The sport of wrestling offers some unique injuries for the Sports Medicine Team to manage. One such injury is a contusion, "bruise" to the external ear or commonly diagnosed as a "cauliflower" ear. This problem is not limited to only wrestlers. The problem can occur with any contact sport such as rugby or Australian Football.    A "cauliflower" ear is a contusion to the external ear as result of a head butt or opponent striking the ear. Because of the unique structure of the human ear, blood and serum "yellowish colored" fluid accumulates between the skin and cartilage, that gives the ear it's shape, causing significant swelling. Normally the body absorbs the excessive fluid that results from a subcutaneous contusion but not so in this part of the body. The fluid left by the contusion simply pools in the space between the skin and cartilage and over a period of 3 to 4 weeks solidifies causing disfigurement unless aggressive management by a medical professional occurs. In high school and College Folkstyle wrestling the rules mandate use of headgear that reduces the possibility of sustaining a contusion to the ear but freestyle and Greco Roman it is optional with the majority of competitors choosing not to use headgear. (Use of headgear will not prevent all likelihood of sustaining a "cauliflower" ear.)    MANAGEMENT OPTIONS   Immediate care involves application of ice to the tissue using an ice bag or cup with a wet towel. Application of a pressure dressing to the contusion will reduce the possibility of swelling immediately after the injury but the reality is that most wrestlers do not seek medical attention until the ear is swollen and disfigured. Thus limiting options to deal with the problem. The most common management options are to evacuate the fluid and apply pressure with a pressure dressing. If done properly, the wrestler can return to wrestling within 24 to 48 hours. Some physicians chose to lance and install a drain but this procedure will result in a loss of training time from 10 days to 3 weeks. Simple evacuation without a pressure dressing will result in additional bleeding and the fluid filling up the space again. In addition, multiple evacuations make the likelihood of an infection of the ear occurring.    Pressure Options:    Option#1. Sewing a "button" through to the ear that applies pressure to both sides of the ear. This is effective but does require the ear cartilage to be drilled through and must remain on for 7 to 10 days. Generally the treating physician limits the amount of activity for 72 to 120 hours to reduce the possibility of infection. Headgear must be worn at all times as the button can be ripped off, tearing parts of the ear with it. The ear tends to be sore for a very long time. Never use a local anesthesia with epinephrine on a cauliflower ear or injectable anti-inflammatory agent.    Option #2  Drain the ear and apply an external pressure wrap. This wrap is worn for 24 to 72 hours and the athlete can return to training within 24 hours and back on the mat in 48 hours.     - Ice the ear for about 7 to 10 minutes    - Swab the ear with Betadyne or Povidione Surgical Scrub.  Always practice aseptic procedures to prevent infection, ie: gloves, sterile gauze, use of surgical scrub, sterile needles and syringes etc.    - Use an 18 to 21 gauge Butterfly Infusion Needle set and a 5 to 10 cc syringe to evacuate the fluid.    - Using a sterile gauze apply pressure to the area of fluid while you are evacuating the fluid. Do push on the actual needle but massage around the area. Once the fluid is evacuated, slowly remove the needle but continue to hold pressure on the area for 5 to 10 minutes.    - The wrestler can take over holding pressure on the area by pinching the affected area.     - While waiting for the pressure to close the entry portal, a pressure dressing must be prepared to apply. This can be done using a product called Pedi-Plast to make a prosthetic appliance or Dental impression material called Aquasol to create an external cast of the ear.    - When using the Pedi-Plast, following directions on package mix the base material with the catalyst and apply to the external portion of the ear. Avoid pushing the material into the ear canal. Always swab the area again with the Surgical Scrub prior to application of the pressure dressing. Once the material is shaped to the ear, cover the material with a Vaseline dressing and then place some soft cotton packing to the back of the ear. Use PowerFlex 2" width to wrap up the dressing completely wrapping the entire head. Always drop the tape below the unaffected ear. Head wrap should be replaced within 24 hours and but do not throw away the Pedi-Plast. Simply place it back and re-wrap. Save the Pedi-Plast mold as it can be taped into the ear for practice to reduce the likelihood of the swelling returning.    - If you do not have any material to create a mold, a pressure dressing using sterile gauze and a Vaseline gauze directly over the affected ear but the head wrap must stay on for 72 hours minimum. The success rate for use of just gauze is not very good.    - When using the Aquasol Impression Material follow directions on the package regarding the mixing of the material. Place a small cotton ball in the ear canal prior to application of the Aquasol. Apply a liberal amount of Aquasol to the ear covering the entire ear and behind the ear as well. Use a tongue depressor to smooth out the material, like "frosting a cake". Make sure that the entire ear is covered and the front and back areas are covered. Work quickly as the material sets up quickly. The Aquasol cast can be worn for 7 to 10 days and the athlete can shower with the cast on. Headgear should be worn to keep from tearing off the cast.    - Pedi-Plast is available through Medco and Aquasol is available through Direct Dental Supply Co in Sparks, NV.    - It is recommended that the wrestler continue to ice the ear using a wet towel for 2 to 3 weeks after practice to reduce the possibility of swelling. Duct tape is an excellent material to use to tape the mold in place and apply pressure to a sub-acute contusion to the ear. It is superior to athletic tape as it does not absorb sweat and is slick, so blows to the ear slide away.