Stan Wood, DVM, Diplomate ABVP

Specialist in Canine & Feline Practice

Hematoma of the Ear in Dogs

(Aural Hematoma)

An aural (ear) hematoma is a collection of blood, serum, or a clotted blood within the pinna (earflap). When present, the pinna will be very thick. The swelling may involve the entire pinna or it may involve only one area.

The earflap is composed of a two layers of skin surrounding a layer of cartilage. The cartilage gives the earflap its shape. Blood vessels go from side-to-side by passing through the cartilage. Violent shaking can cause the vessels to break as the skin slides across the cartilage; however, in some cases, the cause remains undetermined. (See Causes.)

Causes/Transmission

The cause of aural hematomas is unknown. Vigorous shaking of the head and ears has been thought to be responsible, yet a large percentage of affected dogs develop hematomas without shaking their head. Disease of the ear canal is also considered to play a role, but not all dogs with aural hematomas have ear disease (otitis).

Clinical Signs

Most dogs with an aural hematoma have a history of head shaking. Debris or odor may occur in the ear canal if an infection is present. However, the most consistent clinical sign is a thickened earflap.

Diagnosis

A physical examination of the earflap is usually all that is needed to make the diagnosis.

Treatment

There are two approaches to treatment: a medical approach and a surgical approach

Medical Treatment

This is the simplest and least invasive procedure; however, it is not always successful. Many dogs are treated in this manner first. If it is not successful, the surgical treatment is used.

The blood in the earflap is aspirated with a syringe and needle. One of several medications, often a cortisone-type drug, is injected into the space from which the blood was taken. The earflap is taped over the head as described below. The dog is checked in 3-7 days to assess the outcome of treatment. If an ear infection is present, it is also treated.

Surgical Treatment

The blood is removed from the pinna. This is accomplished by making a small incision in each end of the hematoma. A rubber drain tube is passed through the hematoma and sutured to the ear. This assures drainage of any more blood or serum that accumulates in the area.

The space where the blood accumulated is obliterated. Since the skin over the hematoma has been pushed away from the cartilage, it must be reattached to it to prevent another hematoma from occurring. This is accomplished by a series of sutures that are passed through the earflap.

The pinna is stabilized to prevent further damage. The presence of the drain tube will cause the dog to shake its head even more. Shaking at this time may cause further damage to the pinna. Therefore, the pinna is laid on top of the dog's head and bandaged in place. Although the bandage may be somewhat cumbersome, it will prevent further damage to the pinna and allow proper healing to progress.

The cause of the problem is diagnosed and treated. Another important aspect of treatment is dealing with the cause of any potential head shaking. If an infection is present, medication is dispensed to treat it. However, some dogs have no infection but have foreign material (a tick, piece of grass, etc.) lodged in the ear canal. If so, the foreign material is removed. It is also possible that a foreign body initiated the shaking but was later dislodged. If that occurs, and no infection is present, further treatment of the ear canal is not needed.

The drain tube and bandage are generally removed in about 3-5 days. At that time, the hematoma is usually healed. There will be two holes in the skin where the drain tube entered. They will close within a few days. If discharge occurs from the holes before they close, it should be cleaned off with hydrogen peroxide.

If an infection was present, it will be necessary to recheck the ear canal to be sure that the infection is gone. Otherwise, another hematoma may occur.

Prognosis

Usually the prognosis is good for recovery, but it is not uncommon for the hematoma to recur at least once.