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About Eric Barchas, D.V.M.

Eric Barchas, DVM is a veterinarian who lives and works in the San Francisco Bay Area. His emphasis is on small animal medicine, emergency medicine, hospice and wellness. An avid traveler, he has studied lions in Botswana and salmon in southern Chile.

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Ear Hematomas (Aural Hematomas) in Dogs and Cats

Animals Affected

Primarily dogs; occasionally cats

Overview

Aural hematomas occur when blood accumulates underneath the skin in the external portion of the ear.  A noticeably swollen area develops on the ear.  The area is often painful or irritating to the pet.

Aural hematomas develop when trauma occurs to the ear.  Direct trauma or chronic, violent head shaking can break blood vessels in the ear.  Broken blood vessels allow blood to accumulate under the skin, forming a hematoma.

Hematomas are sometimes frustrating to treat, and have a tendency to recur.  They are not life threatening, but they often lead to permanent scarring and disfigurement of the ear.

Symptoms

  • Hematomas occur as a swollen, blood-filled area on the ear. The swelling may be fluctuant (soft) or firm, depending on the quantity of blood under the skin. Mild hematomas occupy only a small portion of the ear. In severe hematomas, the entire external portion of the ear may be affected.
  • Hematomas often irritate pets, causing head shaking or rubbing and scratching of the affected ear.  Some pets develop a posture in which their head is held tilted to the side.

Risk Factors

  • Chronic, repeated head shaking is the leading cause of aural hematomas. Head shaking is most often caused by ear infections or allergic reactions that cause the ear to itch.
  • Direct trauma to the ear, such as a bite wound or blunt injury, may also lead to a hematoma.
  • Dogs with long, pendulous ears (such as Labrador Retrievers and Cocker Spaniels) are at increased risk for aural hematomas.

Complications

Hematomas are irritating and painful.  They often recur, or come back, which can be very frustrating.  Hematomas often lead to scarring of the ear that may be cosmetically unappealing but not dangerous to the animal's well-being.

Diagnosis

Most aural hematomas are easily diagnosed by visual examination of the affected area.  A needle may be used to aspirate blood from the ear; this confirms the diagnosis.

Treatment

Several options exist for treating hematomas. The method chosen depends on the severity of the hematoma and the clinical judgment of the veterinarian.

  • In a relatively simple treatment method, a syringe is used to withdraw accumulated blood from the area.  Cortisone may be injected into the ear after the blood is drained. Some veterinarians advocate bandaging the ear after the blood has been withdrawn.  However, ear bandages can be inconvenient for owners, and many veterinarians feel that the benefits from bandaging do not outweigh the inconvenience.  Aural hematomas often recur after they are drained, and the procedure may have to be repeated several times before it is effective.  In some instances, repeated draining fails to lead to permanent resolution of the problem.
  • Aural hematomas may also be treated by placing an indwelling drain (called a cannula) into the ear.  This allows blood to drain from the area continuously. The cannula typically must be in place for several weeks to be effective.  Some pets find cannulas irritating and do not tolerate them.   Also, blood leaking from the cannula can cause damage to carpeting and furniture.  Most pets must wear an Elizabethan collar (cone collar) while the cannula is in place.
  • Surgery is the most aggressive and effective method of treating aural hematomas. In the surgery, blood is drained from the ear and sutures are used to hold the affected area tightly together.   This prevents further accumulation of blood.  The sutures usually must remain in place for several weeks, and most pets require an Elizabethan collar while the sutures are in place.  Although surgery is the most expensive and involved method for treating aural hematomas, it has the lowest failure rate.  Significant scarring of the ear occurs following most hematoma surgeries.
  • Oral medication with prednisone and antibiotics may be successful for some individuals suffering from aural hematomas.

After surgery or placement of a cannula, most pets require medication with anti-inflammatory drugs, pain killers, and antibiotics.

Follow-up

As has been mentioned, aural hematomas have a high rate of recurrence.  To reduce the risk of recurrence, ear infections, ear allergies, and other identifiable causes of head shaking and ear trauma should be treated if present.  Proper flea prevention should be employed.

Copyright © Eric Barchas, DVM. All rights reserved.
The contents of this page are provided for general informational purposes only. Under no circumstances should this page be substituted for professional consultation with a veterinarian.