Ear (aural) Hematoma

 

On occasion we are presented with a pet that has a swollen ear. The swelling is due to blood vessels that have ruptured inside the ear flap, between the inside and outside layer of cartilage. This causes the ear to fill up with bloody fluid and after a period of time the blood in the ear clots and there is a firm swelling. If left untreated the ear will be painful and will eventually scar down, similar in appearance to a cauliflower ear in a boxer.


Symptoms

The symptoms of an aural hematoma are obvious. Depending on the severity of the problem there will be swelling, which is sometimes extensive. Almost every pet will either be holding the head to one side or either shaking and pawing at the affected side.

This cat has a moderate sized hematoma.


Cause

Pets that paw at their ears or shake their heads vigorously, especially those with large ears, can cause a hematoma. This pawing and shaking can be due to irritants around the face and ears, or irritants in the external ear canals like infections or foreign bodies (foxtails). Food allergy is a common cause of inflamed ears, causing your pet to shake its head excessively and burst blood vessels.


Medical Treatment

In some cases we can alleviate the hematoma by removing the fluid and injecting cortisone into the ear.

This dog is having fluid drained from its ear.

Your pet will also go home with oral medication to be used for 10 days. This treatment is usually repeated in one week, although some cases are healed after the first week of therapy. Pets that don’t heal after the second treatment need surgical correction.

The initial cause of the hematoma, often times an ear infection or food allergy, will be treated simultaneously.


Surgical Treatment

It is advantageous in most cases to use medical therapy first because there is no need for general anesthesia, there is minimal discomfort to your pet, and the cost is less than surgical correction. Surgical treatment is used in those situations in which the problem is not corrected with medical therapy.

Some hematomas are too large or involved to attempt medical treatment initially. Another reason we might perform surgical correction before attempting medical correction occurs when your pet is being anesthetized for another problem simultaneously, for example, dental disease.

The following section has pictures of an actual hematoma surgery, and includes pictures of blood and ear incisions. If you would like to pass this section up click here.

The first step in the surgical procedure is draining of the fluid in the ear. An incision is made with a scalpel blade and the bloody fluid is drained.


Since most hematomas have been present for many days prior to presentation, there are blood clots in the ear. These clots are removed with a hemostat.


When all of the blood and clots are removed the ear is ready for suturing. You can readily visualize the 2 layers of cartilage in this view.


The 2 layers of cartilage are sutured together to prevent the bloody swelling from returning. The incision is left partially open to facilitate further drainage of fluid. We also bandage the ear to the top of the head in some cases. The bandage and sutures are removed in 7-10 days. Healing progresses rapidly and the ear returns to normal in no time.


For well over the last decade this  surgery is done in our hospital with the laser. Using the laser has substantial advantages over the method described above. It is highly recommended that this surgery is done with the laser, particularly because it will dramatically minimize pain during the healing process.


Once your pet has a hematoma it is possible for it to recur. You should check your pets ears daily for any recurrence, treat the initiating cause, and clean them frequently.