If you’ve been grappling or doing MMA for a while, it’s likely you know someone with massive cauliflower ear issues or have them yourself. If you’re an avid fan of the sport, you probably know a fighter or two with these same issues. Even Mixed Martial Arts legends like Randy Couture, Dan Henderson, and Wanderlei Silva all have these massive bunions growing on the side of their heads! It’s probably one of the first things you might see as they make their way inside the Octagon! 

But why is that? Why do even the most grappling elites have cauliflower ears? In this article, we take a look at one of the most common injuries in grappling and MMA alike. We look at Cauliflower Ear – the grappling badge of honor! 

Cauliflower Ear is a common condition in the grappling arts. As it is most commonly known in wrestling, it is sometimes referred to as “wrestler’s ears.” It was nicknamed Cauliflower Ear because the condition makes your ears look like bundled up skin tissue resembling a Cauliflower. But what exactly is it? What causes Cauliflower Ear?

The medical terminology for the condition is called Auricular Hematoma. The condition happens when a collection blood underneath the perichondrium (the elastic cartilage of the ear) which occurs secondary to trauma. The exact epidemiology is unknown, but it mostly happens in martial arts which involve a lot of grappling and clinch fighting.  

Cauliflower ear occurs as the consequence of untreated or improperly treated auricular hematoma. It is a medical condition where the cartilage inside of a fighter’s ear breaks. It leads to disrupted blood supply from the skin. A fluid build-up occurs.   

As cartilage heals, it shrivels up and folds in. As you continue to damage it throughout the years of training, plastic deformation starts to occur, and your ears permanently gets deformed! 

Since grapplers are notorious for not wanting to take breaks away from the mat, these damages build up over time. In a grappling session, you can put pressure against your opponent face to maintain proper head control. This pressure against the ear leaves microtrauma, stopping blood flow to the peripheral parts of your ear.  

Usually the skin is capable of healing itself overtime. But the ears are different. They are much thinner compared to other parts of your body. The healing process isn’t as prevalent. Think of it like a piece of paper. If you crumple it over and over it becomes near impossible to remove the creases! The continuous impact from clinching, striking, or pressure grappling on the ears eventually develops Cauliflower Ear.   

Cauliflower Ear in general can be hassle. People that have it mention that they can be very painful and sensitive to the touch. If left untreated for too long, the condition does become much worse and can be prone to infection. A painful inflammation to the cartilage can form and make the swelling much larger.  

Some severe cases can even cause the ear canal to be blocked. This can really affect your hearing if the swelling gets out of control! 

The pain of untreated cauliflower ear can get so bad that you might be tossing and turning at night. Some fighters report that the pain can get so bad that they even have trouble sleeping. If this happens, make sure to consult your doctor to relieve the pressure on your ears.  

Another risk factor is that there can be massive fluid build up in your ear. One blow to the side of your head can cause it to pop! A bit gruesome to watch but here’s a clip of Leslie Smith’s ear exploding at UFC 180. (Viewer’s discretion is advised).  

One common question often comes to mind when starting grappling is will I get Cauliflower Ear if I try any grappling sport? Will it happen to everybody? Not necessarily.  

When you look at BJJ grapplers that have been doing this a while, your results may vary even if they have a similar game. For example, Andre Galvao, a very top-heavy pressure passer look like his ears been through some times, while Xande Ribeiro’s look unscathed. Both have similar styles but both don’t have the same ear issues. Your fighting style or your genetics might come to play. Some fighters are just prone to it and some aren’t – it really depends.  

The reason these concerns might come up is the bad rep that Cauliflower Ears get. For one they aren’t the most pleasing to look at. They look like shriveled up skin! It can get pretty nasty. Take a look at Alexander Gustafsson’s ears – they’re massive! 

There are a few ways you can treat Cauliflower Ear depending on the level of damage. Some of the main treatment for the damage include:  

It might be unpleasant, but ice prevents swelling. Keep in mind that you can do this even if your ears aren’t swollen. Even if you have slight pain, some ice might do you some good! Here are the steps required:

Here are the steps required:

This is probably the most common practice for Cauliflower Ear Treatment. Apply this process as often as possible at home to prevent permanent damage. It is easy, but you do need a lot of patience. If you have steady surgeon hands, go for it! However, it’s probably best if you have a friend or a doctor do the draining for you.  

Note: Only do this yourself if and only if your hands are steady! Don’t panic, you’re helping yourself! 

Here are the steps:

If your ears are heavily damaged, you may need to use proper first aid to start the healing process. If your ears are so damaged that even a direct blow to the ear can cause your ears to get cut or bleed out, start some first aid.

Here are the steps:

In serious extreme cases when the ear injury is too serious, you might have to resort to plastic surgery. If it gets to the point that you aren’t able to hear due to the swelling or if the pain is just too severe that none of the treatments are working, it might be time for plastic surgery.

If you leave your ears untreated too long, this might be what you might resort to. Rafael Dos Anjos had to undergo plastic surgery when his ear nearly fell off! You don’t want to get to this point. Make sure to treat your Cauliflower Ears! Consult your doctor and surgeon to see if plastic surgery is right for you.  

Probably still the best treatment for Cauliflower ear is its prevention in the first place. You can do so by taking the proper safety precautions when it comes down to training.

Don’t ignore the signs. If your ears hurt, take care of those ears! Make sure you ice them even if they might not be swelling yet. Make sure you get a lot of rest!

And for those BJJ players that can’t seem to stay away from the mats, make sure you make the proper adjustment to your game play. If you are a heavy pressure passer or a half-guard player, maybe switch it up a little. These positions require a lot of close body contact that might rub against the side of your head. These types of movements can easily reinjure your ears and risk developing Cauliflower Ear. Maybe play a little more open guard De La Riva or Spider to keep your distance!

However sometime head contact isn’t avoidable. Your opponent might be able to pass your guard go for choke hold. In this case, if you get caught in a really deep guillotine or triangle, don’t forcefully pull your head out! Every choke attempt carries a heavy risk of ear contact and can easily re-damage your ears if you force yourself. If you don’t have a clear way to get out, just tap. Remember, it’s just training. Permanently damaging your ears just isn’t worth it!

Lastly, the easiest way to protect your ears during a rolling session is to get yourself some proper wrestling head gear. There are some excellent choices out there and they aren’t all that expensive either! Check out some of our picks from Amazon:

Grappling is an excellent sport. But just like anything else, it does come with plenty of risks if you aren’t careful. If you don’t take the proper risk implications, you can develop some major Cauliflower Ear condition.

Remember, your ears are extremely fragile. It doesn’t take a whole lot to damage them. As you grapple more often, you risk re-damaging your ears, and eventually become permanent. And these damages can be painful!

Take the necessary safety precautions to avoid injuring your ears. The pain and hassle that comes with Cauliflower Ear simply isn’t worth it! 

However, if you do have it, keep in mind that they are very common in grappling. It comes with the territory. Wear them proud, you've earned them! Wear them like a badge of honor!