We've all been asked by friends who don't watch or play rugby what exactly a cauliflower ear is, and how you get one. We decided to dig into it properly.

What is that thing?

Cauliflower ear is a permanent deformity of the outer ear that develops after the ear is hit, crushed or rubbed hard, usually again and again.

A knock or a shearing force can make blood collect under the layer of tissue that covers the ear's cartilage (the perichondrium, for the scientists among us). This collection of blood is called an auricular haematoma, and it shows up as a soft, swollen, often tender lump on the ear.

The perichondrium is what supplies the cartilage with nutrients. When blood separates the two, the cartilage underneath is cut off. If the haematoma isn't drained, the cartilage can die or become infected, and the body lays down thick, scarred tissue in its place. That leaves the lumpy, folded shape we all know as cauliflower ear. Once that has happened, it can't be reversed without surgery.

Why rugby players get it

In rugby, the forwards suffer most, especially the front row and the locks. Their ears are ground against heads, shoulders and hips in every scrum, ruck and maul. Crouch, bind, set: cauliflower ear.

Wrestlers, Brazilian jiu-jitsu players, judoka and MMA fighters get it too, often even more than rugby players, because so much of grappling involves heads pressed together and ears rubbing on the mat or an opponent's body.

What to do if your ear swells up

The key is to act quickly. If your ear swells after a game or a training session:

  • Get it seen promptly, ideally the same day or within a day or two, by a doctor, a club doctor or an urgent care or A&E service. Don't leave it to "see how it goes".
  • Don't drain it yourself. A clinician will drain the blood through a needle or a small cut, under a local anaesthetic.
  • Expect a compression dressing. After draining, the ear is usually packed or bolstered with a pressure dressing so the blood doesn't collect again. This is the step that stops the swelling coming straight back.
  • Follow the aftercare. You may be given antibiotics to protect against infection, asked to come back for a check after a day or two, and told to avoid contact training for at least a couple of weeks.

A recent emergency-medicine review (Long and colleagues, 2025) recommends offering drainage for a fluid-filled haematoma within seven days of the injury, followed by a compression dressing. The sooner it's drained, the better the chance of a normal-looking ear. A haematoma can also come back, which is why a lot of front-rowers and grapplers end up with repeat visits.

If an ear that has been drained becomes hot, red, more painful, or you feel unwell, see a doctor quickly, as these can be signs of infection of the cartilage.

Can you prevent it?

You can lower the risk:

  • Scrum caps. Some players wear a scrum cap or headguard for scrums and contact. Not everyone likes them, as some feel they restrict hearing or peripheral vision, but they do reduce the friction and impact on the ears.
  • Tape. Taping the ears flat to the head is the old-school option. It's uncomfortable, but it helps some players.
  • Wrestling-style headgear. In grappling sports, ear guards are the standard protection.
  • Early treatment. The best "prevention" for a permanent cauliflower ear is getting any swelling drained early.

Over the years various inventors have tried to improve on the scrum cap. Back in 2018, for example, a rugby mum called Brenda Phillips developed a silicone ear guard designed to reduce the impact on the cartilage, aimed at players in rugby, wrestling and other contact sports. If you do go looking for ear protection, check that it's allowed under your competition's rules.

Even with all of this, we suspect cauliflower ears will be part of the game for as long as there are scrums.

Cauliflower ear in BJJ and wrestling

For grapplers, cauliflower ear is almost a badge of membership. Ears get ground into the mat and against opponents in guard, in head-and-arm positions and when escaping pins. Many wrestlers wear headgear in training for exactly this reason; in Brazilian jiu-jitsu it's less common, though plenty of players start wearing it after their first swollen ear.

If you're new to the sport, JitsAI's beginner's guide to Brazilian jiu-jitsu and how it works explains the positions where ears take the most punishment. The same advice applies on the mat as on the pitch: if an ear swells, get it drained early and keep it compressed afterwards.

The bottom line

  • Cauliflower ear starts as a haematoma: blood trapped between the ear's cartilage and its lining after a knock.
  • Treated early, with drainage and a compression dressing, it can usually be stopped from becoming permanent.
  • Left alone, the cartilage can die and scar, leaving a permanent deformity.
  • Scrum caps, headgear and tape all lower the risk.

Source

  • Long B, Mason J, Bridwell RE, Gottlieb M. Managing auricular hematoma: an emergency medicine narrative review. Journal of Emergency Medicine, 2025; 69: 62 to 75. PubMed 39904638