Combat Arts Ear Injuries Overview
Ear injuries make up a much smaller share of martial arts injuries than hand, head, or face injuries, but among grapplers they are close to universal — and the site does not have a reliable figure to put on that. Sweden’s favorite fighting son, Alexander Gustafsson says, “I’m proud of them, it means I’ve gone through some tough battles.” It’s not unusual to see the infamous cauliflower ears among martial artists. Ear injuries come with a long history of fighting.
Whilst grappling and practicing mixed martial arts, it’s not uncommon to see a person’s ear on the verge of hanging, because the cartilage is vulnerable and can easily be ripped off during a fight. Over a long career, repeated damage to the ear can damage and alter not only the external ear’s appearance but the internal structures as well.
It’s considered an occupational hazard for many who do combat sports. Ear injuries also get complicated fast because gyms and lockers are dirty. The towels used and the subsequent procedure of repeatedly trying to drain an ear following a fight can be a source of bacteria. Moreover, symptoms are often ignored in view of more pressing concerns like head and neck injuries.
Ear Injury Causes
Some martial artists wear ear guards to protect the ear from injury. However, visible ear injuries like cauliflower ears are worn like a badge of honor. In martial arts, there are specific moves like the ear clap or cupped ear blow, which are designed to attack an opponent’s ear to force them to release you.
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Additionally, to avoid injuring the face, instinct always causes fighters to turn their face sideways, resulting in a blow to the ear. The ear is nothing but cartilage. It can easily be torn off or injured during a fight. Most fighters don’t wear any protective headgear and so just accept the deformities that come with ear injuries and get on with it.
Ear Injury Symptoms
Types of Ear Injuries
The ear is extremely vulnerable to blunt force trauma because of the absence of bones to protect it. Injuries can also rupture the structures inside the ear like the eardrum and the ossicles or smaller bones inside. Some of these injuries are irreversible and can lead to permanent deafness. Here are a few common ear injuries among martial artists: Auricular Hematomas, Perforation of the Tympanic Membrane, Hearing Loss.
Related Injuries
You must have seen these often. BJJ and other MMA fighters have deformed “cauliflower ears” after years of fighting and grappling. The infamous “cauliflower ear” is nothing but an auricular hematoma. An auricular hematoma is an unresolved collection of blood in the perichondrium of the ear.
The perichondrium is the large layer of connective tissue that surrounds the cartilage. It occurs due to repeated trauma. The MMA legend BJ Penn’s left ear is often singled out as an example. Over his illustrious career as a BJJ black belt artist, his ears have been under repeated assault. What’s left of his ear, is two small pieces of tissue barely held together in the middle.
Causes
The auricle of the ear is made up of skin, subcutaneous tissue, muscle, and the perichondrium which supplies the cartilage with blood. During a fight, when blunt force trauma occurs, blood pools between the cartilage and the perichondrium.
This is due to the damage to the perichondrium and the two main vessels supplying the cartilage namely, the superficial temporal and posterior auricular artery. Due to the trauma, the perichondrium separates form the cartilage allowing space to grow where the blood accumulates. Once the blood fills this space, it starts affecting the adjacent tissue as well, causing the cartilage to deform.
If this blood is not evacuated, it clots and stays where it is. Over time, with repeated trauma and further accumulation of blood, the clot scars and calcifies, giving the ear the permanent cauliflower appearance. How long that takes varies from weeks to months. That is exactly why draining the blood early matters more than any fixed deadline — once it has calcified, it is not coming back out.
Symptoms
To learn how Auricular Hematomas are diagnosed, click here.
A perforated tympanic membrane is a tear or hole in the eardrum, the thin membrane separating the external ear canal from the middle ear. It can lead to hearing loss and repeated middle ear infections. When a perforation bleeds, the blood comes out through the external ear canal — not from the inner ear. Clear, watery fluid draining from the ear after a blow to the head is a different and far more serious sign: it can mean a skull fracture, and it is a reason to call emergency services rather than wait and see.
Symptoms
Causes
Insertion of a weapon or even smaller objects in the ear can cause the tympanic membrane to rupture. Blunt force trauma to the ear via an open-handed slap or head trauma can also cause the delicate structure to rupture.
To learn how Perforation of the Membrane is diagnosed, click here.
Disruption or injury to the tympanic membrane or the eardrum can lead to conductive hearing loss. Conductive hearing loss means sound cannot travel normally through the outer and middle ear, while the inner ear and the hearing nerve are still working. A blow to the head or ear can also damage the inner ear or the hearing nerve itself, which causes sensorineural hearing loss. Hearing that drops suddenly in one ear is a medical emergency. Steroid treatment for sudden sensorineural hearing loss works best when it starts within roughly 72 hours, so get to an ENT or an emergency department the same day — do not wait to see whether it comes back.
Significant middle ear trauma can cause hearing loss. Slaps to the ear, blunt force trauma to the ear can damage the small aural bones inside the ear. Blood or fluid in the middle ear can also prevent hearing which further worsens hearing loss.
Disruption of the ossicular chain — the three small bones that carry sound across the middle ear — can cause lasting hearing loss, though it can often be reconstructed surgically. Temporal bone fractures can also cause hearing loss. The loss may be conductive, sensorineural, or a mix of the two, and only a proper examination and hearing test can tell them apart.
To learn how Hearing Loss is diagnosed, click here.
Ear lacerations commonly occur on the pinna. This area of skin covered cartilage forms the majority of the external ear. You will have seen MMA fights where the ear is practically hanging off the face after a blow to the ear.
Lacerations run from simple tears to complete avulsion or amputation of the ear. Facial cuts are among the most common injuries in MMA competition, but there is no dependable figure for ear lacerations on their own, so treat any number you see quoted with suspicion. What matters is knowing what to do with an ear laceration and when to get help.
Due to the prominent position the ear enjoys as it overlies a bony surface, it is somewhat exposed. Its structure is also challenging due to its delicate nature and shape. When the ear is ripped or caught by a blow or weapon, it shreds easily due to the cartilage. Repair and healing are also difficult because while the skin heals easily and quickly cartilage takes time.
To learn how Lacerations are diagnosed, click here.
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Common Ear Injuries
Learn more about injuries such as fractures of the facial bones that can cause changes in hearing in our Common Injuries section.
Ear Injury Diagnosis
Ear injuries are very visible and hard to miss. The external ear has a rich blood supply — chiefly the superficial temporal and posterior auricular arteries — so it bleeds freely and swells fast. External ear injuries are diagnosed easily. Inner and middle ear injuries, however, require further investigation with otoscopy and otomicroscopy. To test the VIIIth nerve and hearing function, multiple hearing tests are conducted before and after treatment.
Injury Specific Diagnosis
Physical Exam
A thorough ear exam must rule out injuries to the middle ear. If there is diffuse pain in the ear on palpation, warmth, or erythema then it likely may not be a hematoma. Not all ear swellings are auricular hematomas. A medical professional can judge the severity after a physical exam.
Imaging
Lab Tests
To learn how Auricular Hematomas are treated, click here.
Physical Exam
On physical exam, the ear is inspected. Rinne and Webbers tests are performed to check hearing. Otoscopy is generally diagnostic for perforation of perforations of the tympanic membrane. If blood is present in the external canal, then it is carefully suctioned. For small perforations, otomicroscopy is done or middle ear impedance studies are more diagnostic.
Imaging
No imaging is required unless a basilar fracture is suspected.
Lab Tests
Blood tests are not recommended unless an infection is suspected. If an otitis media infection is suspected, then a baseline complete blood count is done. Audiometry is performed instead of blood tests. Audiometric studies are usually done before and after treatment. An audiometry test is a painless non-invasive hearing test. Hearing for different sounds, pitches, and frequencies are tested.
To learn how perforation of the membrane is treated, click here.
Physical Exam
A detailed physical exam is conducted to determine the type of hearing loss. An otoscope exam will determine the presence of infection or fluid accumulation in the ear canal. It will also check the status of the tympanic membrane. Screening tests like the whisper test where how a person can hear various sounds with the ear covered are done. How a person responds to other sounds is also checked. Tuning fork tests are also helpful. They reveal where the damage has taken place inside the ear.
Imaging
Fluid behind the eardrum is assessed by looking in the ear with an otoscope and by tympanometry, not by ultrasound — bone blocks the sound waves, so ultrasound is the wrong tool here. Imaging is reserved for suspected fractures, and a high-resolution CT is the study that shows a temporal bone fracture. An MRI is added when the question is soft tissue or a problem behind the cochlea, such as injury to the hearing nerve, rather than the fracture itself.
Lab Tests
Audiometer tests are done to determine the frequency and pitch at which sounds are heard. Each tone or sound is repeated at various levels to determine the lowest level the ear can perceive.
To learn how hearing loss is treated, click here.
Physical Exam
All lacerations must be examined carefully for dirt, debris, and foreign bodies. Review all vaccinations. Measure the depth and length of the laceration. Ensure the laceration does not communicate with any internal structure of the middle ear, skull, or face. Check for any hematomas, hearing acuity, tragal tenderness, and warmth in the area. An otoscope exam will determine any damage to the internal ear.
Imaging
Since lacerations bleed a lot, they tend to look worse than they appear. Initial Xray images are helpful to rule out any basilar fractures of the skull. They are also helpful to determine any facial hairline fractures. CT is done if internal injuries and abscesses are suspected. Though CT is not common and is not done routinely.
Lab Tests
If it is a fist or a foreign body/weapon that has caused the laceration, baseline blood tests are required to rule out the presence of any infection. Complete blood count, erythrocyte sedimentation rate, total lymphocyte count, and antibodies to tetanus are ordered. The latter is ordered if the tetanus vaccination status is unknown.
To learn how Lacerations are treated, click here.
Diagnoses of Common Ear Injuries
Find out how physicians assess other types of ear injuries through physical exam, lab tests, x-rays, and other technology in our Common Diagnoses section.
Ear Injury Treatment
The treatment of ear injuries is often cast aside by MMA fighters as these injuries are external and often are a source of pride. While not all of them need to be treated, some of them can result in permanent damage and irreversible hearing loss.
An injury may look like a hematoma but need to be checked to rule inner and middle ear damage. Symptoms like tinnitus and dizziness are often attributed to head injuries and so the ear is often ignored. Don’t assume these symptoms will pass away by the end of the day. Persistent dizziness, tinnitus and decreased hearing might be a sign that there is internal damage to the ear and needs to be thoroughly investigated.
Injury Specific Treatment
Emergenc
The goal of treatment in auricular hematomas is to prevent damage to the cartilage. Skin is easy to treat; cartilage is the challenge, because it heals in a disorganized way, unlike bone and skin. An auricular hematoma should be drained by a doctor, and soon. Martial artists put this off because they see the swelling as a badge of honor, but blood left sitting in the ear is precisely what scars and deforms it. Never drain your own ear, and never let a training partner do it with a gym needle. Ear cartilage has a poor blood supply and an infection of the perichondrium can destroy far more of the ear than the original blow ever would.
Medical
The first step of treatment is draining the hematoma. Simple needle aspiration works best in the first day or two, but an ear that has been left longer is still worth treating — incision and drainage remains an option well beyond that, so do not assume you have missed your chance. An incision is made in the ear to let the blood escape. A compressive dressing is then applied to sandwich the cartilage between the two skin surfaces, closing the gap that formed between cartilage and skin. Alternatively, a bolster dressing is placed in the potential space. Antibiotic ointment is applied.
Home
At home, the ear must be kept clean and dry. Reapply the antibiotic ointment as advised by the ENT doctor. Stay away from anything that could strike the ear again until the swelling has resolved and the incision has healed — that is the return-to-play rule, not a fixed number of days, and it commonly takes longer than a week.
Emergency
The ear must be kept dry. If the ear continues to leak fluid or perilymph, seek medical attention at once. Avoid any forceful ear irrigation.
Medical
Most perforations are small and do not require surgery. New perforations heal on their own. If the perforation does not heal itself in two months, it likely will not happen on its own. These holes have to be fixed especially if there is hearing loss or if it is getting infected. ENT doctors then repair it via surgery.
They are done as outpatient procedures where the surgeons will cut behind the ear. The hole is repaired with cartilage, muscle, or synthetic material. In some places, they may cauterize the eardrum. Antibiotics for any recurrent infection should be taken until advised.
Home
The best thing one can do until the repair is to keep the ear dry. Avoid swimming. While taking a shower, place a dry cotton ball soaked in petrolatum or Vaseline to prevent any contact with water.
Emergency
Sudden hearing loss must be examined immediately by an ENT to rule out temporal bone fractures and basilar skull fractures. Any accompanying facial paralysis or vertigo points to a serious injury. And so immediate care must be sought if there is hearing loss during or after a fight.
Medical
Depending on the cause, hearing loss is treated in different ways. A physical blockage such as blood or fluid is drained. Perforations of the tympanic membrane are either repaired surgically or left to heal on their own, and surgeons may leave a drainage tube in place to let the middle ear clear gradually. Sudden sensorineural hearing loss is handled differently and urgently: it is treated with corticosteroids, taken by mouth or injected through the eardrum, and the sooner that starts the better the chance of recovering hearing. Hearing aids are considered when a loss does not recover.
These could be removable hearing aids, analog hearing aids, digital hearing aids, behind the ear aids, open fit aids, or in the ear aids. Occasionally, implants are advised. These could be middle ear implants or cochlear implants. Middle ear implants are attached devices to one of the middle ear bones. The device can move the bones directly, which sends stronger sound vibrations to the inner ear. Cochlear implants bypass the inner ear. They send signals directly to the auditory nerve.
Home
Keep the ear dry and protect it from further blows while it heals, and wear protective headgear when you train. Do not sit at home waiting to find out whether the hearing comes back. Sudden hearing loss in one ear needs to be assessed the same day, because if it is sensorineural the window for steroid treatment is roughly the first 72 hours and results drop off sharply after that. Milder changes caused by fluid or a small perforation often settle over weeks — but that judgement belongs to an ENT after a hearing test, not to you or your coach.
Emergency
Inspect the laceration. Apply firm, direct pressure with a clean dressing to stop the bleeding. Rinse it with clean water. Don’t blow on it and don’t scrape it clear. Skip the antiseptic lotion — those solutions do exposed cartilage no favors and are no substitute for proper cleaning and closure. An ear wound that exposes cartilage needs medical closure within hours, because infection of the perichondrium can wreck the ear. If a piece of the ear has been torn off, keep it: wrap it in gauze moistened with saline, seal it in a clean bag, and keep the bag cool — do not put the tissue directly on ice and do not soak it in water. Head to the emergency room if the bleeding doesn’t abate.
Medical
If the laceration is deeper than half an inch and is accompanied by other symptoms like hearing loss, a deformed ear, ringing in the ear, then it must be seen by a doctor right away. Also, if the laceration is gushing after ten minutes of pressure, then irrespective of size, it warrants a look by a medical professional.
Home
Home care for lacerations means keeping them clean and dry to avoid secondary infection. Remove all piercings for the time being. Keep the head elevated and don’t take off the “turban wrap” dressing no matter how hot and scratchy it gets — its job is to press the skin against the cartilage and stop a second hematoma forming underneath. Where a segment of the ear cannot be reattached, reconstruction or a prosthesis is a conversation to have with a surgeon. It is not home care.
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Common Treatments
Read how healthcare professionals treat various ear injuries using physical therapy, medications, surgery, and other approaches in our Common Treatments section.
