5 Causes of Aural Hematoma: Symptoms and Treatment Options

Aural hematoma colloquially is also called cauliflower ear. Aural hematoma is a condition affecting outer ear. It is characterized by swelling, redness and deformity caused due to accumulation of blood between the ear cartilage and its surrounding tissue called perichondrium. Auricular hematoma mostly occurs due to direct blunt injury on the external ear.

It is common among boxers, wrestlers and people playing contact sports. The pooling of blood in the outer ear or the pinna as it is known must be treated immediately because if left untreated it results in external ear deformity. This deformity is called cauliflower ear as its appearance resembles to cauliflower.


  • The external ear or the pinna is mainly composed of cartilage. This cartilage actually gives shape to the ear. It also provides slight movement and flexion to the ear. The cartilage is surrounded by a tissue called perichondrium. The blood vessels do not provide blood to cartilage. The required nutrients are hence received from the perichondrium which has rich blood supply source.
    Hematoma in external ear occurs due to blunt trauma to the external ear. Forceful injury breaks the blood vessels between cartilage and perichondrium (skin). Blood starts to accumulate between the two giving rise to swelling and redness. The collected blood now starts to stimulate growth of new cartilage and fibrous tissue. This tissue is asymmetrical in shape which appears like outer shape of cauliflower.
  • Besides direct blow to the ear, auricular hematoma can also occur as a result of repeated friction and compression to the ear. From repeated forceful friction the perchondrium and the cartilage may separate and the blood vessels may break causing similar accumulation of blood between the skin and cartilage. When this hematoma is left unaddressed it forms fibrous tissue and death of the cartilage leading to what is known as cauliflower ear.
  • Auricular hematoma can occur in anyone due to blunt force injury. People who are most likely to suffer from this condition are boxers, wrestlers, rugby players, water polo and people involved in martial arts.
  • Nowadays auricular hematoma is also seen in people using mobile phones. Prolong physical irritation produced from pressure of the phone against ear can cause traumatize the blood vessels under the skin of external ear. This may lead to form hematoma.
  • On rare occasion auricular hematoma can also occur due to an infection in the upper cartilage of ear. Poorly performed piercing is one such cause.


The symptoms of auricular hematoma are quite easy to recognize. However, the signs and symptoms may depend on the severity of trauma to the ear. Common signs and symptoms are as flows:

  • Visible swelling and redness of the external ear.
  • Mild or severe pain in ear.
  • Change in the shape of ear.
  • Sometimes there is concomitant swelling of face.

In case of severe trauma, patient may also suffer from:

  • Hearing loss
  • Abnormal ringing or fluttering sound in ear known as tinnitus.
  • Bleeding from inside of the ear.


Aural hematoma needs urgent attention as any delay in treatment can lead to tissue death and ear deformity. The best way is to act immediately after the injury has occurred on the external ear. If you are not able to find any doctor nearby, the immediate non surgical measure is to apply ice over the injured ear. This is followed by applying pressure to the ear by wrapping the head and affected ear. Mild to moderate pressure on the injured ear helps to prevent swelling and development of hematoma. Even after following this non surgical procedure it is important to consult the doctor within 2 days. If the doctor finds accumulation of blood has not resolved it may need draining either with needle or with surgical knife depending on the severity. Once the tissue necrosis occur, it becomes difficult to prevent the deformity. Besides drainage doctors also prescribe antibiotics and anti-inflammatory medicines to prevent infection.