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Cauliflower Ear Prevention and Treatment (The Good, the Bad, and the Ugly)

“Wrestler’s ear, an acute hematoma of the external ear, is commonly associated with wrestlers and other athletes who engage in contact sports. It may occur even when protective ear guards are being used.”
–  The Journal for Athletic Training

Basically, cauliflower ear occurs when the skin and cartilage of the ear separate due to trauma which allows the ear to fill with blood which eventually hardens.

How cauliflower ear strikes – Rough contact with the ear. This damage can happen in an instant in fight sports. For example, one hard takedown, while escaping a hold, or a single accidental punch can cause cauliflower ear.

Why is this important? – Unlike a normal bruise where the clotted blood has somewhere to go, the blood in the ear has no escape, so it hardens exactly where it is and then becomes a permanent deformity.

Long-term consequences – The consequences of fully formed cauliflower ear range from simply having deformed ears to problems such as:

Trouble using headphones

Prejudice in professional settings

Loss of hearing

The outer edge of the ear can even fold over and die!


The one common consequence for all who experience cauliflower ear is pain. It hurts when you train, it hurts when you’re done, it hurts enough to keep you awake all night!

Cauliflower Ear Misconceptions

One of the biggest misconceptions about cauliflower ear is that most people believe that it’s something that takes years to develop and happens slowly over time. While this can be the case for some athletes, for many cauliflower ear is something that essentially occurs overnight after a single instance of trauma to the ear.
This is the tricky part of cauliflower ear and why most people encourage the use of headgear every time someone steps on the mat as well as the problem if its ever not used.

Since the 1950’s headgear has been an integral part of the sport of wrestling with the simple and mostly effective idea of creating a pocket of protected area around the ears so that they are safe from trauma.

Most of the time the use of headgear is effective when used correctly. However if used incorrectly, such as not having the straps correctly tightened, the headgear can shift while wrestling, hitting the ear and causing the same trauma it was designed to prevent.

Malfunctions happen rarely, but what happens very frequently is lack of compliance in wearing headgear. This is why the misconception that cauliflower ear doesn’t happen right away is so dangerous. Although competing in headgear is required for many schools and tournaments, practice isn’t often regulated, and many tournaments leave it up to the choice of the athlete.

In fact, the NCAA has been debating whether or not they should continue recommending it to athletes altogether:

“The committee still recommends the use of ear protection, but it has been proven that ear protection offers no protection when it comes to concussions,” Branch said. “In some cases, the ear protection may irritate or be abrasive to the athlete’s ears and promote cauliflower ear.  We felt our collegiate athletes are mature and educated enough to decide what is best for them and their particular situation.”

This is why a large number of collegiate wrestlers get cauliflower ear during their freshman year. When students transition from having their parents and/or coaches forcing them to wear headgear to having the opportunity to choose whether or not to use it, the majority of students decide to go without.

Most wrestlers will tell you that their headgear is annoying to wear. It dampens hearing, the chin strap gets sweaty and uncomfortable and worst of all it creates even more friction and offers another handle for your opponent even though they aren’t supposed to grab it.

With cauliflower ear often happening due to a single blow to the ear and the dislike for headgear, it’s no wonder so many wrestlers end up with the deformity.

What to do if the ear is damaged or an athlete gets cauliflower ear?

*This is as good a time as any to say that you should consult a medical professional before making any sort of decision or action regarding your body and health.

Since cauliflower ear is permanent once the fluid in the ear hardens, time is really of the essence once the ear experiences trauma. Quick action before the ear fills will prevent the need to perform any sort of operation and we will discuss a proven way to accomplish this in a moment. If the ear is allowed to fill with fluid, the fluid must be removed before it sets or there is no way to repair the deformity except for costly reconstructive surgery.

Draining Cauliflower Ear

There are two main procedures doctors may take to remove the fluid from a damaged ear. Each method has pros and cons.

1) A doctor can make a small incision with a scalpel to drain the accumulated blood. He or she may 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 a week. The site will require monitoring for signs of infection or signs that additional treatment may be needed.  Antibiotics may also be prescribed.

2) A medical professional may also use a syringe to pull the fluid from the ear. This is the most common version of treatment, often seen on the internet in videos of coaches and teammates draining the ears. Once again, we do not recommend dealing with a fully damaged ear on one’s own.


The problem with the incision is that it is very painful, leaves a large scar, and the athlete is unable to practice or compete for weeks at a time. The benefit is that the stitches keep the ear from refilling before the athlete returns to the mats.
The problem with draining via a needle or syringe is that it still leaves scar tissue (though less than a scalpel) which makes it easier for recurrence in the future, and without the stitches to keep the ear knit together, the ear simply refills with fluid again and again. Since many drain their ears on their own, there is also the danger of infection.
Also, neither of these methods do anything long term. The strategies discussed above may work to keep the ears shape in the moment, but the second they return to the mat they are in danger of a reoccurrence of cauliflower ear, starting the process all over again.

Ear Splints

This is why the newer technology of ear splinting has become so popular.

The basic idea is that the athlete makes a mold of their ear, preferably before their ear is damaged. The mold is then worn off the mat like a retainer to compress the ear after trauma, ensuring that it doesn’t takes on fluid. If fluid is not allowed to build up in the ear, then cauliflower ear cannot develop.


Not only does it work to prevent cauliflower ear even if an athlete chooses not to wear headgear, but for those unlucky enough to have a filled ear, it makes the healing process faster and less painful.

This process was first documented in the 1992 article from The Journal of Athletic Training “A Simple Splint for Wrestler’s Ear” by Thomas Keating MD, and again in the 2004 article “Case Presentation: A Novel way of Treating Acute Cauliflower Ear in a professional Rugby Player” in the British Medical Journal.

Here’s a quick video of Corey James, the Head Athletic Trainer for USA Wrestling talking about why they use EarSplintz.

“I think it’s a phenomenal product for the general public to be able to use…Being able to apply that in the youth setting really allows the athletes to keep the shape of their ear better. Especially if they’re not interested in wearing headgear.”

This is novel for a few different reasons. First and foremost, headgear now becomes a bonus protection rather than the true prevention of cauliflower ear. If an athlete doesn’t wear headgear, they can simply wear their pre molded splint as soon as they get off the mat when their ear is hurting to prevent the ear from filling.

Second, where normally someone who experiences trauma to the ear would need to stay off the mats for days at a time, the ear splint helps the ear heal faster so they can return to the mat the next day.

Third, if an ear does fill with fluid, the doctor can now use a syringe to drain without fear of fluid accumulation since the mold will keep the ear compressed to prevent refilling.

One final benefit is that the molds can be put in the freezer to wear as a cold compress. This is incredibly soothing when dealing with the pain of a hurt ear.

Here is a video of our partner EarSplintz showing how the molds are made:


EarSplintz has been helping grappling athletes prevent and treat cauliflower ear for the past 10 years and the NWCA (as well as USA Wrestling) are proud to have partnered with EarSplintz on the mission to prevent cauliflower ear for all athletes who don’t want the deformity.

This is the final aspect of cauliflower ear that is potentially dangerous to the sport of wrestling is the thought that cauliflower ear is a badge of honor.

This isn’t something we can really make easy changes to as it can be rooted deep in teams’ cultures. All we can really point out is the consequences of cauliflower ear to the wrestler and the sport.

The more prevalent cauliflower ear is among wrestlers, the harder it becomes to recruit new members into the sport when the athlete or the parents are now scared that the athlete will develop this deformity if they choose to participate.

There is no true advantage to having cauliflower ear. It hurts, it compromises performance, it means time off the mat and sleepless nights.

We urge coaches to have a conversation with their athletes and their parents about cauliflower ear and how it can be prevented easily with a tool like EarSplintz, and to encourage their athletes to focus more on their actual trophies, their friendships, and the knowledge and experience they’ve gained through their sport instead of looking for something like cauliflower ear to “prove” that they are tough and that they have skill.

After all, there may come a time in their lives when “the badge of honor” becomes an unnecessary hurdle on the path towards their goals.

Learn More about EarSplintz at and use promocode NWCA for an extra $10 off!

If you’re a coach and want to help protect your team please visit

Partnership Release – Link