Turns Your House Into a Frightful Mess, and Means Pain and Discomfort for Your Pet

Story at-a-glance -

  • Ear hematomas are fluid-filled pockets that develop on the inside of a dog’s earflap, most often in pets with long, floppy ears
  • Most ear hematomas are the result of a dog vigorously shaking his head or scratching at his ears due to allergies or something else that causes intense itching
  • It’s important to address ear hematomas immediately to prevent them from getting bigger or rupturing
  • Surgery is usually the best option to resolve ear hematomas; medical leeching, though difficult to find, is an excellent alternative
  • It’s important to identify and resolve the underlying cause of your dog’s hematoma to prevent a recurrence

By Dr. Karen Shaw Becker

An ear hematoma, also called an aural hematoma, is a fluid-filled pocket on the inside of your dog's 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, it results in bleeding under the skin and a blood and pus-filled pocket. Ear hematomas are most commonly seen in floppy-eared dogs, but they can occur in any breed, and occasionally even in cats.

Causes of Ear Hematomas

Most dogs develop ear hematomas from shaking their heads or scratching at their ears as a result of allergies or something else that causes intense itching. An ear infection can also cause your dog to scratch and dig at his ears. Even vigorous head shaking can be enough to cause those tiny blood vessels to rupture and a hematoma to form. So can striking the earflap against a hard surface.

Other causes of ear hematomas include injury to the earflap or some other trauma to the ear, often as the result of a dogfight; inflammation or infection of the ear; presence of a foreign body in the ear; and parasites such as ear mites.

Symptoms of an Ear Hematoma

Once bleeding under the skin begins, it creates irritation, which will make your dog shake his head even more. Dogs can tell there's something going on with their ear, and sometimes they even tilt their head to the heavier side because they know the earflap just doesn’t feel right.

If the problem isn't addressed immediately and blood and other fluids continue to accumulate under 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 a dog is shaking his head, spraying blood all over the place. Hopefully, you won’t let your dog’s ear hematoma get to this point!

Ear hematomas are usually very obvious, so your veterinarian can usually diagnose it just by examining your dog’s ear. A swollen, warm, squishy area over the earflap usually indicates a small hematoma. However, a hot, firm feel can indicate the presence of a large hematoma that affects the entire pinna (floppy part of the ear), and can make your dog absolutely miserable.

Treatment Options

Treatment for an ear hematoma involves not only resolving the swelling, but also determining what caused the problem in the first place, which I'll discuss in a minute. There are a few different procedures your veterinarian might use to treat an ear hematoma. Hematomas can be resolved with surgery, but many pet parents want to try other approaches first.

One such approach is aspiration, in which a syringe is inserted into the fluid-filled pocket to draw out the fluid, or a tiny cut is made in the pocket to allow the fluid to drain out. Aspiration is a relatively inexpensive procedure and is popular with dog parents, but there’s always a downside. The most frequent result is that the emptied pocket fills right back up and the drainage continues.

If you opt to take this approach, just be aware that multiple aspirations are usually needed to remove the fluid, and you’ll never completely get rid of it all. There's also a risk of introducing an infection into the aspiration site. In addition, while you’re waiting for the oozing to subside, clotting is taking place and scar tissue is forming. If the fluid and blood forms a clot in the ear, aspiration isn’t possible even though the ear is still full of blood.

Years ago, I had a dog patient with an ear hematoma. The owner was adamant that she didn’t want surgery, which I understood. She insisted that I lance the ear, and her plan was to go home and follow up with herbs to assist the clotting and healing. It sounded like a reasonable plan, but I warned her that the hematoma would probably continue to bleed after I lanced it.

Needless to say, the ear looked better after I pierced it. When she left the hospital she was happy because the ear was back to its normal size. But she called the next morning and said her dog had spent the entire evening shaking his head, and the house looked like a crime scene because there was blood everywhere, which, unfortunately, is not uncommon.

Next, she suggested I insert a vent in the dog’s ear — an idea she came up with while researching the problem online. I explained that some veterinarians do sew or suture a little one-way vent or cannula in the earflap that allows the fluid to drain over time. However, this approach doesn’t fix the blood spray problem because each time the dog shakes his head, blood flies from the little vent, and this can go on for several days or even a week or longer. The owner wound up bringing the dog back the next day for surgery.

The dog’s ear healed without incident, but I tell this story because it’s really important to know that if you wait to do surgery to correct an ear hematoma, the earflap will develop scarring. Scarring is a very common cosmetic outcome in these situations. The Chinese herb Yunnan Baiyao can help resolve small hematomas, and several homeopathics may also encourage healing, so addressing the issue immediately when you notice it is a smart idea.

Medical Leeching to Resolve Ear Hematomas

Another less common but very successful approach to treating ear hematomas is medical leeching. There are several veterinary disorders that can be very effectively treated with leeches, and vascular and blood-borne issues like ear hematomas are one of them. It sounds pretty gross, but believe it or not, it’s incredibly effective, and part of the reason is that leeches do a great job of removing stagnant blood.

Leeching is minimally invasive, and there’s little to no discomfort thanks to an anesthetic substance found in leech saliva. When a leech feeds, it can remove 1 to 2 tablespoons of blood per feeding. The site will continue to ooze a bit after the leech falls off, usually for another day or two.

As soon as the leech attaches to the treatment area, it begins to release saliva into the wound that causes the animal’s blood to become dilute and fluid, which resolves clots.

As the leech feeds, removing the blood in the hematoma, saliva continues to be released into the wound, providing anti-inflammatory and antibiotic benefits. The saliva also has properties that stimulate blood circulation to and from the wound site, and provide analgesic and vasodilator effects as well. It’s an all-natural, very effective way to treat an ear hematoma.

Animals tolerate leech therapy very well. There’s no reason dogs can’t move around during the treatment. However, they must be closely supervised to prevent them from pawing or rubbing at the treatment area. Medical leeching should only be performed by someone trained in the procedure, which can be difficult to find. But it’s a great solution if you can find a practitioner who does it.

Surgical Correction of Aural Hematomas

There are a number of surgical techniques veterinarians use to resolve ear hematomas. All of them involve draining the hematoma and then placing multiple sutures in the deflated earflap to create an adhesion between the skin and the cartilage. Picture a quilt. The earflap is in a sense quilted or closed with sutures so blood and fluid can’t get back into the space.

In some cases, bandages are applied after surgery, but not always. Sutures are left in for up to three weeks to intentionally create scarring in the area, which will prevent the earflap from filling back up. All surgical options result in some degree of scarring, because that’s the goal.

Scarring is unavoidable if the hematoma has existed for many days or weeks prior to the surgery, because the underlying cartilage has been damaged. Surgery will not fix the underlying cartilage damage, so the more scarring that occurs, the more crinkled the earflap will be after surgery.

If the dog’s ear hematoma is never addressed, in addition to being very uncomfortable and painful for many weeks or months, intense scarring is unavoidable. In some cases the entire earflap crinkles and shrivels up as the fluid is reabsorbed back into the body.

Identifying the Cause of Your Dog’s Ear Hematoma

Treatment of an ear hematoma involves not only resolving the swelling, but also determining what created the problem in the first place. There's usually an underlying cause for ear irritation and head shaking, and it’s important that your veterinarian investigates potential underlying issues, and treats the root cause of the hematoma to prevent recurrence.

If there’s trauma or injury to the earflap, obviously the wound will need to be treated. But most of the time, the underlying cause is an ear infection or an intense systemic allergic response, or sometimes, both. Dogs can develop secondary ear infections resulting from an underlying allergy that creates massive inflammation in the ear canals.

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 there are bacteria on the swab, a culture will be performed to determine what infections are present and what medication is going to be most effective in resolving the infection.

If the problem is allergies, which usually means there are more symptoms than just the one ear issue, 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, a tremendous amount of debris can accumulate in the ears, which can cause irritation and inflammation. It’s really important that you check the ears regularly and clean them as often as necessary to make sure they stay dry and gunk-free.

In particular, you should give them a careful cleaning and ensure they’re thoroughly dry after swimming and baths to help prevent an ear hematoma from developing.