Swelling of the Ear (Aural Hematoma) in Dogs and Cats
DR. ROHIT RAJ,PET CONSULTANT,KOLKATA
A hematoma is a pool of blood that forms outside of blood vessels and is usually found under the skin. Commonly found in dogs, an ear hematoma, also referred to as an aural hematoma, is a blood-filled pocket on the inside of the ear flap. An ear hematoma is extremely painful for a dog, and the intense swelling can be alarming. If left untreated, a hematoma will heal on its own, but that can mean weeks of discomfort.
Ear hematomas occur when a blood vessel in the ear bursts and bleeds into the space between the ear cartilage and skin. This is most commonly associated with trauma such as scratching, shaking the ears, or bite wounds. Dogs with ear infections may violently shake their head or scratch their ears causing an aural hematoma. 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 long, floppy ears are at greater risk for developing ear hematomas. Pets with clotting or bleeding disorders may also develop hematomas, with or without a history of trauma.
The hematoma must be treated as soon as possible or permanent disfigurement may result.
The preferred method of treatment involves surgical correction of the hematoma. The actual surgical technique varies with the individual circumstances and veterinarian’s preference, but always involves the same basic steps. First, the skin over the hematoma is surgically incised to drain the blood and remove any blood clots. Next, the empty space (called dead space) is removed by placing numerous sutures through the ear, which will promote controlled scar tissue formation, reattaching the cartilage to the skin, and helping prevent future recurrence. A surgical drain may be placed to promote drainage. Finally, the pinna is supported to minimize further damage and promote healing. It may be supported by a bandage or other material applied directly to the ear, or by bandaging the ear against the head.
As well as treating the hematoma, it is important to treat the underlying cause, which in many cases is an infection or allergy. Once the hematoma has been surgically corrected, if an underlying cause of the ear problem is found, such as an infection, an allergy, or a foreign body, it will be treated.
An ear hematoma in dogs, also referred to as an auricular or aural hematoma, is a localized mass of blood that is confined within the ear flap. A hematoma typically occurs in one ear flap but can take place in both ears with swelling throughout the entire or partial ear flap.
Signs & symptoms of ear hematomas in dogs
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.
If your dog is exhibiting any of these symptoms, they should immediately be checked out. This condition is extremely painful, so you will want to quickly determine the best course of treatment.
Causes of dog ear hematomas
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
- 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.
Diagnosing ear hematomas in dogs
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.
So the next step after a physical exam is to focus on the reason behind the head-shaking and/or scratching. The initial evaluation may include, but is not limited to, the following tests:
- Needle aspiration, which will confirm that the fluid in the pocket is blood.
- Routine blood work
- Urine test
- Examination of the ear canal to check for signs of infection, parasites, and/or foreign bodies lodged in the ear canal. This exam will include taking a swab from the ear canal and looking under a microscope for bacteria and yeast (which is referred to as cytology).
- Food trials/skin tests to identify food or other allergies that can cause discomfort. This can be a bit trickier than simply examining samples under a microscope; some trial and error may be required to identify the allergen. Additional allergy testing may need to be conducted.
Treatment for dog ear hematomas
An ear hematoma is painful for a dog, so it’s important to have it examined as soon as possible.
There’s always the chance that a small hematoma might not need to be treated; they can resolve on their own as the blood becomes reabsorbed. But hematomas should still be checked out. Even a small hematoma can be painful, and while the swelling will eventually subside, the ear may permanently appear thicker and take on a cauliflower appearance where the hematoma was located.
In order to treat the hematoma, your vet will most likely try to treat the underlying cause first, to prevent the possibility of another hematoma forming on the same or opposite ear.
Many veterinarians will recommend conservative care, using at-home warm compresses and/or anti-inflammatories or other pain medications. But other possible treatments include the following:
- Needle aspiration: A simple and relatively inexpensive treatment that involves the insertion of a thin needle into the hematoma to drain the fluid. A steroid may be injected into the ear to reduce inflammation, swelling, and itchiness, along with medicine to combat any infection. The process will be repeated a week later.
- Placing a drain inside the ear: In larger breeds, placing a drain inside the ear flap may be an option if the ear is large enough to accommodate the drain and the dog is willing to tolerate it. This method allows the fluid to drain continuously for a week or more, rather than fill up again rapidly as often occurs with aspiration. However, drains are very rarely used to treat hematomas.
- Surgery: Surgery requires general anesthesia. A small incision is made in the affected ear to drain out the fluid and any blood clots that are present. Next, the veterinarian will suture two cartilage layers together in the ear flap, with a small incision remaining open for drainage purposes. This incision will eventually heal on its own. For larger-eared dogs, the ear may need to be secured to the head with a bandage to protect the blood vessels in the event of any head-shaking during the recovery period. Post-surgery, your dog may also need to wear a cone to prevent scratching in the area. The sutures usually remain in place for a few weeks while the incision is left open. While this surgery is not a major one, it’s important to remember that all surgeries and applications of general anesthesia carry inherent risks and the potential for complications.
What happens if an ear hematoma in dogs remains untreated?
While ear hematomas can be slowly reabsorbed by a dog’s body, they are particularly painful and require treatment to provide relief from this pain. Even if absorbed, inflammation from the hematoma may cause significant scar tissue, resulting in a distorted, cauliflower-shaped ear — damage that is often permanent.
Untreated ear hematomas can also cause additional problems for your dog. The swelling from a hematoma can block access to your dog’s ear canal — preventing you from treating any underlying ear infections that can occur. Hematomas are also known to reoccur and the swelling may fill up at any time if left untreated.
Recovery and management of an ear hematoma in dogs
If the hematoma is treated with needle aspiration, your veterinarian will provide you with medications and instructions for at-home care.
If surgery is required, you’ll receive a set of specific instructions regarding postoperative care. These recommendations may include:
- Cleaning, drying, and treating the ear canal with appropriate medication.
- Cleaning the incision and massaging out any small pockets of fluid that may accumulate after surgery.
- Keeping a cone on your dog until sutures are removed and the hematoma has completely healed.
Proper follow-up care and close monitoring are important to prevent not only a recurrence but the potential for a hematoma to develop in the other ear.
Preventing ear hematomas in dogs
It can be difficult to prevent an ear hematoma from developing, but preventing or successfully treating the underlying problems that cause head-shaking/itching will help reduce the risk.
Ear hematomas form when blood pools under the skin of the ear, following scratching or head shaking. Be aware of the signs and symptoms of aural hematomas; prompt treatment is advised since they can be painful for your dog. Your veterinarian will advise you on how to provide postoperative care as needed. Prevention of ear hematomas relies on fostering good overall health, hygiene, and awareness.
Prevention of Dog Ear Hematomas
Preventing ear infections and ear mites will also help prevent the formation of hematomas in your dog. When ear infections or mites do occur, they should be treated promptly to avoid the formation of a hematoma.
If you see these common signs, take your dog to the vet so they can be properly diagnosed and treated for an ear infection or ear mites before a hematoma develops:
- Frequent head shaking
- Excessive ear scratching
- Pain, redness, or odor
- Crust in the ear or discharge
What follow-up treatment is needed?
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 occurs from the surgery sites 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 recheck of the ear canal to be sure that the infection is gone. Otherwise, another hematoma may occur.
If it is a blood blister, won’t it disappear with time, just like a bruise?
If left untreated, the hematoma may be slowly reabsorbed, but the associated inflammation will have caused damage to the surrounding ear tissues resulting in a distorted, cauliflower-shaped ear. Aural hematomas are very painful, and for humane reasons they should be treated.
Can you just drain the swelling?
Drainage may result in a temporary correction, but in the vast majority of cases, the hematoma returns within one to two days . The longer the hematoma is left untreated the greater the likelihood of permanent damage and disfigurement. Drainage may be used if the hematoma is very small, or if the patient cannot undergo surgery for some reason. If drainage is the chosen treatment, be prepared to return to your veterinarian for a few visits, as repeated draining is often necessary. This treatment method may eventually eliminate the problem, although it will take longer to achieve the same result as surgery. Anti-inflammatory medication is usually prescribed in these cases.
https://firstvet.com/us/articles/swelling-of-the-ear-aural-hematoma-in-cats-and-dogs
https://www.pashudhanpraharee.com/haematoma-in-dog/
