Cauliflower ear is caused primarily by blunt trauma or repeated hits to the outer ear, such as during contact sports like wrestling, boxing, or martial arts. This trauma causes blood vessels in the ear to tear, leading to blood pooling between the ear's cartilage and the thin layer of skin covering it. This collection of blood (hematoma) disrupts normal blood flow and nutrient supply to the cartilage, which can result in cartilage death. Over time, the untreated hematoma leads to fibrosis and cartilage deformation, giving the ear a swollen, lumpy appearance resembling a cauliflower. The condition can also arise from nontraumatic inflammatory conditions but is mostly due to direct injury to the ear.
The key mechanism involves blood accumulating between the perichondrium (the connective tissue layer tightly attached to the cartilage) and the cartilage itself, causing cartilage necrosis and subsequent abnormal healing with scar tissue formation and new cartilage growth in a disorganized way.
