat it right away. This involves numbing the ear and then using a needle to drain any blood build-up. If someone waits longer than six hours, the treatment might need to be more aggressive.

After draining the blood, doctors use special bandages to help the ear heal properly. There are different types of bandages, but all of them work to close up the space and help the ear heal correctly. Without these bandages, the problem could come back.

Even with treatment, the ear problem might return, especially if a bandage wasn't used. That's why patients need to check back with their doctor a few days later to make sure everything is healing well.

In cases where the ear is really bad and it's too late to drain it, surgery is usually the answer. This is especially true for ears that have already healed wrong and are stiff. The surgery depends on how the ear looks. The goal is to fix the ear without changing its normal shape too much. If the ear is really badly damaged, the doctor might need to use special techniques to fix it. However, if the ear isn't causing major problems and the person is still doing activities that could hurt it again, doctors often suggest just wearing ear protection instead of surgery.

Source: National Library of Medicine

Protective Gear

The primary purpose of this gear is to shield the ears from impacts and friction that can cause auricular hematomas, which lead to cauliflower ear. Remember, the best protective gear is the one that is used consistently. Even the most advanced headgear won't prevent cauliflower ear if it's not worn during activities that pose a risk to the ears.

Headgear features

  1. Hard Outer Shell: This component is crucial for absorbing and distributing the force of impacts, thereby reducing the likelihood of direct trauma to the ears.
  2. Padded Interior: The inside of the headgear is usually lined with foam or a similar soft material. This padding not only adds an extra layer of protection but also ensures comfort during prolonged use.
  3. Ear Cups: A key feature of this headgear is the ear cups, which are specifically designed to cover and protect the ears. These cups are usually rigid to prevent the ear from being crushed or folded, and are padded to cushion any blows.
  4. Adjustability: Good headgear must be adjustable to ensure a snug and secure fit. If the headgear is too loose, it can shift during activity and expose the ears to injury. If it’s too tight, it can be uncomfortable and distract from the sport.
  5. Ventilation: Since these sports often involve intense physical exertion, it's important for the headgear to have proper ventilation to prevent overheating and to manage sweat.

This protective gear is particularly important for athletes who are already prone to ear injuries or those who have experienced cauliflower ears in the past. Consistent use during training and competition is essential for effective protection.

Despite its effectiveness, the use of this protective gear can vary among athletes. Some may choose not to wear it due to comfort issues, a desire for greater freedom of movement, or cultural aspects within their sport where wearing such gear is not the norm. However, for those looking to prevent cauliflower ears, the use of appropriate, well-fitting protective headgear is one of the most effective measures available.

cauliflower protective gear
Apply the way of karate to all things. Therein lies its beauty.
Gichin Funakoshi