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.
WHAT DO WE DO TO RELIEVE IT?
There are several options when dealing with hematomas. Unfortunately, because they are usually caused by the dog shaking its head due to an ear infection, hematomas often recur regardless of what we do. The following are two commonly performed procedures:
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. With small hematomas, we may see good results. Sometimes a bandage is used to keep the dog from inflicting more trauma to the ear flap.
SURGICAL REPAIR – 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, with or without ear cartilage removal. Sometimes bandages are applied post-operatively, sometimes not. Sutures are generally left in place for 3 weeks to allow good scarring to take place so that refilling will not occur.
WHAT IF THERE IS A CONCURRENT EAR INFECTION?
An ear infection is the most common reason why a dog has been shaking his head. This means that the ear infection must be treated along with the hematoma. The ear will need cleaning, microscopic examination of the discharge, and medication. Sometimes ear shaking just happens and there is no underlying infection but one should be prepared for the expense and trouble of treating an ear infection along with that of the hematoma.
WHAT IF WE LEAVE IT ALONE?
If left alone, an ear hematoma will usually resolve by itself over time. The fluid will be re-absorbed back into the body and the ear flap will again be flat. The problem is that we are often treating an ear infection along with the hematoma and that makes it difficult to keep the dog from re-traumatizing the tissue. It can take weeks to months for the swelling to go away and a lot of scarring is associated with this process.The ear will often have a crinkled, “cauliflower” appearance afterward. Also the weight of a large hematoma may be uncomfortable for the pet, again increasing the likelihood that he will shake his head. Sometimes the skin of the ear will be so weakened that it will split with the pressure and you will have a big, bloody mess. While messy, this is not usually life threatening, but the dog will need antibiotics and possibly surgery to treat the wound.