To the best of our knowledge, this is the first study using audiologic tests at different frequencies, showing that the rate of hearing loss in wrestlers with cauliflower ear is higher than this rate among a control group of wrestlers without cauliflower ear. According to the results of PTA, hearing loss in all frequencies was significantly higher in cauliflower ears, except 8 kHz frequencies. This might imply the importance of establishing preventive policies like mandatory use of ear gears.
Our finding supported results of previous study by Kordi et al. (
2) which was a questionnaire based survey reporting significant differences between the rates of hearing loss in wrestlers with cauliflower ear (11.5% ) in comparison with wrestlers without cauliflower ear (1.8%) (P < 0.05).
The percentage of positive history of ear infections in wrestlers with cauliflower ear was about twice this rate among other group of wrestlers. Although this finding was not statistically significant, it could be considered as a possible reason for higher rate of hearing loss in cauliflower ears; thereby, ear infection prevention and on time treatment of ear infections may be recommended to prevent possible hearing loss in wrestlers. In this regard, partial obstruction of ear canal in cauliflower ears, may increase the probability of collection of pathogenic microorganisms in the ear canal and thereby increase the rate of infection in such ears. Direct trauma to the external ear, which happens in many contact sports such as wrestling, could indirectly damage the middle and inner ear as well.
To evaluate the effect of probable direct trauma and abrasions (as the major mechanisms leading to cauliflower ear in wrestlers) on the middle ear, the impedance audiometry was also performed for all wrestlers. According to the results of impedance audiometry, it was found that there is no significant relation in rate of abnormal acoustic reflex between cauliflower and non-cauliflower ears. As acoustic reflex test implies the intensity of stapedius through movement of tympanic membrane through generation of a loud sound. With respect to the mentioned findings, it may be concluded that there is no significant difference in the rate of diseases involving the stapedius muscle at its innervating nerve branch between the cauliflower ears in comparison with non-cauliflower ears, although some false negative conditions have also been described for this test (
According to the results of acoustic reflex test, even though cauliflower ears have suffered from more possible trauma, they do not have significant abnormalities in comparison with non-cauliflower ears. This finding maybe due to the type of trauma that usually leads to cauliflower ear since abrasion and blunt trauma can have less effect on the middle ear of the wrestlers due to its inner anatomical position as opposed to external ear.
As it is shown by the results, the static admittance in cauliflower ears was not found to be significantly higher than this rate in other group. It may imply that there is no significant connection between the severity of tympanic membrane tenacity of both groups leading to a non-significant relationship between the maximum compliance of the middle ear in the groups.
The number of wrestlers in case group with low Equivalent ear Canal Volume (ECV) was higher; in addition, the number of external canal stenosis found in cauliflower ears group was higher than non-cauliflower ears. These may be due to the role of fullness and stenosis of the canal in hearing loss of wrestlers with cauliflower ears (
Considering the PTA and impedance results, it could be suggested that the resonant frequency of the external auditory canal has been changed, and this finding might be due to repetitive minor traumas to the cartilagous part of external canal. As a limitation of the study, the audiologic tests were performed in the wrestling clubs. While according to standard protocols, the tests should be done in a sound protected place. In this regard, a quite silent condition in a private room in the wrestling clubs was provided for performing the audiologic tests. Also, bone conduction testing was not performed on wrestlers, therefore, we could not differentiate the type of hearing loss (sensorineural, conductive, or mixed). However, due to the effect of environmental noises on the PTA data in 0.5 KHz, the percentage of wrestlers with hearing loss in this frequency has increased in both with and without cauliflower ear groups. If this frequency is ignored, the maximum number of wrestlers with hearing loss would be in the 4 and 6 KHz frequencies (higher frequencies). Therefore, despite the importance of bone conduction audiometry for determination the type of hearing loss, it doesn’t seem useful for interpreting the study’s findings. This study was a retrospective study and more prospective studies might be needed to confirm our finding that hearing loss is a consequence of ear injuries that lead to cauliflower ears. However, within our limitations, we recommend that wrestlers wear ear protectors during wrestling training and promptly treat their ear hematoma.