How soon should treatment for cauliflower ear be initiated?

Treatment Timing for Cauliflower Ear

Cauliflower ear must be treated within 48-72 hours of injury to prevent permanent deformity. 1

Understanding Cauliflower Ear

Cauliflower ear (wrestler's ear) is an auricular deformity that occurs following trauma to the external ear. The trauma causes:

• Subperichondrial hematoma formation
• Separation of cartilage from perichondrium
• Loss of blood supply to cartilage
• Subsequent necrosis, fibrosis, and cartilage overgrowth

Treatment Timeline

• Immediate to 72 hours: Critical window for intervention
  • Hematoma evacuation and compression should be performed as soon as possible
  • Delay beyond 72 hours significantly increases risk of permanent deformity 1
  • Fluid frequently reaccumulates after simple aspiration, requiring definitive treatment

Recommended Treatment Approach

1. Immediate evacuation of hematoma:

   • Aspiration with needle or small incision
   • Complete drainage of blood/serum

2. Compression application:

   • Tie-through suture technique with buttons 1
   • Silicone mold application 2
   • Ensure even pressure across the entire auricular surface

3. Follow-up monitoring:

   • Re-evaluate within 24-48 hours
   • Check for fluid reaccumulation
   • Reapply compression if needed

Warning Signs Requiring Urgent Care

• Increasing pain beyond 48 hours
• Signs of infection (increasing redness, warmth, fever)
• Reaccumulation of fluid despite treatment

Complications of Delayed Treatment

• Permanent cartilage deformity
• Fibrosis and scarring
• New cartilage overgrowth
• Potential for auricular perichondritis 3
• Need for complex surgical reconstruction 4, 5

Prevention for At-Risk Individuals

• Protective headgear for wrestlers, boxers, and other contact sport participants
• Immediate medical attention after ear trauma

Treatment of Established Cauliflower Ear

For deformities that have already developed due to delayed treatment:

• Surgical reconstruction options are available but complex 6, 4
• May require costal cartilage framework reconstruction 4
• Ultrasonic aspirator techniques for recontouring 5

Remember that the window for preventing permanent deformity is narrow. The best outcomes occur when treatment is initiated immediately after injury, and certainly within the first 72 hours.