The love-hate relationship fighters have with cauliflower ear

WHEN HE WAS 8 years old, Bo Nickal went to his parents like so many little kids do. He figured out a major goal for himself. “I want cauliflower ear,” he announced.

A second-grader dreaming of permanently damaged ears would generate panic for most parents, but Nickal’s dad and mom, Jason and Sandy, are combat sports people. And for combat people cauliflower ear isn’t a lifelong injury. It’s a sign of a life well led.

Bo’s dad had cauliflower ear. His dad’s dad had cauliflower ear. And his mom is a former amateur boxer who smiled with pride at her young son. It was like a kid saying he wanted to take over the family business someday.

Yes, Nickal literally hoped for cauliflower ear. But what he actually desired was to be the kind of person who earns a scarred ear or two. He wanted to be an all-time great American wrestler, and he later achieved it with three national titles at Penn State. Now, at age 28, he has emerged as MMA’s most exciting prospect. He’s 5-0 at middleweight, with five first-round stoppages, and will fight on the UFC 300 card against veteran Cody Brundage as around a -3000 favorite, an absurd number. For an organization badly in need of American star power, Nickal is the perfect combination of talent to win and bravado to sell. “My opponent is a body that I get to go and destroy,” he says. “I try not to see a person in front of me. I see a dummy that I want to smash. My goal is to be UFC champion and the No. 1 pound-for-pound fighter in the world.”

As silly as it might sound, don’t underestimate the impact of cauliflower ear on Nickal’s rise. Even as a little kid, Nickal knew that cauliflower ear would be a black belt on his body, a signal that he had put in the work to have earned a lifetime of fluid pooling in the hardened cartilage of his ears. He wore headgear in matches, as most youth wrestling programs mandate. In practice, though, he took it off and didn’t mind a stray knee or knuckle drilling him on the side of his head because maybe he’d get started on cauliflower ears. The problem was that Nickal dominated almost every match he ever participated in. You could probably count the number of times his face got smooshed into the mat with your ears.

So his cauliflower ear journey actually took a while to get off the ground. But like so many combat athletes — wrestlers, MMA fighters, boxers, jiu-jitsu competitors and those in countless other martial arts — he can remember the exact moment when it finally happened. It was a practice when he was 9, and another kid clipped him at the top of his left ear. He felt swelling immediately and he laid his head on his pillow that night hoping for a visit from the cauliflower ear fairy.

And she did visit. The next day, Nickal’s ear had ballooned to the point that his mom took a hypodermic needle and drained as much as she could. Then he went to school as the happiest kid in his class. “I was so excited to finally have it,” he says. “But then I was like, ‘Man, this really hurts.'”

For the next five years, Nickal’s left ear accumulated scar tissue at the very top, causing the northern part of his ear to sag out and down toward the southern portion. His mom would drain it for him but he never sought formal treatment or sat out to let it heal. “I was all lopsided,” he says. “One ear was nice and the other one was mangled.”

By the time he was 15, Nickal had become one of the nation’s elite high school wrestling prospects. And that’s about when he realized that the only thing he wanted more than a cauliflower ear was another cauliflower ear.

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IN INTERVIEWS FOR THIS STORY, an interesting premise came up: In the 1990s, if you went to a bar and saw somebody with lots of tattoos, you knew not to mess with that person. But then, the number of tattoos surged (Americans with at least one jumped from 21% in 1999 to 40% in 2014). So, the world needed a more accurate badass detector. Enter the cauliflower ear.

It’s not an entirely new phenomenon. Many Greek statues depict gladiators with rippling muscles and cauliflower ears, and Romans often represented Hercules as having mangled ears, too. The famous Boxer at Rest statue in Rome features a nude fighter wearing nothing but hand wraps and cauliflower ears. “If you’re going to wrestle or fight for a long time, you might as well just go ahead and get it,” says Ben Askren, a two-time NCAA wrestling champ and former MMA star. “Everybody respects somebody with cauliflower ear.”

For centuries, cauliflower ear became a prized corner of the combat sports world, especially for wrestlers, and then the UFC debuted in 1993. For the first time, we finally knew who the actual toughest human beings were… and most of them had ears that looked like mini versions of Princess Leia’s hair buns. Over the next 30 years, regardless of age or gender, the idea of a banged-up ear didn’t sound so bad. “The birth of the UFC turned cauliflower ear into something quite popular,” says Dr. Douglas Wyland, an orthopedic surgeon in South Carolina and a two-time NCAA wrestling All-American. “Since then, it’s taken on a life of its own. People are more afraid of getting made fun of for not having it than if they get it.”

But many wrestlers and fighters — including Nickal — say they are both proud to have it and also don’t love some of the issues that come with it. Though cauliflower ear’s long-term effects are mostly cosmetic, it is quite painful and begins as a hematoma, where blood vessels are damaged and blood starts to back up in the ear. The best analogy might be a four-lane highway that shuts down two lanes during rush hour — traffic clogs pretty quickly but eventually gets through. Proper treatment involves draining the ear immediately and then avoiding any other direct hits for an extended period.

That’s the rub for most combat athletes who already probably don’t mind having it: They’re unwilling to sit out for a few weeks and let the ear heal. Nickal got right back on the mat the next day, even though everybody involved knew that would prevent the condition from healing. After a week or so, the damaged ear basically becomes a scar that is impossible to repair — the four-lane road permanently becomes a two-lane road. Cauliflower ears often only grow over time and after more sustained punishment. Surgery is possible but very rare. “The only option at that point is plastic reconstructive surgery that is expensive and probably not covered by insurance,” says Dr. Harold Pine, an ear, nose and throat doctor in Texas. “So most people end up walking around with cauliflower ear.”

Ear protection for wrestlers has been required in competitions for decades now in most states. But wrestlers mostly chuckle about how the vast majority of their practices were headgear-free. The few studies that exist have mostly shown that headgear can be effective if it fits well and is worn both at practices and in competition. “Headgear works,” Wyland says. “You can’t get flimsy plastic headgear. You need to use the old-school metal ones. But there’s no question headgear works.”

But one 1989 survey of 500-plus Division I wrestlers showed that only 35% or so actually used headgear all the time. Good luck finding an NCAA wrestler, pro MMA fighter or jiu-jitsu black belt these days who uses headgear during every training session. “That can be a dog chasing its own tail,” Wyland admits.

That leads to some potentially ugly moments for those with cauliflower ear. UFC veteran Michael Chandler, who was an All-American wrestler at Missouri, loves what his ears represent. But they are gnarled up so much that it looks like they’re pregnant with other ears, and they bulge out enough that he occasionally gets them caught in clothing — and nearly ripped off — when he trains. “Every now and then, I don’t like that I have these big old hunks of scar tissue on the side of my head,” Chandler says. “But I love them. I worked hard for them, and they’re like my little companions.”

There are different levels of cauliflower ear. Chandler has similar ears to the original cauliflower GOAT, Randy Couture, where the outer, inner and middle parts are all equally stuffed. Chandler can’t fit AirPods in his ears, and he sometimes has sweat drip down his cheek an hour after a workout because it had gotten trapped in the small cavities within his ear. Other athletes end up with what Nickal got as a 9-year-old, where the ear becomes top-heavy and flares out like a wing but the actual canal is normal.

Horrific cauliflower ear explosions have happened. Former UFC fighter Leslie Smith took a direct kick to the side of her ear during a 2014 fight, and it popped midfight, sending blood soaring up into the air in a scene that was much harder to look at than whatever you’re imagining right now. She tried fighting on with the top of her ear basically split in half, but the ref eventually stopped the bout. “I understand why it is someone else’s job to make that decision for me,” she said afterward. “But I would trade my ear for a win in a heartbeat.”

It’s actually a misnomer to use the word “exploding.” Dr. Nicholas Rossi, a former Texas state prep champ wrestler and now a resident at the University of Texas Medical Branch, says a better description would be “traumatic decompression of an auricular hematoma,” which is a very doctorly method of saying that the gruesome injury was just an ugly way to drain a cauliflower ear. Smith got about 10 stitches and her ear healed up nicely.

Both Rossi and his boss, Pine, watched a video of another fighter, Jose Penaloza, getting a very similar injury in an Ultimate Warrior Challenge Mexico bout. The ref looked at Penaloza’s right ear between rounds after it turned dark purple and swelled so much that the top began to droop toward the lobe. The fight continued, and Penaloza’s ear eventually burst — er, traumatically decompressed — as the broadcast team groaned, “Oh god, you have to stop the fight.” Blood poured onto the floor of the cage, and the ref waved off the bout.

As stomach-turning as Penaloza’s ear was, Rossi expressed surprise that the fight was stopped. “Without actually seeing the patient in person, I would wager the ‘explosion’ just looked bad more than anything,” Rossi says. “I definitely would not call that a life-threatening injury.”

Rossi and Pine work primarily with kids, so they only see about three to five cauliflower-type ear injuries per year in the office. But they see plenty of cauliflower ear in their personal lives — they belong to the same jiu-jitsu club and often practice together. But with his strong wrestling background, plus a size and a 20-year age advantage, Rossi tends to pretzel up his boss most days. About a year ago, he got Pine into a tight headlock that made one of his ears feel like it had been lit on fire. “Oh man, I wonder if this is going to cause cauliflower ear,” Pine thought as he tried to get out of the hold.

But Pine escaped unscathed. When told he must have been glad to have been wearing headgear, Pine sounds a little sheepish admitting a stunning truth: He doesn’t wear headgear … and he doesn’t plan to. “I’m aware it doesn’t look good, and I would get it treated if I got it,” Pine says. “But if I got a little bit of cauliflower ear, I absolutely would wear it as a badge of honor.”

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BY THE TIME he was 15, Nickal had gotten used to his lopsided head. He still didn’t wear headgear when he wasn’t in an actual match, but he’d mostly avoided any kind of trauma to the right side of his head. His left ear was full-blown cauliflower — if he took a shot and it ballooned, his mom would drain it and he’d go back to wrestling right away. The damage had been done, and he loved it.

That summer, Nickal went to the 2012 Fargo tournament in North Dakota. Fargo has become an annual national wrestling tournament where some of the world’s best youth wrestlers show up. The tournament gives out cool eight-sided plaques to the champions, so every aspiring wrestler grows up hoping to win a “stop sign” in Fargo. Nickal had struggled the year before, finishing third in Greco-Roman and seventh in freestyle. He was determined to get a stop sign or two this time around.

Nickal was entered in both styles again, so he had 10-plus matches over the course of a week coming up. During one of his Greco matches at the beginning of the week, Nickal got blasted in his left ear. Within a few minutes, the ear was an alarming deep purple color, swelling to the size of a pingpong ball. And man, it hurt.

The tournament medical staff told him he should probably withdraw. They worried that if they drained the ear, he’d have a small cut that could get infected if he tried to keep wrestling. Their suggestion? Forfeit out of Fargo and go to the hospital. If he did that, he could get it treated and conceivably avoid cauliflower ear by staying off the mat.

But that’s not really how the cauliflower people of the world roll. Nickal bandaged up his ear and won the Greco tournament. The day off before the freestyle tournament began, Bo’s mom drained his ear, then he and his coaches created headgear to protect it as much as possible.

They concocted a mixture of clay putty and foam for the right side of the headgear so it was about three times the size of the other ear. Nickal strapped up looking like he had half of his normal head and half of a heavyweight’s head, then proceeded to win the freestyle tournament on top of his Greco title. “It wasn’t fun,” Nickal says. “But we got it done.”

When Nickal got back home to Allen, Texas, a few days later, he unpacked his bags and pulled out his two stop signs. He put them on the dresser and then looked in the mirror at what might be his actual favorite trophy: a complete set of glorious cauliflower ears.

“My ears represent a lot of hard work, a lot of years of my life, countless hours and tournaments and practices,” Nickal says. “I love them.”