Cauliflower Ear in MMA: Why the 'Gnarly' Injury Is Considered a 'Badge of Honor'

Jonathan Snowden@JESnowdenCombat Sports Senior WriterJune 26, 2019

A fighter's cauliflower ear
A fighter's cauliflower earB/R

Leslie Smith was feeling pretty good when her ear exploded. At least, she was feeling as good as you can feel in the middle of an athletic contest with incredibly high stakes and potentially life-changing consequences. High above sea level, in front of a raucous crowd in Mexico City that she believed seemed desperate for blood, Smith was trying to give the audience exactly what it wanted.    

The fighter known as "The Peacemaker" was stalking Jessica Eye in the Octagon when it happened. It was 2014, and Smith and Eye were two of the world's best flyweights, looking to establish traction in the UFC's then-newly opened bantamweight division—a possible fight with Ronda Rousey for the UFC championship the long-term prize both had their sights on.

Smith was so intent on living up to her reputation as "the female Diaz brother"—of wreaking havoc and chaos in the cage—that she didn't even notice that the plasma was already flowing, or that it was hers. But no one else who saw the gruesome slow-motion replay is likely to soon forget the spectacle.

It was an innocuous right hand near the end of the first round that did it. Nothing special. No elaborate windup or secret technique. One punch among dozens that Eye had winged her way that night. Even back in her corner between rounds, it didn't occur to Smith that she was part of the kind of drama that basically only exists in the wild world of combat sports. 

"I had no idea it had exploded like that," Smith tells Bleacher Report almost five years later. "It didn't hurt. I didn't feel it. Adrenaline is one hell of a drug." 

MEXICO CITY, MEXICO - NOVEMBER 15:  Leslie Smith walks to her corner after her fight against Jessic Eye was called due to her ear being damaged in their women's bantamweight bout during the UFC 180 event at Arena Ciudad de Mexico on November 15, 2014 in M
Jeff Bottari/Zuffa LLC/Getty Images

A few blows in the second round exacerbated a bad situation, leaving Smith's ear literally dangling (some images NSFW) from her head as referee Herb Dean stepped in to stop the fight. Smith threw, by her own description, a tantrum in the cage, furious that she wasn't allowed to continue. It still hadn't quite dawned on her that she'd nearly gone full-on Mick Foley in front of millions of fans watching around the world on television.

"The first time it hurt was after they'd already stopped the fight," she says. "One of the officials came over, took a wad of gauze and shoved it inside of my ear at the front where it was coming off my head. He shoved a lot of it in there. That's when I realized it might be pretty serious.

"They spent an hour in the back sewing it back together as I lay there. Even then, I was still mad. I truly would have traded that ear for a win. That's why they have people in there to make those decisions for us."

Smith's ear, of course, didn't spontaneously explode. Eye doesn't possess a death touch like the masters in an old Sunday morning kung fu flick. Instead, the culprit was a typical ailment, at least for those who exchange either fists or holds for a living. Doctors might call it an auricular hematoma. Fighters and wrestlers simply call it "cauliflower ear."

Your body hurts all over after a training session for combat sports, at least if you're doing it right. But only the ear presents the unique combination of cartilage and space for blood to pool that creates the environment for flesh to die on the spot, trapped forever in a profusion that resembles cauliflower.

"It's an occupational hazard for combat sports," Will Carroll, a former sportswriter now working in biomechanics and injury prevention at Motus Global, says. "The basic etiology is that the ear gets hit, and there's trauma inside the ear, usually with damage to the cartilage.

"The resulting bruising can actually cut off the blood flow and make the tissue in the area die, which is called necrosis. The trauma also separates a space inside the ear, which is filled with blood, loose tissue, and all sorts of other crap, which eventually solidifies and adheres to the area, which is what causes the unusual shape and swelling."


Lindland displays his Olympic silver medal and two cauliflower ears
Lindland displays his Olympic silver medal and two cauliflower earsAl Bello/Getty Images

Draining the swollen area is the most common treatment for cauliflower ear. United States Olympic Greco-Roman coach Matt Lindland recommends a large-gauge needle for the job, and even then there is some degree of trial and error required to find and remove all the fluid that's built up from the constant trauma that comes from the rubbing and tugging of wrestling. 

"You don't want some tiny insulin needle," the 2000 Olympic silver medalist and former UFC title contender says. "There is definitely some pain involved, but life is pain.

"It's totally a complete metaphor for fighting or wrestling in general. You break down the cartilage in your ear, and it hardens back up and becomes stronger over time. That's just part of hardening up your entire body and becoming stronger. Really, it's a problem that kind of goes away. Your ears transform. I don't know if you call it a deformity since it comes from all the trauma, but they take on a new form.

Most wrestlers and fighters can remember their first time. The pain is sharp—the fluid that comes out when you stick the swollen area with the needle is a little disconcerting for many.

"By the time I tried to drain it the first time, it was too late," One FC star and former UFC champion Demetrious Johnson says. "It had already partially calcified, and there was a little pocket of blood we couldn't quite get to. They kept sticking the needle in and kind of digging around for it. I was like, 'Just leave it guys. This is stupid.' ...

"When it got raw, I just massaged it. It kind of spreads out the blood. Everyone was like, 'Doesn't that hurt?' Well, yeah. What are you going to do? Eventually it calcified like this, and since it did that, it hasn't blown up and gotten sore ever again."

Demetrious Johnson's cauliflower ear
Demetrious Johnson's cauliflower earPhoto by Jonathan Snowden for Bleacher Report

Whether it's a needle or a painful self-massage, something must be done, both to alleviate the pressure and prevent the explosive solution to the problem Eye inadvertently offered Smith. Resorting to the needle is most common—but it's a temporary solution that's not exactly conducive for the active life of most fighters.

"After, the ear needs pressure on it for a good long time, and even then, there's usually some permanent deformity," Carroll says. "There's also a massive risk of infection, both because of the spot and the fact that people tend to get back into a dirty environment like a gym or locker room too quickly." 

For most competitors, rest and relaxation simply isn't an option in the aftermath of treatment. After all, the cauliflower ear most likely occurred while training for an athletic competition. Taking time off is unlikely, meaning it's a problem that goes from a short-term nuisance to a long-term reality rather quickly. 

"You can drain it right away, and it will be fine," former UFC fighter and current Major League Wrestling champion Tom Lawlor says. "Of course, that's if you do nothing afterwards. But no one does nothing afterwards and lets it heal. You go train right away, and the next day it's going to be an issue all over again. But I don't have to drain them anymore. There's nowhere left for any cauliflower to grow."


Tom Lawlor's hair can't fully hide his cauliflower ear.
Tom Lawlor's hair can't fully hide his cauliflower ear.Photo by Ryan Loco for Bleacher Report

For Lindland, cauliflower ears were never a concern. Evolutionarily, he believed, men were born to be warriors and defend the tribe. His ears merely connected him to ancestors who spanned the centuries—and one closer to home.

"I remember looking at my grandfather, who was a plumber when they actually had cast-iron pipes, and his hands looked like sausages," Lindland says. "You said to yourself, That guy worked for a living. When I was young, I worked a lot, too, so my hands were calloused. When I became an athlete and started wrestling, my ears became calloused. That was part of doing the work."

Smith was wary at first of what has become a permanent accessory, a reminder of her fighting days that will never go away. When she had first gotten it, early in her career before turning pro, some of the young men at her gym were jealous. They had trained for years and never gotten it, only for Smith to see her ear swell up almost immediately. 

But it always went away when she drained it, and she didn't think about it much. After the Eye fight, her ears bore the mark of combat—not just for a couple of days, but all the time.

"At first I was like, Oh man, this is freaking gnarly. This isn't cute. It's kind of gross," Smith says. "But I remember talking to my chiropractor, Casey Strand, who was an NCAA All-American at Arizona State. He told me about being in Japan and the wrestlers there rubbing each other's ears and trying to give each other cauliflower ear because it was a cool symbol of dedication and perseverance there. That's a different take on it. That's kind of cool."

As Strand pointed out, in some cultures a cauliflower ear is a status symbol, signifying the wearer is a participant in combat training. While some American wrestling programs encourage the use of head gear to prevent it (with some success), athletes in other countries often seek out the required trauma instead. 

"There's a video I saw on Instagram recently of these Russian kids smashing their ears with bottles trying to get cauliflower ears," says Brandon Gibson, who coaches UFC light heavyweight champion Jon Jones. "It's definitely a badge of honor. Some people are more prone to it than others, though. I know guys that wrestled their whole lives—some of the toughest guys in the world—and they never had any problems. Their ears look just like yours.

"As a coach, it is something you think about. It can definitely affect training. It can break open, bleed everywhere and be at risk for infection. It can also make things like sleeping comfortably or even wearing headphones a challenge when it's real bad. Luckily, I don't have to be involved in the treatment of it. Their teammates usually help each other drain their swollen ears to take care of it. That's just part of being a fighter in this sport."

A 1989 survey of more than 500 college wrestlers done at Ohio State's Department of Otolaryngology indicated 39 percent will develop cauliflower ear. And, while the treatment can be straightforward, the consequences aren't something to be courted cavalierly. A study by the Asian Journal of Sports Medicine in 2015 showed athletes with cauliflower ear are more likely to have ear infections, possibly because it "may increase the probability of collection of pathogenic microorganisms in the ear canal and thereby increase the rate of infection in such ears."

Worse, the same study confirmed previous research that demonstrated an increased likelihood of hearing loss associated with cauliflower ear, symptoms some fighters such as Lawlor have experienced. While he's considering permanent reconstructive surgery when his combat sports career is finally over, that procedure can be difficult and involves reshaping the damaged ear tissue or replacing it with artificial cartilage or part of the ribs.

Most fighters, it appears, are content to wear the proof of their combat experience for the rest of their days. To Lindland, it's a potential deterrent to bad actors looking to cause problems. 

"You see a guy with cauliflower ear, and you're like, That's somebody I might not want to f--k with," he says. "He knows how to fight."

For Smith, it's a way to remember all she's done.

"I walk around now, and people see my ears," she says. "It wasn't until 2015 that it got really big. Now you can't miss it. I was up in Tahoe renting bicycles to ride the flume trails, and the guy was like, 'I don't know much, but I bet you could whoop my ass.' And I was like, 'Oh, gosh, that's so nice of you.' And it was because of my ear.

"It's freaking evidence I've put a lot of hours on the mat to get this mark of my ear. I'm definitely not going to get it fixed. I'm going to keep it forever."

                         

Jonathan Snowden covers combat sports for Bleacher Report.

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