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Cauliflower ear (complication of hematoma auris, perichondrial hematoma, or traumatic auricular hematoma) is a condition that occurs when the external portion of the ear suffers a blow, blood clot or other collection of fluid under the perichondrium. This separates the cartilage from the overlying perichondrium that supplies its nutrients, causing it to die and resulting in the formation of fibrous tissue in the overlying skin. As a result, the outer ear becomes permanently swollen and deformed, resembling a cauliflower.
Headgear (called a "scrum cap" in rugby, or simply "headgear" or earguard in wrestling and other martial arts) that protects the ears is worn in wrestling and rugby, many martial arts, and other contact sports to help prevent this condition. For some athletes, however, a cauliflower ear is considered a badge of courage or experience.
Because an acute hematoma can lead to cauliflower ear, prompt evacuation of the blood is needed to prevent permanent deformity. The outer ear is prone to infections, so antibiotics are usually prescribed. Pressure is applied by bandaging, helping the skin and the cartilage to reconnect. Without medical intervention the ear can suffer serious damage. Disruption of the ear canal is possible. The outer ear may wrinkle, and can become slightly pale due to reduced blood flow; hence the common term "cauliflower ear". Cosmetic procedures are available that can possibly improve the appearance of the ear.
Historically, the condition has usually been seen with wrestlers. An extensive literature and serious science on this condition developed between the 1860s and the turn of the century. It was defined as "An effusion of blood or of bloody serum between the cartilage of the ear and its perichondrium, occurring in certain forms of insanity and sometimes among the sane". Alienists (psychiatrists) advanced various theories linking it to abnormalities of bone, blood, blood vessel (specifically the carotid artery) or brain in the insane. Some thought it was involved in all types of insanity, while others thought it to be worse "in those forms of insanity in which the mental excitement runs high for any length of time".
Some theorists argued ardently that it was a symptom of insanity and had nothing to do with mechanical causes. Others argued that it resulted from an interaction between nervous system degeneration in the insane, and mechanical causes such as the insane hitting themselves or being boxed around the ear by asylum staff. It was thought to affect the left ear more often than the right, and it was pointed out that physical trauma might be the easier explanation for this pattern, since most staff were right-handed. It was thought that it could occur in sportsmen, to a lesser extent than among the insane, due to an interaction between mechanical blows and the heat and excitement of physical combat. It is also possible that some ear injuries became infected, the infection spread to the brain, and permanent brain damage resulted, which was then diagnosed as "insanity".
By the end of the first World War the topic disappeared from the medical press and the experts moved onto new fashions. Its mainstream acceptance as a psychiatric symptom has been said to have relevance to scientific and conceptual concerns over psychiatric diagnosis today.
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- Williams, Preston (2008-03-06). "For Wrestlers a Swelled Sense of Pride". The Washington Post. p. PG14. Retrieved 2008-04-02.
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- Berrios, G.E. (1999). "Pieterson's 'Haematoma auris'". History of Psychiatry 10: 371–5. doi:10.1177/0957154X9901003906.
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