Ear (Aural) Hematoma

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An aural hematoma is a pool of blood that collects between the skin and the cartilage of a pet’s ear flap. It’s typically caused by overly aggressive ear scratching or head shaking that results from an ear infection. Dogs and cats can both suffer ear hematomas, though dogs (particularly those prone to skin allergies and ear infections) are more prone to them. Treatments range from draining the hematoma with a needle, to surgical correction of the problem.

Overview

An ear hematoma is a pocket of blood that forms within the exterior portion of a pet’s ear flap. Although both dogs and cats can suffer ear hematomas, the condition is much more common in dogs.

Ear hematomas are usually caused by some kind of self-trauma — such as when a pet aggressively scratches at the ears or shakes his or her head, causing the ear flaps to slap against the skull. This trauma can cause blood to leave the vessels and pool in a pocket between the skin and cartilage components that make up the outer part of the ear flap. Usually, there’s an underlying cause for the scratching and head shaking, such as ear mites or bacterial and/or yeast infections of the ear canal. Because dogs that suffer from skin allergies are prone to ear infections, allergic skin disease can be an important part of the underlying problem.

It’s undeniably crucial to treat both the ear hematoma and the underlying parasites or ear infection and address possible allergies.

Symptoms and Identification

A pet with an ear hematoma will have a fluid-filled swelling on all or just part of the ear flap (called the “pinna”). Sometimes the swelling will seem firm, other times, soft and fluctuant. It may occlude the ear canal or simply involve the very tip of the ear.

A veterinarian can diagnose this condition during a physical exam. However, it is also important to diagnose underlying conditions that may lead to excessive ear scratching or head shaking. The veterinarian will most likely inspect the ear canal and swab it for a sample to examine under the microscope for signs of parasites or infection.

Allergic skin disease (including inhalant allergies and food allergies) is probably the most common condition underlying this disease in dogs. Definitively diagnosing this possibility, however, is not as easy as identifying organisms under a microscope. Food trials (to investigate food allergies) and other kinds of allergy testing may be in order.

Affected Breeds

Any dog or cat can develop an ear hematoma. Because allergic skin disease is a common cause, any pet prone to skin allergies in more likely to develop an ear hematoma. The problem develops easier in dogs with more pendulous ears, because heavy ear flaps easily slap against the side of the head during head shaking.

Treatment

Surgical repair is often considered the most effective treatment for ear hematomas. While under anesthesia, an incision is made along the length of the hematoma on the inner surface of the ear. After the fluid and blood clots are removed, the inner surface of the ear is tacked down to the outer surface of the ear with sutures. The sutures hold the inner and outer surfaces against each other so that when scar tissue forms, the two surfaces are smooth and not lumpy. The sutures generally stay in place for a few weeks while the incision is left open so that fluid will continue to drain as the ear heals. Eventually, the incision will heal on its own.

For a dog with droopy ears, the treated ear is often flipped up and bandaged against the head to prevent head shaking during recovery. An Elizabethan collar (a cone-shaped hood that fits over the pet’s head) is often recommended so the pet can’t scratch at the ears.

As an alternative, several small incisions may be made on the inside surface of the ear with a laser. In this case, sutures are not needed.

Another treatment involves the placement of a small drain, or rubber tube, in the external portion of the ear. The drain stays in place for several weeks as the fluid resolves and the ear heals. Some pets may not tolerate this, and cats’ ears are usually too small for this technique.

In some cases, veterinarians may draw out the fluid with a needle and syringe. Medication may also be injected into the space to reduce swelling and inflammation. However, it is very common for the hematoma to return with this procedure.

With an underlying ear infection or ear mites, the pet will most likely need to have the ear canals cleaned and treated with appropriate ointments or solutions. Resolution of the underlying problem will help prevent another ear hematoma. Allergic skin disease, however, has a way of leading to chronically affected ears that may suffer recurrent ear hematomas unless the problem is adequately addressed.

Without treatment, an ear hematoma will eventually heal on its own, but the pet often experiences weeks of discomfort. In addition, the two sides of the ear often form thickened, wrinkled scar tissue, so the ear won’t look or feel natural. This cosmetic issue may not make a difference to an owner.

Prevention

While ear hematomas themselves may not be easily preventable, preventing (or successfully treating) underlying issues that cause head shaking will certainly reduce the risk of this complication.

This article was reviewed by a Veterinarian.

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