By Dr. Emily Hoppmann
When dogs have issues with their ears or really bad allergies, they often shake their head or scratch at their ear. The problem with a dog shaking his head too much or scratching too much is that it causes trauma to the outside of the ear (the pinna). This trauma can cause an aural hematoma, which is a localized collection of blood (often times clotted) within the cartilage plate of the ear (a fancy name for the outer ear/pinna). The cartilage can be broken or the blood vessels in the ear (the auricular artery) can be broken to cause the collection of blood. These look to owners like small to large fluid-filled swellings that are on the inside surface of the pinna. It can fill the entire ear or just part of it. This can occur in multiple types of animals, but we are going to focus on dogs in this article.
The first thing that needs to be addressed is the reason the dog is shaking his head or scratching at the ears because if we don’t address that problem, then the hematoma will come back. The next step is addressing the hematoma itself and there are multiple options depending on what the owner wants to do and what stage the hematoma is in. Some hematomas are in the earlier stage and are soft and fluctuant, but others have progressed to becoming firm and thickened and may even develop a cauliflower appearance. It is important to catch hematomas as early as possible, because once they reach the firm, thickened, and crinkled stage there is no medical or surgical way to make the ear normal again.
Medical management includes draining the fluid in the ear and starting medication that will help with the inflammation and infection. The problem with medical management is that there is a good chance that the ear will fill up with blood again since the two sides of the ear have been separated from the hematoma that was drained and the blood vessels in the ear may or may not have stopped draining. If medical management fails and nothing else is done, the ear will eventually become firm and have a abnormal appearance.
Surgical management is the treatment of choice. There are multiple surgical approaches that vary in intensity and the general rule of thumb is that the more involved the surgery, the better the chance of not only having the hematoma resolve and not coming back, and the ear looking completely normal after the surgery. An example of a very simple surgical technique is cutting out a small amount of the tissue of the ear so the blood can drain and either suturing the hole open or not. An example of the more advanced surgical technique is placing multiple (ten or more) smaller holes covering the entire ear and placing sutures holding all the smaller holes open until the ear is totally healed.
The most important things to remember are to treat hematomas early, treat the underlying cause and try to prevent it from happening again, and pick the best treatment plan for the hematoma repair that you can.