WHAT IS AN AURAL HEMATOMA?

A hematoma is swelling created by a broken blood vessel after bleeding has occurred inside a tissue. Hematomas within the ear flaps (“aural hematomas”) occur when head shaking breaks a blood vessel within the ear flap. The ear flap may partially or completely swell with blood. The swelling may be so large that the opening of the ear canal is occluded. The extra weight of the ear flap may be uncomfortable and may lead to a permanent change in the carriage of the ears. This condition is more common in dogs but can occur in cats as well. The ear flap will feel fluctuant and fluid-filled, like a water balloon.

WHAT DO WE DO TO RELIEVE IT?

There are probably as many ways of correcting ear hematomas as there are veterinarians. The following are some commonly performed procedures:

ASPIRATION – This procedure involves simply using a syringe to remove the fluid contents of the hematoma.  The problem is that a space is left behind when the fluid is removed and this space readily refills with more fluid.  It is common for only temporary results to be obtained when the aspiration method is employed; usually this method is not a good choice.

PIE-CRUSTING SUTURES – Here an incision is made in the ear flap surgically. The hematoma is drained of fluid and blood clots. To prevent the hematoma from refilling with fluid, multiple sutures are placed in the hematoma space either vertically or horizontally, either partly through or completely through the ear flap, with or without ear cartilage removal. Sometimes bandages are applied post-operatively, sometimes not.  Sutures are generally left in place for 3 weeks to allow good scarring to take place so that refilling will not occur.

TEAT CANNULA PLACEMENT – A teat cannula is a small device used in the treatment of udder inflammation in cattle. It can be placed in the opening of the teat to allow drainage of milk or infected discharges. Teat cannulas can also be placed in a dog’s aural hematoma if the ear flap is large enough to accommodate the device.  The hematoma is drained of fluids and allowed to heal over the next several weeks. This method is generally successful but does involve the dog tolerating a “gadget” inserted in its ear flap for several weeks.

WHAT IF THERE IS A CONCURRENT EAR INFECTION?

Usually there is a reason why a dog has been shaking his/her head: an ear infection. This means that the ear infection must be treated along with the hematoma. The ear will need cleaning, microscopic examination of the discharge, and medication. Sometimes ear shaking just happens and there is no underlying infection but one should be prepared for the expense and trouble of treating an ear infection along with that of the hematoma.

For more information on ear infections click here.

WHAT IF WE LEAVE IT ALONE?

If left alone, an ear hematoma will resolve by itself. The fluid will be re-absorbed back into the body and the ear flap will again be flat. The problem is that a lot of scarring is associated with this process and the ear is often not cosmetically appealing afterwards (a “cauliflower” ear). It can also take several months to resolve a large hematoma which may be uncomfortable for the pet.  If the patient is a poor anesthetic risk it is certainly reasonable to forgo surgery.