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Dog: Aural Hematoma

General information

Other common/scientific names: ear hematoma, blood between membranes of ear, pocket of blood on earflap, blood filled ear

The pinna of the ear is also known as the earflap. It consists of skin overlying the auricular cartilage. There are many blood vessels between these layers of skin. When these blood vessels rupture or bleed, a hematoma or pocket of blood is formed between these layers of skin. This blood may clot over time leading to scarring and disfigurement of the ear if left untreated.

Causes

Aural hematomas are caused by trauma to the ear causing the blood vessels to rupture and bleed. The most common cause is excessive shaking and scratching of the ears due to otitis (ear infection). A bite wound or blunt trauma to the ear may also cause a hematoma. Dogs with long pendulous ears such as Bassett Hounds and Cocker Spaniels are more susceptible to developing hematomas.

Cardinal symptom

Swollen earflap

Symptoms

Aural hematomas usually occur as a soft, fluid filled pocket. These swellings may be mild, occupying only a small portion of the pinna or they may be severe where the entire portion of the external ear is affected. Once the earflap is filled with blood, the extra weight is both irritating and painful to the dog. Because of this, these dogs may hold their head to the side and alter the normal carriage of their ear.

Abb. GSR9J3E8
Abb. GSR9J3E8: Aural hematoma.
The hair on the ear has been clipped

Diagnosis

Aural hematomas are diagnosed on physical examination by the clinical signs. Although not usually necessary, a small needle can be inserted into the fluid filled pocket to obtain a sample of the fluid which is usually blood tinged in appearance.

Treatment

There are several options for treating aural hematomas. The method chosen will depend on the severity of the hematoma, the patient and the attending veterinarian.

  • Aspiration: A syringe can be used to remove the fluid and blood from the pocket. Corticosteroid may be injected into the ear after the blood is removed. The ear may or may not be bandaged. This procedure is simple and inexpensive. However, hematomas tend to recur more frequently when drained and a bandaged ear can be difficult for owners to manage at home.
  • Drain or cannula placement: A cannula is a small device that allows fluid to drain from tissue. This can be placed in the hematoma to allow the blood to drain and the underlying tissue to heal. Typically, the cannula must stay in place for several weeks to be effective. Some dogs will not tolerate a gadget in their ear. Also, the blood and fluid leaking from the cannula can be damaging to furniture and carpet.
  • Surgery: Surgery is the most effective method for treating aural hematomas. During the surgery, an incision is made on the underneath side of the pinna to drain the fluid and remove any blood clots and fibrin. Multiple sutures are then placed through earflap to hold the skin and membranes tightly together keeping the earflap straight and flattened to prevent refilling of the hematoma. This allows the tissues to heal and prevents blood from refilling in the pinna. Another surgical method uses a commercially available hematoma kit consisting of silicone ear pads, locking clips and rings to oppose the tissues and allow for healing without disfigurement.

The ear may or may not be bandaged and the sutures or clips are usually removed in 3 weeks.

Abb. GSR9LWP3
Abb. GSR9LWP3: Bandage of the ear after surgery.

With both the drain placement and surgical correction, most dogs will need to wear a special collar (E-collar) to prevent them from scratching the treated ear. Anti-inflammatory and/or pain medication are used after the procedure. Treatment must also include diagnosis and medication for ear infections, skin allergies and other causes of the head shaking. This includes microscopic examination of ear swabs, ear cleaning and medication at the time of the hematoma treatment.

While aural hematomas can resolve if left untreated, treatment is recommended. The body can reabsorb the blood and fluid. However, this leads to scarring of the earflap and auricular cartilage causing the pinna to be deformed. Without treatment, resolution of a hematoma can take months which is uncomfortable for the pet.

Prognosis

Prognosis is good if the initial cause of the trauma to the ear is treated and the dog tolerates the procedure of repairing the hematoma. However, due to their tendency to recur and the propensity for some dogs to develop chronic ear problems, aural hematomas can be frustrating.

Prevention

Prevention centers on early treatment of eliminating head shaking and ear scratching. Paying attention to any changes in size of your dog’s earflaps can catch this condition early and possibly prevent surgery. Additionally, following veterinarian’s recommendations and administering all medication can aid in preventing aural hematomas.

Tips

All dogs should be seen by a veterinarian at the first signs of head shaking and/or ear scratching.

Update version: 4/24/2014, © Copyright by www.enpevet.de
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