Aural Haematoma

Aural Haematoma

What is a haematoma of the ear, and how does it occur?

An aural (ear) haematoma is a collection of blood or serum, and sometimes a blood clot within the pinna or ear flap. This blood collects under the skin and causes the ear flap to become thickened, it may involve the entire ear flap or only one area. Aural haematomas usually occur as a result of local irritation to some part of the ear. When something irritates the ear canal, the dog responds by scratching or shaking the head. Excessive shaking causes blood vessels to break, resulting in bleeding. An understanding of the anatomy of the ear helps to explain how haematomas occur. The ear flap is composed of a layer of skin on each side of a layer of cartilage. The cartilage gives the ear flap its shape. Blood vessels go from side-to-side by passing through the cartilage. Violent shaking causes the vessels to break as the skin slides across the cartilage.

How is it treated?

There are 2 steps for successful treatment -

1. The fluid needs to be removed from the pinna This can be done in 2 ways.

Small haematomas can be treated by aspirating the fluid via needle and syringe whilst the pet is under sedation, (it is often possible to do the procedure conscious in cooperative animals). We usually insert an small amount of anti-inflammatory solution into the space where the blood was to prevent further accumulation. This is successful in about 80% of cases. If the haematoma reforms then the procedure can be repeated.
Larger, or recurrent smaller haematomas, need to be incised with a scalpel and stitched. This is done under a general anaesthetic. A small piece of skin is removed from the underside of the pinna and the haematoma fluid drained away. Several sutures are then placed through the pinna to obliterate the space where the blood had accumulated. Since the skin over the haematoma has been pushed away from the cartilage, it must be reattached to it to prevent another haematoma forming.

2. The cause of the problem needs to be diagnosed and treated.

Dogs with aural haematomas often have ear infections that has caused them to shake their head, or scratch their ears. Any infection present will need medication to treat it; usually in the form of ear drops. Some dogs have no infection but have foreign material (wax, grass seeds etc) lodged in the ear canal. The ear canals will be cleaned out and any foreign material removed.

What happens if a haematoma is not operated on?

If a haematoma is left untreated the blood in the ear flap will separate into serum and a clot and will gradually be absorbed over a period of 10 days to 6 weeks. Unfortunately some scarring takes place during this process and causes deformity of the ear flap resulting in a "cauliflower ear".

Will I need to bring my dog back for further treatment?

All haematomas will need checking post-operatively to check they have not recurred. Sutures are generally removed in about 10 - 14 days. At that time, the haematoma is usually healed. If discharge occurs from the wound before it closes it should be cleaned off with saline solution. If an infection was present, it will be necessary to recheck the ear canal to be sure that the infection is gone. Otherwise, another haematoma may occur.