Rugby ears (petrified auricles)

Case contributed by Jan Frank Gerstenmaier
Diagnosis certain


A professional rugby player presented to the ED following a head clash during a match. There was loss of consciousness for 10 minutes, but on arrival he had a GCS of 15/15.

Patient Data

Age: 30
Gender: Male

Unenhanced CT brain


No skull fracture.

There is high density material in both external ears in keeping with petrified auricles.

Case Discussion

Petrified auricles as a complication of traumatic auricular hematoma is most common among forwards in the rugby union, but is also seen in participants of other contact sports such as boxing, wrestling, mixed martial arts and vale tudo 1. Acrobatic manipulation of ears by teenagers has been described as the etiology 2. The condition has also been described as a complication of BlueTooth headset use 3.

Other causes of petrified ears include hypothermia and frostbite, or hypercalcemia secondary to a metabolic or endocrine disorder, such as Addison's disease or hyperparathyroidism 4.

Cauliflower ear is the name given to auricular hematoma that occurs due to blunt trauma and is left untreated. The precise location of the hematoma is unclear, but positions between the perichondrium and cartilage, or intracartilaginous have been proposed. Complications include infection, cartilage necrosis, contracture, and neocartilage formation, with eventual ossification. This can be prevented by prompt treatment, such as aspiration and silicone splints 5.  

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