Randy Couture's left ear is permanently mangled after decades of punishment. Landry Major/Getty Images

HE IS 230 POUNDS of impossible-to-miss muscle, a famous athlete and actor who's used to being gawked at in grocery stores, airports and gas stations. By now, his response in those moments has become reflex: Randy Couture sees strangers approaching, and he smiles and waves back at them. He imagines for a minute what they might already know about his life and what they might want to ask. Maybe they belong to one of his three MMA gyms or attend one of his camps or wear something from his Xtreme Couture clothing line. Maybe they watched him win one of his five UFC titles or saw him wrestle as a college All-American. Maybe they remember him as the star of two TV shows and multiple movies.

Or maybe they just want to ask about his ears.

"Nobody really cares about the other stuff. It's my ears that are famous," he says. "People want to feel them, squeeze them and take pictures. These ears attract a crowd."

Couture has cauliflower ear, a relatively common affliction among fighters, wrestlers and other contact-sport athletes. Years of being pulled, punched and torn can create blood clots in the ear and damage the tissue. Over time, blood and pus become trapped in the gnarled cartilage of a damaged ear, often causing the lobes to morph into hardened balloons. Like pimples that have crusted into permanent scars, Couture's ears are blue-and-red deformities that hover on the sides of his head -- creviced, bulging and so noticeable that they've helped inspire a movement.

Whether they wanted to or not, Couture and other elite fighters have turned cauliflower ear into a coveted badge of honor in wrestling, boxing and MMA. What was once an unsightly injury has now become a living trophy that commands respect. (No formal stats exist, but Couture estimates that 20 percent of elite wrestlers have it.) There is a Cauliflower Alley Club for elite wrestlers and online videos that suggest ways amateurs can accelerate their own cauliflower symptoms. (Hint: It involves repeatedly slamming your ear in a door.) Wrestling fans can even buy pairs of plastic cauliflower ears to wear.

What's crazy is that developing cauliflower ear is essentially a choice, doctors say. If you wear protective headgear during practice and bouts, it's unlikely you'll get it. But if you go without headgear, you might have strange-looking ears for the rest of your life. "It's ugly and painful, but everybody wants it," says Cael Sanderson, a wrestler who won a 2004 Olympic gold medal and now coaches at Penn State. "There's this idea that it puts you in a secret society of tough guys and top fighters. Most of the guys I know would do anything to have it."

Except, of course, for Couture, who mostly wishes his famous deformity would go away.

"What does it feel like?" strangers ask.

"Basically like hell," he tells them.

That's the secret of cauliflower ear, Couture says: You want it until you finally have it, when you want nothing more than for it to go away.

Boxer Sebastian Lujan's left ear cartilage is torn off after a 12-round title fight. Ed Mulholland/WireImage/Getty Images

Couture wore headgear as a high school wrestler to protect his ears but stopped when he began grappling in the Army because his coach didn't allow it. First his left ear started filling with blood during practices and matches, then his right did the same. He went to a doctor, who stabbed his upper ear with a supersize syringe and drained it of blood and pus. "It feels like somebody is digging a tunnel through the side of your head," he says. The doctor told him to rest for four weeks and the ear would return to normal; Couture went back to practice the next day. His ears filled again. The doctor drained them. The cycle continued. After 10 or 15 of these procedures within a few years, some of the pus and cartilage in his ears began to harden, turning to sediment, until there was nothing left to drain. The doctor explained that he had a condition called cauliflower ear, and he would live with it every day for the rest of his life.

Take one of those days, then: Couture, 50, wakes up in his Nevada home after sleeping on his right side because his left ear is much more swollen, and sleeping on that side feels like sleeping on a rock. He dodges around in the shower like a boxer against the ropes because the sting of the water hurts his ears. He rubs Neosporin on his ears, and even that subtle touch begins a dull ache that will last for most of the day. He leans in to hear the TV because his ear canals are swollen and it's hard for him to hear. He heads to the gym with gauze and painkillers because his hardened ears no longer bend on contact and instead tend to tear. He practices to the soundtrack of a low-level ear ringing -- a steady hum that never goes away. He rubs his ears again with Neosporin when he's done with practice and goes back to sleep for a nap on his right side. "Cool and glamorous isn't really the way I'd describe it," he says.

Yet the allure of cauliflower ear surrounds him. In his travels around the world, Couture has watched athletes with disfigured ears get ushered to the front of lines and to the best tables at restaurants. Gene LeBell, a legendary wrestler and Hollywood stuntman, gave Couture a golden pin of a deformed ear -- a pin that LeBell has given to a dozen professional wrestlers and fighters whom he considers worthy: "You work hard to earn that ugly ear, so show it off," LeBell said. Mike Swick, another UFC fighter, made a video of himself draining his cauliflower ear and posted it on YouTube, where it has been watched more than 350,000 times.

At Couture's gym in Las Vegas, so many young fighters are acquiring cauliflower ear that Couture has become an expert at treating it. Doctors who diagnose cauliflower ear advise stitches and weeks of rest. Fighters in training have time for neither. So about once a week, Couture leads a fighter into a room with sterile gauze, alcohol, iodine and cleaning solution. He scrubs the ear and stabs it with a syringe. He watches the thick blood flow through a needle, then wraps the ear and sends the fighter back to practice.

But the question remains: Why would anyone want cauliflower ear when it's so easily avoided? The NCAA and most high school associations mandate that wrestlers wear headgear during competition, and most youth wrestling leagues do the same. But headgear is largely optional in practices and at summer camps, and coaches say few wrestlers wear it when they have a choice. It's heavy and uncomfortable, and it gives opponents one more thing to grab.

About the only amateur wrestlers who wear headgear at all times are the ones forced to by a coach or parent. Dr. Douglas Wyland, an All-American at North Carolina in the 1980s, won't let his two sons step onto the mat without ear protection. He knows personally the pain of cauliflower ear and now treats it for his patients in Spartanburg, S.C. "I know enough to tell [my sons] that getting cauliflower ear is something you can avoid, and they better try to avoid it," he says. "Kids might not think headgear is cool, but a lifetime deformity is a lot worse. Any wrestler who listens to me is going onto the mat with protection -- in practice, at home, wherever."

Rugby player Graham Rowntree's bleeding ear was the real loser after his team lost a match. David Gray/REUTERS/Landov

The reality is, cauliflower ear probably isn't going anywhere. In July, at the prep national championships in Fargo, N.D., dozens of teenage wrestlers waited in line near 10 training tables in the underbelly of a stadium to have their ears drained between matches. At one of those tables, senior All-American Kacee Hutchinson underwent the quick procedure three times during the weeklong tournament before finishing fourth. "It hurts, but you lie down at those tables and nobody is complaining," he says. "I know guys who punch themselves in the ear to get a bubbled ear. If you're getting drained at nationals, that's a sign you are legit."

Sanderson's wrestlers rarely choose to practice in headgear, and he doesn't force them. He didn't use headgear as a kid and began developing cauliflower ear before he turned 9. Now only one of his team's wrestlers typically wears headgear in practice: two-time NCAA champ Ed Ruth. Teammates tease him for wanting to look pretty. "He's a little funny about it," Sanderson says. "He's worried about his looks."

So is Ryan Couture, Randy Couture's son, who is also a pro MMA fighter. Ryan grew up seeing people stare at his dad and hearing the questions they asked. "That was always the first thing my friends would want to know about my dad: 'What happened to him? Look at those nasty ears!'" Ryan says. Which is why when Ryan began wrestling as a kid, he chose to wear headgear. And even though he stopped when his MMA career began, he continued to protect and rest his ears. He's never had them drained and has little visible cauliflower. "If my dad has the worst-case scenario, I have the best," he says.

For a long time, Ryan worked a day job at a bank, standing behind the teller window, cashing customers' checks. Some days, he came to work after sparring and had bruises and cuts. "People thought the bank had just been robbed, and I just felt weird about that," he said. On those days, he felt especially thankful that at least he wasn't also blemishing his suit-and-tie look with a hideous case of cauliflower ear.

"It might look tough and great for some guys," he says. "But from my experience, all it really gets you is a lifetime of stares."

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