A cauliflower ear – a condition also known as an ear bruise – is a lesion that causes bleeding and inflammation on the inside of the ear, causing the tip to swell. This occurs after a hard blow directly to the site, excessive rubbing when rubbing, or small, repetitive trauma to the ear. Ear bruises are relatively common in wrestling, mixed martial arts, rugby, boxing, and water polo. In general, treatment consists of combating swelling and draining the blood, which must be done within 48 hours of the injury to avoid permanent damage and disfigurement. The use of syringes and needles to drain the cauliflower ear should always be done by medical professionals, unless the situation is an emergency.
Method 1 of 3: Starting Immediate Treatment
Step 1. Apply ice
Immediately after suffering an ear sore that causes swelling, stop the activity and apply ice – or something cold – to reduce inflammation and lessen pain. Ice reduces blood circulation to the space between the skin and cartilage at the top of the ear. Use this method for about 15 minutes with each application (which can be done every one hour or three to four hours from the time of injury).
- Wrap ice cubes, crushed ice, or a cold compress in a thin cloth before applying to the ear, avoiding frostbite or skin irritation.
- An alternative is to use a packet of frozen vegetables or fruits to fight the swelling.
Step 2. Wear an elastic head bandage and compress the injured ear
In addition to applying ice to the swollen ear, use a bandage or elastic bandage around the head, feeling the pressure against the ear. Combining treatment with a cold compress and compression of the site is the most effective way to combat swelling in virtually all musculoskeletal injuries, as pressure helps to reduce internal bleeding more quickly, reducing the deformation caused.
- Another option is to take a large piece of gauze or an elastic exercise band and press the ice against your ear.
- Before wrapping the ear with some compression bandage, apply gauze to increase pressure.
- Do not overtighten the gauze against the ear to avoid headaches or dizziness. Also, avoid holding it in a way that blocks your vision or reduces the hearing of the ear opposite the lesion.
Step 3. Consume anti-inflammatory drugs
Another method of reducing cauliflower ear swelling and pain is by taking over-the-counter anti-inflammatory drugs such as ibuprofen (Advil), aspirin or naproxen (Flanax). Take them as soon as possible after the onset of the condition for best results. Combine them with the application of cold compresses and local pressure.
- Pain relievers such as acetaminophen (Tylenol) will lessen the discomfort, but not the swelling.
- Aspirin and ibuprofen can make internal bleeding worse. It is important to consult a doctor to find out if anti-inflammatory drugs can be used in your case.
- Avoid taking anti-inflammatory drugs for more than two weeks to minimize side effects such as kidney and stomach irritation. For ear hematoma, the use of medications for a few days is enough.
Method 2 of 3: Draining Cauliflower at Home
Step 1. Understand the risks
Although it is possible to drain light swellings in the ear without going to the doctor, especially when the patient has some medical training, the procedure increases the chance of suffering an infection and further complications. It is advisable to try drainage only when there is no possibility of seeing a doctor or health care professional within two or three days.
- Also, only attempt to drain the ear if the trauma is mild, with moderate swelling, and no torn skin.
- Pick up your cell phone and call emergency services for support and advice.
Step 2. Sanitize your hands or wear gloves
Before treating ear bruises, clean your hands with hot soapy water for about 30 seconds and dry them with a paper towel. If you have latex surgery gloves, put them on after washing your hands, but they are not mandatory. Keeping your hands clean and protected greatly reduces the risk of being contaminated at the injury site.
- Those who do not have soap and water can wash their hands with an antiseptic for them with alcohol.
- Moist wipes and alcohol can also be helpful for cleaning your hands in emergency situations.
Step 3. Disinfect and prepare ear treatment
Before draining, disinfect it carefully. Dip a sterile cotton ball in alcohol or witch hazel oil and apply to the upper half of the ear, where swelling is worst. The upper half of the ear is where the skin will be punctured, so it needs to be completely disinfected.
- Witch hazel oil is a natural antibacterial agent, but don't let it get in your eyes as it can sting.
- Apply a good amount of alcohol or witch hazel to coat any slits in the swollen area and on the inside and outside of the upper half of the ear.
- Alcohol patches are also good for disinfecting, as they have alcohol-based sanitizing lotions that can be applied with a clean cotton swab.
- Apply ice for 10 to 15 minutes before puncturing the ear to reduce pain. Ice is a natural anesthetic.
Step 4. Pierce the hematoma with a needle and syringe
If you don't have any at home or near where you are, buy a 20 gauge needle and 2.5 cm, with a 3 ml syringe to puncture the hematoma, which will be filled with blood. The 20-gauge needle is not the smallest, but it is the best choice for sucking thick, clotted blood into the lesion.
- The 3 ml syringe is enough to remove all the fluid, while the 2.5 cm needle prevents the ear piercing from being too extensive, damaging the cartilage.
- Pierce only the swollen part from the middle to the top of the ear, deep enough for the tip of the needle to enter. Do not insert the needle too deeply or further damage may be caused.
Step 5. Remove blood and other fluids
Once the tip of the needle pierces the skin of the hematoma, slowly and steadily depress the plunger to remove blood, pus, and inflammatory fluid. Continue withdrawing fluid until you can no longer push the plunger or until the injured site appears to be free of fluid and completely drained.
- One option is to gently squeeze the hematoma while draining so that all the blood and fluid is drawn to the tip of the needle, making it easier for them to get out of the ear.
- The fluid may look milky and red if there is pus, or bright red if the wound has been contracted recently (a few hours).
- When removing the needle, take your time and do it slowly, with a steady hand so that the piercing remains small. Moving the needle too much can tear the skin, so be very careful.
Step 6. Disinfect the site once more
After carefully removing the fluid that is left inside the ear, disinfect the puncture with more alcohol, antiseptic with alcohol or witch hazel oil, which should be applied to a cotton ball, moistened tissue or soft cloth. If the lesion remains open, the chance of getting an infection at this time will be greater, so it is important to disinfect the area very well.
- Note that the skin will still “wrinkle” after draining, but over time it will heal and will be normal as long as all the fluid has drained.
- The puncture may continue to expel some fluid and blood for a few minutes.
Step 7. Apply pressure to stop bleeding
Depending on the injury and the successful drainage, the ear hematoma may not have any more blood after a few minutes, even if it continues to expel some blood. However, when bleeding persists or drips from the perforation, it may be necessary to apply pressure for a few minutes, using clean gauze or a soft cloth to stop the bleeding and promote clotting.
- After a few minutes of pressure to stop the bleeding from continuing, put a small bandage to cover the puncture and prevent infections.
- It is important to change the bandage every day or whenever it gets wet or dirty.
Method 3 of 3: Getting Professional Treatment
Step 1. Submit to drainage and compression
Although needle drainage is widely used in this type of treatment, it is no longer recommended by many specialists, as in many cases the hematoma recurs. Still, the physician may prefer to perform needle aspiration and apply a technique similar to the one in the previous section. The provider will then apply a compression bandage over the piercing to prevent more blood from pooling in the injured ear.
- In addition to being specialized in performing the procedure, the main difference between the doctor and the treatment performed by the patient is that the professional can apply a local or topical anesthetic so that the puncture is practically painless.
- Applying pressure with a pressure bandage also helps to heal the skin torn apart from the cartilage that underlies it.
- Your doctor will likely apply gauze to both the front and back of the ear before wrapping it with clean bandages.
Step 2. Learn about the process of draining and applying splints
Much like using a needle, syringe and compression, this technique replaces the pressure bandage with a special splint that the doctor will apply to maintain constant pressure on the ear wound, draining it.
- The splints can take the form of stitches and sutures, which are placed in the ear in such a way that the special gauze is immobile.
- Sometimes the splint can be made of silicone and molded to the ear.
- When applying the splint, it is important to return to the office in a week for the doctor to review the site again. The stitches are firm for two weeks until tenderness or redness appears. Molded splints can stay on longer.
Step 3. Make an incision to drain the ear hematoma
The most recommended method of treating cauliflower ear is through a small incision with a scalpel. Making the incision completely drains the blood, greatly reducing the chance of a new hematoma forming, a frequent problem with needle drainage. The incision also facilitates the removal of thick, clotted blood from the inner part of the swollen ear.
- This type of procedure is usually done by a plastic surgeon or an otolaryngologist (specialist in nose, throat and ear problems).
- Through the incision technique, the doctor will have to close the site with some stitches, which will be absorbed by the body or removed by the professional about a week after the application.
- The stitches cause the torn skin to stay on top of the cartilage, allowing it to re-attach.
- In addition to swelling, other common symptoms of cauliflower ear are pain, redness, bruises and deformities in the curvature of the ear.
- Keep the ear dry. The affected site must not be wet for at least the first day after the drainage procedure.
- Do not bathe or swim for 24 hours after draining the affected ear.
- The compression bandage must remain in place for at least 24 hours – and even longer in some cases – to speed recovery.
- When you get home after draining, apply antibacterial ointments to the puncture or incision site to prevent infections.
- Wait a few days to get back to practicing the sport. Wear head protection equipment to prevent this condition from reoccurring. Always wear a helmet that complies with the rules and that fits snugly over your head.
- Your doctor may prescribe topical or oral antibiotics to prevent an infection, especially if an incision was made or your skin was torn apart when you were injured.
- Seek treatment within the first 24 to 48 hours after the injury. In the early stages of the injury, the cauliflower ear will be soft and full of fluid, which must be drained during this period because it will harden soon after. Once the site becomes rigid, the deformity will only be corrected with plastic surgery.
- Go to the emergency room immediately if you suspect an infection has formed. Serious infections need to be treated by surgeons through open drainage and the use of intravenous antibiotics. Some of the symptoms that indicate contamination are: headache, redness, presence of pus, fever, increased pain, swelling, tenderness or hearing loss.
- It is highly recommended that a doctor perform the drainage, not yourself. The procedure will be safer and done with more care by the professional.