Aural Hematoma
Aural means “ear” and a hematoma is “a space abnormally filled with blood,” so an “aural hematoma” is a blood-filled pouch in the ear flap. It is a collection of blood (blood blister) within cartilage of the “pinna” (ear flap) and the skin.
Why do Aural Hematomas Occur?
An ear hematoma in dogs can be caused by aggressive head-shaking and/or scratching. The tissue of the ear flap (or “pinna”) is very thin, and when it’s injured, the blood vessels can break. The space between the ear cartilage and skin fills up with blood and fluid, causing the ear to swell rather quickly, and forming a balloon-like nodule on the dog’s ear.
Any breed of dog can develop ear hematomas, but those with larger ear flaps are more susceptible, because the ear flaps slap against the skull when the head is shaking.
But what triggered the head-shaking and scratching, which in turn caused the hematoma to form? There are a number of underlying conditions that could be the culprit:
Yeast infection or another type of bacterial infection
Allergies
Blood-clotting disorder
Immune disorder
Skin diseases
Foreign bodies
Inflammation
Parasites
Trauma to the pinna (i.e. a bite to the ear)
Ear mites (very rare in dogs)
The vast majority of aural hematomas are caused by infection or allergies.
Signs and Symptoms
One of the most common signs of an ear hematoma is the appearance of the ear. As a result of the lump or fluid-filled pocket, the ear may appear thicker in size, taking on an inflated look, sometimes referred to as “cauliflower ear.” The swelling can be firm to the touch, or soft and fluctuant. Here are the indicators to look for:
All or part of the ear flap filled with fluid
Itching
Ear-scratching
Head-shaking
Tilting of the head sideways
These signs and symptoms are not only indicators your dog may have an aural hematoma – they may also indicate that there is an underlying condition causing the hematoma that needs to be diagnosed and treated.
Diagnostics
The hematoma itself is easily identifiable and not difficult for a veterinarian to diagnose by visual examination. What’s more important when determining treatment is understanding what caused the hematoma in the first place.
A few simple tests may be performed to make sure there is not an underlying reason for the ear being irritated or hard to heal from the bleed. The initial evaluation may include, but is not limited to, the following tests:
Fine needle aspirate and cytology (this exam will include taking a swab from the ear canal and looking under a microscope for bacteria and yeast)
Systemic testing for underlying causes may include –
Allergy testing
Endocrine testing
Ear swabs
Routine blood work
Urine test
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/itching will certainly reduce the risk of this complication.
If you have any questions or concerns, you should always visit or call your veterinarian — they are your best resource to ensure the health and well-being of your pets.