What causes an aural hematoma to occur?
The external ear has a layer of skin on both sides and a layer of cartilage sandwiched between the two skin layers. Blood vessels run just beneath the skin. When something irritates the ear canal, your dog will respond by scratching or shaking its head. Excessive or violent shaking causes one or more blood vessels to break, resulting in bleeding into the space between the ear cartilage and skin on the inner surface of the ear.
Most dogs that develop an aural hematoma have an infection, allergy, bite wound, or other inflammatory ear condition that causes excessive scratching and head shaking. In some cases, there may be a piece of foreign material lodged in the ear canal, such as a tick or piece of grass. It is also possible that a foreign body initiated the shaking but was later dislodged.
Dogs with a bleeding or clotting disorder may also develop an aural hematoma, with or without a history of trauma.
What is the treatment for an aural hematoma?
There are many ways to treat aural hematomas in dogs and your veterinarian can discuss their recommendations with you. Surgery can treat the hematoma quickly and effectively. The actual surgical technique varies with the individual circumstances and the veterinarians preference but always involves these basic steps:
1. The blood is removed from the pinna. This is accomplished by making a small incision at each end of the hematoma. A drain tube may be passed through the hematoma and sutured to the ear to remove any more blood or serum that accumulates in the area. Alternatively, the skin over the hematoma may be incised and opened completely.
2. The space where the blood accumulated is eliminated. This is accomplished by placing a series of sutures (stitches) that are passed completely through the ear flap holding both layers of skin to the cartilage.
3. The pinna is stabilized to prevent further damage. It may be supported by a bandage or other material applied directly to the ear, or by bandaging the ear against the head. Shaking after the ear pinna has been sutured at this time may cause further damage to the ear.
Some aural hematomas are treated by draining the hematoma and injecting a steroid into the pocket. Repeated draining is often needed so be prepared to return to your veterinarian for a few visits. Oral steroids are often recommended as well. This treatment method may eventually eliminate the problem, although it may take longer to achieve the same result as surgery. Some hematomas are treated with oral steroids alone depending on their size and location.
If an underlying cause is found, such as an infection, allergy, or foreign body, it will be treated once the hematoma is corrected.
Drainage tubes or bandages may be removed by your veterinarian after 3-14 days. In some cases, there may be one or more drainage holes from the drain or incision, which will be left to heal by scar tissue. The sutures (stitches) may be removed after two weeks if the ear is completely healed; in severe cases, some or all of the sutures may be left in place for up to two weeks longer.
If discharge from the surgery sites occurs before they close, it should be cleaned off with mild cleansing soap. If an infection is present, your veterinarian may prescribe medication and will recommend a recheck of the ear canal to be sure that the infection is resolved. Otherwise, another hematoma may occur.
What are the Symptoms of Ear Hematomas?
The appearance of the ear is one of the most prevalent indicators of an ear hematoma. The ear may appear thicker and inflated as a result of the lump or fluid-filled pocket, which is frequently referred to as “cauliflower ear.” The swelling might be hard or soft, and it can fluctuate.
Here are some symptoms to look for:
It’s important to remember that these symptoms don’t just indicate an ear hematoma but might be pointing to an underlying condition that needs to be treated. If your dog is showing these signs, veterinary intervention is required as soon as possible.
DOG EAR HEMATOMA BLOOD DRAINING . DO IT YOURSELF AT HOME
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If you’re a dog parent, chances are good that at some point you may have to deal with an ear hematoma. Disliked by vets due to their tendency to come back again and again, and visually alarming to pet parents (not to mention messy), ear hematomas in dogs can be one of the most frustrating conditions to treat.
Ear hematomas happen when a blood vessel in the ear bursts and starts to bleed into the space between the skin of the ear flap and the cartilage underneath. This is usually the result of the dog violently shaking his head or scratching at his ears, often because of ear infections, skin allergies, or debris (such as dirt or foxtails) getting lodged in the ear canal. Once the bleeding starts, the ear can swell significantly until it looks like a giant, over-stuffed ravioli.
Although ear hematomas are more common in floppy-eared dogs (since their ears flap against their heads when they shake), dogs with straight ears, cats, and even humans can develop ear hematomas. Pets with blood-clotting disorders can also develop them spontaneously, even without any trauma to the ear.
Once an ear hematoma forms, it causes pain and irritation, causing the dog to shake his head even more. If not treated, an ear hematoma can continue to grow so large that it blocks off the opening to the dog’s ear canal, or worse, it may rupture. Any dog parent who’s come home to a dog with a ruptured ear hematoma knows how incredibly scary it is to see blood sprayed all over the walls from the poor dog shaking his head everywhere!
Diagnosis of an ear hematoma is pretty straightforward – the dog’s ear looks like a swollen pillow and feels squishy to the touch. However, it’s important to diagnose the issue that caused the problem in the first place so it can be treated immediately.
The veterinarian will start with an examination of the ear canal, looking for the presence of ear mites, a bacterial or yeast infection, or any sort of debris which might have gotten stuck inside the ear.
If the ear canal looks healthy, the vet will then examine the dog for signs of allergic skin disease, which is the most common reason why dogs scratch at their ears. If the vet suspects allergies, a change in food or allergy testing may be recommended.
It’s very important to identify and treat the underlying cause of the head-shaking or ear-scratching, otherwise the ear hematoma will just keep coming back.
Without any treatment, an ear hematoma will eventually resolve on its own; however, there are problems caused by not providing treatment. First, ear hematomas can be, at best, very uncomfortable, and at worst, extremely painful for the dog for a period of several weeks.
Second, if an ear hematoma is not treated promptly, once the fluid in the ear is re-absorbed by the body, the ear will crinkle up and shrivel down into a mass of scar tissue. This results in a permanent, unsightly deformity called “cauliflower ear” that can never be repaired and may make it very difficult to clean the dog’s ear in the future.
Although it’s less expensive than surgical repair, simply drawing blood out of the ear has several drawbacks. Sometimes multiple trips to the vet and several aspirations are needed in order to remove all the blood from the ear flap. Also, once the blood is drawn out, it leaves a large open pocket that can quickly fill back up with fluid, making aspiration effective less than 50% of the time. There’s also a risk of introducing infection into the ear with this procedure.
Another option involves placing a small drain, or rubber tube, into the outer portion of the ear. This drain stays sutured in place for several weeks until all the blood and fluid drains out of the pocket. This method is usually reserved for those patients who are too old or too sick to tolerate the general anesthesia needed for surgical repair.
However, just like with aspiration, there are drawbacks. Some ears, such as those of cats and very small dogs, are too small for this technique to be used. Many dogs will not tolerate a drain being in place for such a long period of time, and the drain can become dislodged when the dog shakes his head. Also, just like with aspiration, the pocket can quickly fill back up again when the drain is removed.
Surgery is the most effective treatment for ear hematomas in dogs. While the dog is under general anesthesia, an incision is made in the ear and any fluid and blood clots are removed. Then the veterinarian places sutures in the ear to tack down the outer surface of the ear to the inner surface, holding the two sides flatly together so that when scar tissue forms, the surfaces remain relatively smooth and there is no pocket to fill back up with blood.
Some veterinarians then place a surgical drain to help drain out any fluid that may form after surgery, while others leave a portion of the incision open to drain on its own. The dog’s ear is then flipped up against his head, and an elastic bandage is applied to hold the ear tightly against the head, keeping it in place in case the dog shakes his head after surgery. Lastly, the vet will fit the dog with an Elizabethan collar (e-collar) so the dog can’t scratch at the bandage. Sutures are left in place for anywhere from 2- 3 weeks until the ear is completely healed.
After treatment, the dog will be able to go home with pain medication, antibiotics, and an e-collar, which must be left on at all times to prevent the dog from re-damaging the ear by scratching it or rubbing it against furniture or carpeting. It only takes a few seconds for all the hard work of treatment to be completely undone if the e-collar is removed.
If the ear hematoma was surgically repaired, several recheck visits with the veterinarian will be needed to change the pads underneath the bandage, make sure the ear is draining and healing properly, and to ensure there is no infection. If all goes well, the ear should heal in 2-3 weeks.
At the final recheck appointment, the veterinarian will remove the sutures (and the drain, if one was placed). Another bandage may be necessary until the ear is completely healed, there’s no more drainage, and the dog is no longer shaking his head.
Ear hematomas in dogs can be painful, unsightly, and downright messy. Although they can’t always be prevented, they can be successfully treated, and the risk of recurrence can be greatly decreased when the underlying issues that caused the head-shaking and scratching in the first place are treated and eliminated.
It’s important to regularly inspect your dog’s ears, keep them dry, and clean them as often as needed, especially if your dog has long or floppy ears. Also, if your dog is scratching his ears, or licking and chewing at his fur and skin, have your veterinarian examine him for skin allergies. These pre-emptive practices will greatly reduce the risk of your dog developing an ear hematoma in the future.
And if your dog does develop an ear hematoma, get to the vet quickly. With fast and appropriate surgical treatment, prognosis for recovery is good to excellent – and you won’t have to worry about spatter damage to your walls or furniture!
Has your dog ever had an ear hematoma? If so, how did you deal with it? Please share your story with us in the comments below!