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Old 04-20-2008, 12:59 PM   #1
supertac

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The Definitive Cauliflower Ear Thread (please sticky)

Every time I log on, there seems to be a new "How do I treat my cauliflower?" or "How do I prevent cauliflower?" thread. So, because I was so sick of seeing this topic done so repetitively, I decided to make this thread. I know I'm only a white belt, but this is a topic I am quite familiar with. So without further ado I give you the...

Definitive Cauliflower Ear Thread

*I take no responsibility for any harm that comes to you or your ear if you choose to drain it at home*

What it is:

Cauliflower ear is term commonly used to describe the appearance of an ear that has had a perichondrial hematoma. A perichondrial hematoma occurs when the ear is struck, hit, or excessively and abrasively rubbed. When hit, the skin on the ear tears away from the underlying cartilage. The perichondium, which supplies nutrients to the cartilage, is also ripped off of the cartilage. If left untreated, the cartilage will be starved of nutrients and die. The blood and puss that filled the gap when the skin was torn off of the cartilage will harden and leave a cauliflower like appearance.

How it happens:

Cauliflower ear occurs when the ear receives a hard strike, or is grinded against for extended periods of time. This is why it is so common among combat athletes and rugby players. In rugby, when tackles occur, the ear can be hit against the athlete being tackled, resulting in cauliflower. In jiu jitsu and wrestling, the ear can not only be struck hard (for instance: during a takedown, your ear hits his hip bone), but also abrasively rubbed (escaping from chokes, headlocks etcÖ). Boxers are also prone to cauliflower ear as the get hit in the head repeatedly. Some people are more susceptible to it than others. I am not, and it takes a big hit to give me any kind of cauliflower.

Treatment:

Multiple treatments are available for cauliflower ear. It is possible to have cauliflower ear surgically fixed once it has hardened. This operation is typically quite expensive and is performed by a plastic surgeon or ENT. If you donít want to do that, then you must treat cauliflower ear as soon as possible. If you leave it for a while(more than about 5-7 days), it will harden and the only way to fix it is the above described treatment.
The most common treatment is to drain the fluid using a syringe (I will go into detail later). Sometimes you hear horror stories about doctors who have never treated cauliflower ear and are not sure how to go about doing it. There are many accepted ways for doctors to treat cauliflower ear. One way to treat it is to have the ENT lance the front of the ear and scrape/suck all the gunk out. After all of the debris is out of the ear, the ENT should bolster the ear. To do this, he/she will put a piece of gauze or a cotton roll on each side of your ear, front and back. The doctor will the sew through the gauze. This keeps the perichondrium attached to the cartilage in the ear, allowing the cartilage to continue living.
The easiest way to treat cauliflower ear is to simply drain it with a syringe. Below is a step by step guide for draining cauliflower ear. Once again, I take no responsibility for any damage or harm you do to yourself or your ear by following the directions below. You do so at your own risk. I highly recommend getting cauliflower ear treated by a doctor so that the risk of infection is lower. The ear doesnít have a lot of blood flow and is at a higher risk of infection. Only your doctor can prescribe antibiotics, and he/she probably wouldnít be too pleased to prescribe antibiotics to you because you got an infection from a home surgery.
1. Take a shower. Be sure to wash your hair, ear, and the area surrounding your ear very well. It may be a little painful to touch the ear, but at least run some water over it for a while. You want these areas to be particularly clean so that you lower the risk of infection.
2. You now need to clean the ear. I know you just took a shower and made them nice and squeaky clean, but you can never be too careful. I have used Hibiclens in the past with good results. It is a surgical grade antiseptic skin cleanser. CAUTION: Do not get Hibiclens in your ear. It says not to on the bottle. Iíve never had it happen to me, but donít take the risk. Pour a little Hibiclens on a cotton swab and wipe the ear with it. Let it sit for a few minutes, then wipe it off using water. You can also use alcohol prep pads. Just wipe the ear with the alcohol swab or prep pad and let it sit for about 20-30 seconds.
3. Now you need to stick the syringe in the ear. Insert the syringe at an angle into the area that has cauliflowered up. Insert the needle in the front of the ear, not the back. Pull back the plunger of the syringe a little bit. You donít want to pull back too much at first. This should start a trickle of blood flow into the syringe. If the flow of blood and puss stops, give the plunger another little pull. Keep repeating this process until the ear has completely drained. If you fill up a syringe, DO NOT SQUIRT THE BLOOD/PUSS OUT AND REUSE THE SAME SYRINGE. Make sure you have another unused, sterile syringe on hand. Simply cap and set aside the filled syringe insert and use the new one in the same manner as the first. When you are done, and the ear looks normal, cap the syringes. You should dispose of them properly in a sharps container. Wipe the ear down with another alcohol swap after it is drained.
4. Sometimes (if youíre lucky) the ear will simply look normal after draining and will not refill. It is best to not take the chance of it refilling (and you having to repeat the above process again). To do this, you will want to make a compression bandage. To do this, take a bunch of gauze, or a cotton roll, and fill the outer crevices of the ear with it. Then use tape (paper tape or cloth medical tape works best) and tape the ear. Hold it down (pinch your ear, thumb in back, forefinger on front) for about 5-10 minutes. This will keep the perichondrium attached to the cartilage and is vital if you want your ear to be normal again.
5. Change the compression bandage often and if the ear refills with blood and puss, just repeat the process. Sometimes it will refill multiple times, but usually with less and less blood each time. Eventually, it should look pretty normal.

Prevention:

Many people choose to not drain their ears because they believe that it is a ďbadge of honorĒ, others are simply training for a fight and canít take a couple days off to baby it. Some people have jobs where they are in the public eye a lot and having a nice fat cauliflower ear would not be ďrespectable or presentableĒThere is a saying: An ounce of prevention is worth more than a pound of cure. Seriously, if you donít want cauliflower then wear headgear. Itís cheap and easy. The problem is that most people find it uncomfortable. The problem is that most jiu jitsu guys just go to Big 5 or Sport Chalet or whatever and buy whatever headgear they have there. Iíve been wrestling for a long time and I can tell you, sports stores sell crappy headgear. The most comfortable headgear has to be bought online. I highly recommend www.suplay.com and www.wwsport.com . In my opinion, the most comfortable headgear is made by Cliff Keen. Try either the Tornado, Twister, or Signature model. All have nice padding and are plenty comfortable. Adidas also just came out with a very comfortable headgear. If you donít want cauliflower ears, wear your headgear. If you donít want to wear headgear, but also donít want cauliflower ears, then you can get it drained, but chances are you will end up with at least a little cauliflower.

If you have any other questions about cauliflower ear just post them in this thread and I will, to the best of my ability, answer them.

Set up, shoot, finish,

ST


Last edited by supertac; 04-20-2008 at 08:49 PM.
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Old 04-20-2008, 01:00 PM   #2
SFinclined

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A lot of good information.

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Old 04-20-2008, 02:12 PM   #3
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Quote:
Originally Posted by supertac View Post
The doctor lanced the front of his ear with a scalpel and the sucked and scraped all of the blood and puss out of the ear. He then stitched the ear back up using cotton rolls (he put one cotton roll on back, and one on front and then stitched around them to make an improvised compression bandage). While this is certainly an imaginative way to treat cauliflower ear, it is most definitely not the best.
The above is ignorant and wrong. What you describe is, in fact, the exact way that a well informed doctor will treat cauliflower ear. The procedure is known as bolstering, and is the quickest and most effective way to insure that the drained ear does not refill. Syringes and compression bandages are not nearly as effective in allowing the skin and cartilage to re-attach. While I'm at it, when an ear is bolstered, the stitching is not around your ear, it's through it. 2-3 stitches are placed through the ear to compress the skin to the cartilage through the cotton bolster pads.

I've drained my own ear with a syringe once, which I had to do multiple times, and kept refilling, over the course of 10 days. I've also had my ears bolstered twice, those healed in 4 days. The doctor who did the bolsters in both cases is a board certified Plastic surgery and Ear, Nose and Throat guy. I'll assume he's more familiar with standards of care for this injury than you are.

Now I wear headgear, all the time.


Last edited by pittfrog; 04-20-2008 at 02:22 PM.
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Old 04-20-2008, 02:19 PM   #4
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Bolstering looks like this.

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Old 04-20-2008, 02:28 PM   #5
supertac

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I have no doubt that bolstering can prevent recurrent filling, but it also requires stitches and subsequent visits to the doctor's office to have said stitches removed. I know people who have had both methods done. The problem with the bolstering is that it left a small scar on my friends ear. Please don't call me ignorant, as I have quite a bit of experience with cauliflower. The bolstering method works, but you have to first go to doctor for the procedure and to get the stitches out. While you may have to re-drain your ear by doing it the way I described, it is something that you can do at home for very little cost. In addition to the very low cost, if done correctly, it will leave no scar and you ears will look perfectly normal.

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Old 04-20-2008, 02:38 PM   #6
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Thanks for the info. My method of dealing with it is to leave it alone. Nature says it's cauli for me, so who am I to argue?!?

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Old 04-20-2008, 03:07 PM   #7
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Pretty solid post, I vote toward stickyness!

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Old 04-20-2008, 03:23 PM   #8
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i've had that bolstering procedure done and it was one of the most painful experiences of my life. I would either use the syringe method or just let your ears get cauli.

Honestly, unless my ears start to look like randy couture's im not too concerned about them.

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Old 04-20-2008, 05:08 PM   #9
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I too support this thread being stickied, it is very informative.

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Old 04-20-2008, 07:30 PM   #10
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I've had each ear bolstered once, and drained one ear multiple times over the course of 10 or so days. Bolstering was more painful, but it also healed my injured ears more quickly than the ear that I drained myself.

If there's a scar from my ears being bolstered, I can't see it, nor can my wife. My wife is kind of anal, and she's on my ass about cauli, because she's concerned my kid will get it from Judo. Believe me, if my persnickety wife can't see the scar, there isn't one. My ears also look entirely normal(ask Frodo), although the cartilage is a bit hard in the spots I've been injured.

As for calling you ignorant, I stand by it. Google the words "auricular hematoma treatment" and you'll quickly see that bolstering is the accepted standard of care, because it effectively mitigates the risk of the hematoma re-filling. Additionally, those who have their ears bolstered, will also most likely be prescribed covering antibiotics, minimizing the risk of infection when compared with multiple rounds of bathroom surgery by a layman. Given that those doing this to themselves are grapplers, the infection risks are not insignificant.

You made bolstering sound as if it was some quack treatment applied only by ignorant doctors, when nothing could be further from the truth. Indeed, there could easily be some people who find that draining their ear injuries themselves is finally too much, and would seek medical attention. The provider of that attention will likely then bolster their ears, which, if that person was stupid and listened to you, they would resist.

I don't want to turn this into a flame war over draining yourself/seeking medical attention. Bottom line, if you're susceptible to cauli, and susceptibility seems to be in part genetic, either wear headgear or just suck it up and resign yourself to effed up ears. I choose headgear.


Last edited by pittfrog; 04-20-2008 at 07:40 PM.
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