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Aural (Ear) Hematoma

Aural hematomas are hematomas (blood blisters) that occur in the ear of dogs and less commonly cats. They develop when the dog shakes its head violently as a result of an irritant such as an insect bite or more commonly from an ear infection. The shaking of the head causes blood vessels between the ear cartilage and skin to break, resulting in a blood-filled blister on the inside of the ear. This can emerge literally overnight and manifests as a soft, fluctuant swelling that can be small or very large resulting in occlusion of the external ear canal.

Aural hematomas are common and easily managed. It is very important to treat the underlying cause, ie ear infection concurrently. There are several treatment options:
Aspiration- this is accomplished by inserting a needle and syringe into the hematoma and draining the blood out. This is simple to do and requires no anesthesia, but is usually a temporary measure because it leaves a small hole which seals up quickly and the empty pocket tends to fill back up with blood.

Lancing- this is also a simple procedure not requiring anesthesia. We normally perform this procedure outside because it can get quite bloody. We take a sharp blade and make a sizable incision over the hematoma and drain the blood. We do not numb the area, as the numbing hurts more than the quick nick of the scalpel blade. This leaves a larger hole which the owners can “milk” more easily. Milking is massaging the blood out that wants to refill the defect. The object is to keep doing this, preventing the hole from closing so the blood can drain out. This is done only if there are 2 people with the dog going home, one to drive and one to hold a gauze over the dog’s ear. We do not do this procedure when the dog is brought in by one person because the dog will shake its head and create a bloody mess in the car, mimicking a crime scene. This could result in having the authorities pull you over and search the vehicle for the “body”.

Canula insertion- Cow teat canulas are small plastic tubes that are used to treat cows with mastitis. They work wonderfully as a semi-permanent drain for a hematoma. The dog is given light sedation, a nick is placed in the ear with a sharp scalpel blade and the canula is inserted into the hematoma. It is the sutured in place and left for 30 days. We instruct the owners to milk the ear twice a day, massaging the blood out of the ear through the canula. This procedure works nicely, is minimally invasive, does not require general anesthesia, and is not expensive to do. It also is the one procedure that leaves the most cosmetically pleasing result.

Do nothing- this is the least desirable option. Eventually, the blood in the hematoma will clot and consolidate. The ear will shrivel and create a cauliflower ear. An ear hematoma is uncomfortable as the ear becomes heavy with blood, and the constant head shaking could cause a hematoma in the other ear to form. This is why few clients choose this option.

The best results are achieved when a hematoma is first observed by the owner before clotting has taken place. Clots are more difficult to remove and can cause permanent scarring.

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