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October 13, 2020

Aural Hematomas in Dogs

Aural Hematomas in Dogs

What is an aural hematoma? 

An aural hematoma, also known as an ear hematoma, is a blood blister that develops between the skin and cartilage of the “pinna” (ear flap). It’s very common in dogs who are prone to ear infections, especially if they have floppy ears rather than ears that stand straight up.

The condition occurs when trauma or an injury to the ear flap causes the small blood vessels inside the pinna to break and leak internally, resulting in a blood-filled swelling.

What does an aural hematoma look like?

With an ear hematoma, your dog’s ear flap will be swollen.

If the lesion is confined to just one part of the pinna, the swelling may be small. For larger hematomas, the whole ear flap will be engorged, and the weight of the collection of blood may cause the ear flap to droop and hang lower than usual.

An ear hematoma may feel squishy or taut to the touch. More than likely, your pup will object to you touching it, since the pressure can be painful.

Suspect your pet has an aural hematoma? Book a vet visit.

What causes aural hematomas?

In almost all cases, some sort of trauma or injury is to blame — that’s what causes the blood vessels between the ear cartilage and skin to break and leak.

The most common type of ear flap trauma is from a dog repeatedly scratching their ear and shaking their head, due to an ear infection, allergic skin condition, ear mites, or a foreign body lodged in the ear canal. For that reason, your vet will take a close look inside your pet’s ears.

Aural hematomas can also develop from an accidental bump or injury to the ear flap. For example, this could happen during vigorous play, if your pup runs through bushes and their ear gets scraped by a sharp branch, or following a bite wound on the ear flap from another dog or a wild animal.

Less commonly, health conditions that cause blood clotting abnormalities can also lead to a blood pocket formation in the ear flap. 

Can aural hematomas be prevented?

Since scratching and head shaking from an ear issue are by far the most common cause, the best way to prevent ear hematomas is by keeping your pet’s ears clean and healthy.

Ask your vet for advice on your pet’s ears because care instructions may vary a lot from dog to dog. Some pups might only need an occasional ear cleaning. However, other dogs — especially droopy-eared breeds like Basset Hounds and Cocker Spaniels that are at a great risk for ear infections and ear problems — may need frequent ear cleanings with special ear maintenance solutions.

How is an aural hematoma diagnosed?

Diagnosis is usually straight forward. The appearance and feel of the ear tell your vet a lot, especially if an ear infection is also present.

In some cases, your veterinarian may take a needle sample to confirm there is blood in the swollen area, and to rule out other conditions that would need a different treatment — for example, a mass on the skin or swelling due to a bee sting.

What is the treatment for an aural hematoma?

A surgery is usually best because it can provide a permanent solution for the hematoma, and surgery has the best chance of preventing scars.

Additionally, it’s crucial to treat the underlying cause of the aural hematoma — so if your dog has an ear infection, that needs to be addressed, too.

Is surgery really necessary? Can’t hematomas be drained or heal on their own?

If the hematoma is mild/small, or if surgery is not a treatment option (for example, if your pet isn’t healthy enough for anesthesia), your veterinarian may try draining the hematoma with a large needle.

However, this is not ideal because aural hematomas usually come back without a surgery (the ear flap could even swell up again that same day!).

Also, if blood clots are already present inside the blood pocket, it will be difficult — maybe even impossible — for your vet to remove the swelling via a needle. The blood clots will be too big to fit through the needle.

In some cases, particularly with very small hematomas, your vet may even recommend waiting and monitoring. But these small hematomas are much less common than the big ones. 

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What does the surgery entail?

The surgery for an aural hematoma involves a vet making a small incision to open and then drain the blood blister.

After that, many small sutures (stitches) are placed to close the blood pocket — this helps to prevent blood from accumulating again. There are many different techniques, but one common suture pattern is the “quilting” technique, where stitches are placed in a pattern that resembles a quilt.

Additionally, your vet may use a surgical drainage tube, too, which is then removed in a few days.

Either way, your pet will go home with bandaging on their head that’s designed to place pressure on the ear as it heals, preventing the pocket from filling again, and preventing further damage to the ear.

Surgery may result in some scarring and changes to the appearance of the ear flap, but far less scarring than would occur without surgery. This is especially true if the hematoma is addressed as soon as possible.

And, the good news is, a surgery provides a permanent solution, since the odds of a hematoma happening in that ear again after surgery are very slim.

What’s recovery like after aural hematoma surgery?

Your pup may be sore for a few days following surgery, but your veterinarian will give you pet-safe medications for pain and inflammation, as well as antibiotics if needed.

You’ll also receive an Elizabethan collar for your dog. This will prevent them from ear scratching, reducing the risk of inflammation, bleeding, or accidentally removing their sutures too soon. And, most pets will have a bandage on their head to help protect the ear and place gentle pressure.

Your vet will let you know how to monitor and care for your pet at home after surgery, and when to come back in for rechecks and for suture removal. 

SEE ALSO: Aural Hematomas in Cats

My dog’s hematoma just popped on its own. What should I do?

Sometimes, hematomas burst on their own. And, while it can be quite messy (you may notice blood spatter from your dog shaking their head while the hematoma is draining), your pup will probably feel better initially due to the relief from the pressure.

Unfortunately, there’s a good chance the hematoma will return, though. Ear hematomas are notorious for filling up again after they’ve been drained.

Also, having an open wound in the pinna could lead to an infection.

Here are some home treatments you can perform to help your pup if you can’t make it into the vet immediately:

  • Try to gently clean the area with warm water and a mild, non-stinging cleaning solution (like dilute chlorhexidine or povidone-iodine). If your pup is in too much pain and not allowing you to clean the area, don’t force it.
  • If your dog allows, place gentle pressure on the area to help it fully drain.
  • You can also wrap a soft bandage around your dog’s head (holding the ear flap flat against the head) to help keep the pocket from filling again. Make sure to check and replace the bandage often to ensure it stays clean and dry. 

You’ll still need to bring your pup into the vet so they can properly clean and repair your pet’s ear, but these measures are the first step to addressing a hematoma burst. 

What happens if my dog’s aural hematoma is left untreated?

Without treatment, a hematoma will eventually decrease in size and form scar tissue. However, for the reasons mentioned below, it’s not recommended to leave a hematoma untreated:

  • This can be very painful for your pet. Until the hematoma heals, the swelling, pressure, and weight of the hematoma may cause discomfort.
  • If the ear flap is very swollen, it may block access to your pup’s ear canal — preventing you from treating the underlying ear infection.
  • It can take a long time for an ear hematoma to shrink down on its own (often longer than a month), especially for a larger one — and, unfortunately, your dog could be uncomfortable the whole time.
  • The hematoma can reoccur. Even if the swollen area appears to be shrinking, it may fill up again at any time.
  • Letting a hematoma heal on its own will result in “cauliflower ear,” a deformity caused by excess scar tissue.

For all these reasons, it’s much better to seek treatment for your pup.

While a hematoma isn’t an emergency, it should be addressed as soon as possible. Faster treatment will minimize scar formation and prevent the discomfort of pressure and a heavy ear flap. In addition to treating the hematoma, your vet can also talk to you about what caused the hematoma in the first place and how to prevent it from happening in your dog’s other ear.

If you suspect your dog has an aural hematoma, bring them to Bond Vet. We’ll diagnose them, treat the condition, and address any underlying issues that may exist.

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