Boxer’s Ear: Can your ear explode?

About Dr. Ryan Osborne

Ryan F. Osborne, M.D. is the Director of Head and Neck Surgery at OHNI and is an internationally renowned expert in head and neck oncology. He has developed a special interest for the treatment of parotid gland tumors and focuses on the use of minimally-invasive techniques in the care of patients needing parotid surgery.

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About Dr. Hootan Zandifar

Dr. Hootan Zandifar is board-certified in Otolaryngology and fellowship-trained in Facial Plastics and Reconstructive Surgery. Dr. Zandifar is the director of the Skin Center at the Osborne Head and Neck Institute based at Cedars-Sinai Medical Towers.

No. 3-ranked UFC fighter, Leslie Smith sustained a match-ending right cross to the side of her head in a bout against contender Jessica Eye. The 125lb fighter was forced to stop the fight when a hematoma in her left ear violently ruptured after a direct blow from her opponent. Leslie had been draining a preexisting auricular hematoma multiple times a day leading up to the fight. Smith’s ear continued to fill with blood during the fight and ultimately burst under the pressure of a well placed blow to the ear. Much to Leslie’s dismay, the fight was stopped shortly thereafter. It was definitely the right call, which Leslie also admitted herself after watching the video after the fight concluded. This is one tough fighter, though she may have placed herself under unnecessary risk.

Figure 1: Leslie Smith pictured with a ruptured auricular hematoma of the left ear.
Figure 1: Leslie Smith pictured with a ruptured auricular hematoma of the left ear.

Unfortunately scarred, gnarled, and deformed ears have become a modern day sign of a warrior. Media outlets incorrectly described the injury as cauliflower ear, so we thought we would spend some time highlighting the differences between cauliflower ear and auricular hematomas. Understanding how to prevent both injuries can help to prevent permanent deformity.

What is an auricular hematoma? An auricular hematoma is a swollen and tender collection of blood trapped between the skin and cartilage of the ear. The normal contours of the cartilage are no longer easily identifiable and the ear may feel like a water ballon.

Figure 2: Right auricular hematoma.
Figure 2: Right auricular hematoma.

When should I see a doctor? If an auricular hematoma is not drained and splinted early it can lead to a condition called cauliflower ear.

What is cauliflower ear? Cauliflower ear is the permanent change to the shape of the ear. It occurs when an auricular hematoma is not drained appropriately. Prolonged pressure from an auricular hematoma causes permanent damage to the cartilage of the ear and leads to scarring and disfigurement of the ear’s framework. A cauliflower ear is much harder to treat and difficult to reverse. As such the best treatment for cauliflower ear is prevention with immediate and appropriate treatment of auricular hematoma.

What are my treatment options? Needle drainage of auricular hematomas is not the appropriate treatment to prevent a cauliflower ear. The typical result, after needle drainage of an auricular hematoma is that the blood simply re-accumulates. Furthermore, the needle can only remove unclotted blood and fluid. Needles cannot remove larger blood clots that have already formed. As such, needle drainage of an auricular hematoma is not the appropriate treatment. Proper treatment of an auricular hematoma requires making a small incision on the skin of the ear; the hematoma is then drained completely. A pressure dressing is then applied for 3-5 days so that another hematoma does not re-accumulate under the skin. After the appropriate time has passed the dressing is removed. Headgear should then be worn for 2-3 months to protect the ear as it continues to heal. In cases of preexisting cauliflower ear, the ear can sometimes be sculpted to look like a normal ear after the fighter has retired.

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