Other hearing diseases

Understanding the causes & treatments of auricular hematoma

Auricular hematoma, also known as cauliflower ear, is a condition caused by an injury to the outer ear. Learn more about how it happens and why preventing it is important.

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Dr. Thomas Tedeschi, Au.D.

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Definition

Causes

Symptoms

Treatments

Complications

FAQs

Key takeaways

Auricular hematoma is a buildup of blood underneath the skin of the outer ear.
“Cauliflower ear” is a common name for the condition, since it causes a puffy, puckered appearance in the ear.
It is mostly caused by trauma to the ear, often from contact sports, but also from accidents, falls or piercings. It can also be caused by infection or even overuse of mobile phones.
Symptoms can include swelling, pain, bruising and tinnitus.
Treatment involves draining the wound and then keeping pressure on it afterward to prevent blood from re-accumulating.
Auricular hematoma is prone to re-occurring, so fast and proper treatment is important. It’s ideal to see a doctor for treatment within 48 hours of the injury.
Scarring of the outer ear caused by auricular hematoma can contribute to conductive hearing loss.

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Definition of auricular hematoma

What is auricular hematoma? The definition of this medical term is a buildup of blood underneath the skin of the outer ear. It is also sometimes called a “pinna hematoma” because it develops on the pinna (the outer part of the ear), but you might know it by its more common name, “cauliflower ear.”

Causes of auricular hematoma

Individual auricular hematoma causes vary, but ultimately, it’s due to an injury that tears apart layers of ear tissue or damages the cartilage (the stiff material that gives your ears their shape). Blood then collects where the injury occurred. If left untreated, scarring causes the puffy and puckered look that led to the name “cauliflower ear.” Injuries that lead to auricular hematoma are associated with:

Contact sports (e.g. wrestling, boxing, rugby)
Vehicle accidents
Falls
Piercings

But, besides trauma, what could cause auricular hematoma? There are a few possibilities:

Infection
Medical conditions (e.g. leprosy)
Congenital issues
Cell phone use

It’s true: there are some auricular hematoma cases caused by mobile phones. The pressure of the phone up against the ear can cause tissue and blood vessel irritation — but this is only likely with excessive use. Studies of cell-phone-related auricular hematoma showed that people who developed them were using their phones for three to four hours per day over an extended period.¹

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Symptoms of auricular hematoma

If you’ve had an ear injury, pay attention to auricular hematoma symptoms such as:

Swelling of the ear
Ear pain
Ear bleeding
Bruising or discoloration
Tinnitus

Conditions similar to auricular hematoma

As doctors work to identify your condition, they have to consider other causes that may have similar looks or characteristics, in order to rule them out. This is called “differential diagnosis”.² For auricular hematoma, differential diagnosis conditions might include:

Abscess (a collection of puss caused by infection)
Cellulitis (a bacterial infection)
Hemangioma (a non-cancerous tumor caused by irregular blood vessel growth)
Keloid (a type of scar with a puffy appearance)
Otitis externa (outer ear infection)
Perichondritis (an infection that inflames the ear tissue)
Skin cancer
Sunburn

Auricular hematoma: common occurrence areas in ear

Each section of the ear has a specialized medical name, so let’s look at the spots where auricular hematomas form most often:

Helix: The “rim” at the top of your ear
Antihelix: The inner “ridge” of the ear, just inside of the rim
Tragus: The bump that’s on the outside of your ear canal opening, nearest to your cheek
Antitragus: The bump on the opposite side of the ear canal opening

However, hematomas can form in other places around and in the ear as well.

It’s possible to develop an auricular hematoma behind the ear as well. The same kind of tissue damage — separation of the skin from the cartilage — that causes a pocket of blood to form on the front of the ear can also happen on the back side.

When it occurs behind the eardrum, hematoma is known as hemotympanum. This buildup of blood in the middle ear can be caused by trauma, ear infection, bleeding disorders or nasal packing (the insertion of gauze or cotton in the nose to stop bleeding). It’s a different condition than auricular hematoma and requires other kinds of treatment.

Perichondrial hematoma is a medical term that doctors might use to add specificity about where a hematoma occurs. There’s a layer of tissue under the skin — the perichondrium — which covers the cartilage. When blood collects between the perichondrium and the cartilage, as opposed to within the cartilage or between the skin and the perichondrium, it’s called a perichondrial hematoma.

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Treatments of auricular hematoma

There are a few kinds of auricular hematoma treatments, but it’s always advised that if you have an ear injury, you should see a doctor as soon as you can.

For auricular hematoma aspiration, your doctor will use a needle and syringe to draw blood from the injury. With the blood removed, the tissue layers can be brought back into contact to prevent scar tissue from forming. This treatment typically works better on small, new injuries (less than 48 hours old).

In auricular hematoma incision and drainage, an incision is made in the ear so that blood clot can be drained out. The goal is the same as needle aspiration — removing the blood so that the layers of tissue can heal together — but this method is more often used on hematomas that are larger and more than 48 hours old.

Auricular hematomas have a high tendency to reoccur — and the hole-punch technique was developed to prevent that from happening.

In this procedure, doctors make an incision in the ear and then use a tool to punch tiny holes in the cartilage. These holes allow the tissue layers under the cartilage and on top of the cartilage to come into contact. When they heal together, it tightens the tissue and there is less room for a hematoma to reform.

Auricular hematoma surgery, or otoplasty, can be done to help improve the appearance of cauliflower ear. In the procedure, doctors remove scar tissue and then work to rebuild the ear; they may use a prosthesis or cartilage taken from the ribs.³

Care and management of the ear after auricular hematoma

Post-auricular hematoma treatment is important and needs to be monitored carefully to prevent the tissue from separating again and allowing another clot to form. The key to this is constant pressure on the ear, which can be done in a few ways. Before attempting the treatment options below, consult with your doctor to ensure it is safe and appropriate for your condition.

Auricular hematoma pressure dressing is a non-invasive method. Petrolatum gauze (gauze soaked in Vaseline) is molded to the shape of the ear and then a bandage is wrapped around the head. The bandage should be tight enough to put pressure on the ear, and the molded gauze places more direct pressure on the hematoma site.

In auricular hematoma bolster dressing, either petrolatum gauze (see pressure dressing, above) or dental rolls (small cylinders of compressed cotton), are placed on the front and back of the hematoma site and held in place with stitches. These “bolsters” apply pressure that can prevent another clot from forming.

For auricular hematoma, mattress sutures are another way of applying post-treatment pressure. In this method, stitches are made directly in the ear at the hematoma site, putting pressure on the tissue to prevent more blood clotting.

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Complications of an auricular hematoma

Auricular hematoma complications can be simply cosmetic — or more serious.

Re-occurring hematoma: If the ear tissues don’t reattach properly, they can re-tear and lead to another hematoma.
Chondritis: The ear cartilage can become inflamed, causing swelling and discomfort.
Conductive hearing loss: Changes to the structure of the outer ear can partially block sound from entering the ear, or they can make it harder for the ears to naturally drain earwax. Either case can lead to what is known as conductive hearing loss, in which when a physical blockage reduces your ability to hear.
Infection: Wounds that are not properly cared for can become infected.

FAQs about auricular hematoma

No. An inner ear infection cannot cause auricular hematoma. However, infections like perichondritis (which affects the perichondrium tissue of the outer ear) can lead to auricular hematoma.

Ideally, auricular hematoma should be drained within 48 hours of the injury occurring. Early treatment can help reduce the development of scar tissue and the risk of recurring hematomas.

Sources

^{1 Halil E. Özel, Selahattin Genç, Erkan Esen, Fatih Özdoğan, Adin Selçuk, Auricular hematoma cases caused by mobile phones, Oral and Maxillofacial Surgery Cases, Volume 1, Issue 4, 2015, ISSN 2214-5419. https://doi.org/10.1016/j.omsc.2015.10.002.}

^{2 Hohman MH, Jamal Z, Krogmann RJ, et al. Auricular Hematoma. [Updated 2024 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK531499/.}

^{3 Putri IL, Bogari M, Khoirunnisa A, Dhafin FR, Kuswanto D. Surgery of Severe Cauliflower Ear Deformity. Plast Reconstr Surg Glob Open. 2023 Apr 19;11(4):e4953. doi: 10.1097/GOX.0000000000004953. PMID: 37091928; PMCID: PMC10115543. https://pmc.ncbi.nlm.nih.gov/articles/PMC10115543/.}