Aural Hematoma

A hematoma is swelling created by a broken blood vessel after bleeding has occurred inside a tissue. Hematomas within the ear flaps ("aural hematomas") occur when head shaking breaks a blood vessel within the ear flap. The ear flap may partially or completely swell with blood. The swelling may be so large that the opening of the ear canal is occluded. The extra weight of the ear flap may be uncomfortable and may lead to a permanent change in the carriage of the ears. This condition is more common in dogs, but can occur in cats as well. The ear flap will feel fluctuant and fluid-filled, like a water balloon, which is extremely painful to the touch. If left untreated, the pain will subside somewhat after several days, but the swelling will continue and eventually, as the fluid-filled space generates scar tissue, the ear may become permanently disfigured.

A hematoma generally is the result of trauma to the pinna (ear flap) from an injury or from the dog or cat scratching at the ear. The itchy ear can result from ear mites, allergies, infections or foreign matter in the ear canal. Frequent scratching at the ear, or even vigorous shaking of the head, can result in a rupture of small blood vessels beneath the skin of the pinna.

The entire ear flap can become swollen, infected and severely uncomfortable to the dog. Hematomas can heal themselves but will leave behind a scarred, crinkled and shrunken pinna. And since the original cause is usually an infected ear canal, the original cause needs to be treated as well as the hematoma itself. Veterinarians generally will recommend surgery to open and drain the hematoma and remove dead and degenerating clots and fibrin. Then sutures are used to tack the skin layers over the thin cartilage center tight to the cartilage to eliminate any space for more blood or serum to accumulate.


A cat with an aural hematoma.

The symptoms of an aural hematoma, include extensive swelling of the ear flap. Most pets will either be holding the head to one side or either shaking and pawing at the affected side.


Moderate sized aural hematoma in a cat

Hematomas can be caused by pets that paw at their ears or shake their heads vigorously This pawing and shaking can be due to irritants around the face and ears, or irritants in the external ear canals caused by ear infections or foreign bodies (foxtails), or ear mites. These conditions must be treated along with the hematoma. The ear will need cleaning, microscopic examination of the discharge, removal of the foreign body if present, and medication.

There are many ways of correcting ear hematomas, but the preferred method is done with laser surgery. Below are a few of the methods used in some veterinary hospitals today:

ASPIRATION - This procedure involves simply using a syringe to remove the fluid contents of the hematoma. The problem is that a space is left behind when the fluid is removed and this space readily refills with more fluid. It is common for only temporary results to be obtained when the aspiration method is employed; usually this method is not the best choice.

PIE-CRUSTING SUTURES -



Here an incision is made in the ear flap surgically. The hematoma is drained of fluid and blood clots. To prevent the hematoma from refilling with fluid, multiple sutures are placed in the hematoma space either vertically or horizontally, either partly through or completely through the ear flap. Sometimes bandages are applied post-operatively. Sutures are generally left in place for 3 weeks to allow good scarring to take place so that refilling will not occur.

The Hematoma is seen on the underside of the dog's pinna. Cats do get Hematomas, too, usually due to ear mites. Hematomas are painful and surgical intervention is common.	The Hematoma is outlined. It could spread along the entire underside of the pinna within days. The ear canals are examined and any pathology is vigorously treated.	The incision is made through the skin down to the thin cartilage to drain and explore the Hematoma. Once healed, hematomas rarely affect the same ear again.	As many sutures as needed are placed through the entire pinna to tack the skin back to the cartilage. Healing is uneventful and generally occurs within two weeks after surgery.

TEAT CANNULA PLACEMENT - A teat cannula is a small device used in the treatment of udder inflammation in cattle. Teat cannulas can also be placed in a dog’s aural hematoma if the ear flap is large enough to accommodate the device. The hematoma is drained of fluids and allowed to heal over the next several weeks. This method is generally successful, but does involve the dog tolerating a “gadget” inserted in its ear flap for several weeks.

LASER EAR SURGERY - This procedure has the best outcome, and involves using a laser to create cylindrical openings in the ear flap to release the pressure of the hematoma and allow healing of the ear. This procedure creates an atmosphere that promotes healing and does not result in the ear flap filling with blood again. It is highly recommended that this surgery be done using a laser, particularly because it will dramatically minimize pain during the healing process. The affected ear may or may not be wrapped to the head for a few days to prevent the dog from shaking his head.

The laser works best for ear hematomas because a smaller opening is needed to drain the fluid. This minimizes scarring of the ear.

The laser has ability to selectively go through layers of tissue in a gentle and controlled fashion. The opening made in the ear is small. Several of these small openings are usually needed to drain out the fluid that has built up in the ear.

If left alone, an ear hematoma will resolve by itself. The fluid will be re-absorbed back into the body and the ear flap will again be flat. The problem is that a lot of scarring is associated with this process and the ear is often not cosmetically appealing afterwards (it may resemble a "cauliflower"). It can also take several months to resolve a large hematoma which may be uncomfortable for the pet.


Cat with a cauliflower ear after no treatment following an aural hematoma




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