By Dr. Becker
Ear or aural hematomas are fluid-filled pockets on the inside of the earflap. There are tiny blood vessels in the pinna or the floppy part of your pet's ears. When something causes these little vessels to rupture, they bleed under the skin and form a fluid-filled pocket. Ear hematomas are most commonly seen in floppy-eared dogs, but they can occur in any breed of dog — whether their ears are floppy or not — and even occur in cats.
How Ear Hematomas Develop
Most dogs develop ear hematomas from shaking their heads or chronically scratching at their ears. Dogs shake their heads a lot. They shake after baths. Sometimes they try to shake themselves dry. Other times the ear is bothering them, which could be an allergic response that is causing intense itching in the ears, or it could be an ear infection. Shaking the head alone can cause those tiny blood vessels to burst, but so can smacking the ear against something while shaking.
Trauma to the ear can cause bleeding as well. Other causes of ear hematomas are injury to the earflap (usually from a dogfight), infection or inflammation of the ear, presence of a foreign body, or even a parasite in the ear. Once bleeding under the skin begins, it creates irritation, which will make your dog shake his head even more.
If the problem isn't addressed and blood and other fluids continue to accumulate in the skin, the hematoma can become quite large, even to the point of blocking off the opening of the ear canal. It's not uncommon for ear hematomas to rupture while the dog is shaking his head, spraying blood all over the place. Hopefully, pet owners don't let ear hematomas get to this point.
Diagnosing and Treating Ear Hematomas
Usually a problem with your pet's ear is quite visible and your veterinarian can confirm the presence of a hematoma. If there is swelling, the ear is warm, and there's a squishy feel to it, the hematoma is probably small. A hot, very firm feel can indicate the presence of a very large hematoma where the whole pinna is affected. Treatment of an ear hematoma involves not only resolving the swelling, but also determining what caused the problem in the first place.
There are a few different procedures that your vet might use to get rid of the hematoma. One is called aspiration. This is where a syringe is inserted to draw out all of the fluid from the hematoma. Aspiration is a relatively inexpensive and an easy process to do, but it has a lot of drawbacks. The most frequent consequence is that the space left by the aspirated fluid will simply fill back up. Another drawback to this approach is sometimes multiple aspirations are needed to drain all the fluid out.
There's also a risk of introduction of infection into the aspiration site. And finally, if the fluid in the ear hematoma is clotted and scar tissue is already forming, there may not be a whole lot of fluid to even draw out of the ear. Most vets, including me, resolve the majority of ear hematomas with surgery. Clients almost always want me to try something more minimalistic before surgery. Of course, I'm not opposed to trying, but I always relay a story that occurred in my practice years ago.
I had a dog that presented with an ear hematoma. The owner was adamant she didn't want surgery. She insisted that I lance the ear – which means create a little opening in the "blood blister" (that's what she called it). Then she planned to follow up with herbs to assist in rapid clotting and healing.
I told her that the dog would probably continue bleeding from the ear hematoma after I lanced it, but she insisted. Of course, initially, the ear looked better, because all the fluid came rushing out, and the ear went back to its normal size. The owner left happy.
However, the next day I received a call from her. She said her dog had spent the last 24 hours shaking his head. The owner had blood on her walls, on her lamps, on her sofa, all over her furniture, on her ceiling, all over her car … you get the picture. It wasn't pretty. The owner was angry that I didn't fix the problem through lancing. She also suggested that I consider a vent. She had been online. She said, "Some people sew a little cannula or vent in the ear."
Some vets do this by sewing or suturing a little vent in the earflap. It allows the fluid to drain over time. But then again, every time the dog shakes, blood still goes everywhere as it exits the little vent in the earflap. The owner ended up coming back the very next day for a procedure that ended all potential for more bleeding. That procedure was, of course, surgery.
There are a lot of surgical techniques veterinarians use to resolve ear hematomas. All of them involve draining the hematoma, then placing multiple sutures in the deflated earflap to intentionally create an adhesion between the ear skin and the ear cartilage. Think of it like a quilt. The earflap is in a sense quilted or closed with sutures so blood or fluid can't get back into that particular area. In some cases, bandages are applied, but not always.
Sutures are left in place for about three weeks to create a deliberate scarring in the area, which will prevent the earflap from filling back up with blood or fluid. All surgical options unfortunately result in some degree of pinna scarring. Scarring becomes unavoidable if the hematoma has existed for many days or weeks prior to surgery, because the underlying cartilage has been damaged. And surgery will not fix underlying cartilage damage.
The more scarring that occurs, the more crinkled the earflap will be. If the dog's ear hematoma is never addressed — in addition to being very uncomfortable for many weeks or months – the intense scarring is unavoidable. A lot of scarring will occur, sometimes causing the entire earflap to crinkle up and shrivel as the fluid is resorbed back into the body.
Root Causes of Ear Hematomas
There's usually an underlying cause for ear irritation and head shaking. It's important for your vet to investigate the underlying issue and treat the root cause of the hematoma to prevent recurrence. If there's an obvious trauma or injury to the earflap, obviously the wound will be treated. But most of the time, the underlying cause is an ear infection or an intense allergic response.
Your pet's ear will be examined with an otoscope and cleaned out. The discharge will be microscopically examined for the presence of bacteria, yeast, or mites. Anything that could create an underlying irritation that causes your pet to scratch or shake will be evaluated. If necessary, a culture will be performed to determine what infection is present, and most importantly, what medications will be needed to help resolve the infection.
If the problem is allergies, you'll need to figure out what your pet is allergic to if possible. This means eliminating the source of the problem, whether it's a dietary issue or an environmental allergic response. Especially if you have a dog with long floppy ears, it's important to regularly inspect them and clean them as often as necessary to make sure they stay dry.
In particular you should give them a thorough cleaning and insure they thoroughly dry after swimming and baths to help avoid an ear hematoma from developing.