Thursday, August 8, 2013

A Repeat Offender. The Ear Hematoma


How miserable does this poor kitty look? When I entered the exam room I was met by this uncomfortable face. She was a quick easy diagnosis.

I skimmed through her medical record.

  • indoor cat
  • spayed
  • friendly
  • up to date on all veterinary care
  • new patient to our clinic
  • previous history of ear hematomas


Her ear is full of fluid and looks like a pillow. The fluid in the ears is making them hang. Instead of having normal looking ear flaps that stand up (erect ears) she looks like a Scottish Fold that just spent ten rounds in the boxing ring.

The veterinary terminology for this condition is aural hematoma. A hematoma is a collection of blood that is stuck in a pocket. It is like a bruise.

Hematomas happen due to trauma. Either self induced trauma like scratching your ears, or shaking your head so violently that the blood vessels in your ear rupture. The blood then pools between the front and back skin and around the thin piece of cartilage in the ear flap. The pool of blood resembles a pillow. The problem with a hematoma in your ear is that the blood has no place to go. The hematoma gets stuck. Without some way to provide drainage for the hematoma it will just sit there. Over time the blood coagulates, solidifies and causes the ear flap to scar and distort. In people (boxers in particular) we call it 'cauliflower ear." In pets the ear flap contracts, shrivels, and calcifies. Pets with chronic recurrent ear hematomas develop scrunched deformed ear flaps that close off the ear canal, precluding air circulation, and trap dirt, debris, moisture, and other gook inside.





I see ear hematomas primarily for the following reasons;

Dogs;

  1. Ear infections.
  2. Allergies.
  3. Fleas.
  4. Scabies.
  5. Playing or rough housing with another pet and they either run into some hard object, or the other dog is playing/biting on the ears.



Cats;

  1. Allergies.
  2. Fleas.
  3. Ear mites.
Although if it is a wild/feral cat the above is reversed.

When this kitty came to see me her dad knew what the diagnosis was and he already knew what the treatment plan would include. He had been down this road before. 

Before I could say anything he said, "So, is it OK if I just leave her here until you can do her surgery?"

Many of us vets are happy to have a client that already understands and accepts the diagnosis and treatment plan, it saves us lots of talking and explaining.

But this vet likes to talk. More accurately I like to educate.

"Well, I think that we do need to drain this ear, but I wonder how this happened? Can we talk about that?"




He looked at me quizzically?

"Umm?...Well?...I don't know how it happened?" He replied hesitantly.

We began a discussion of her history, her diet, her in home care, her previous veterinary care and her environment. Initially her dad seemed a bit put off by the barrage of questions. He was here to drop her off and get on with the rest of his day.

We discussed the cat list above. Why would an inside, parasite free, only pet in the household have bilateral ear hematomas? Why would she get them again after a year?

He started to see the reason for my questions and the Q & A turned into a round table discussion.

Isn't it far better to not only treat this episode, BUT also prevent the next one?

Seeing your vet for a problem shouldn't be just about getting a diagnosis and a treatment plan, BUT also preventing?

Next time you are in your vets office ask them about preventative care, it's part of the healthcare plan.

Here is an article on aural hematomas, but I would not recommend treating this at home, and I do not inject steroids into ears.

If you have any questions about this or any other pet care items you can ask me, or any of the other Advisors at Pawbly.com, or @pawbly.

Other blogs on this subject: Aural Hematomas. The veterinarians guide to treating. Dog version.

9 comments:

  1. Hi Y'all!

    Many years ago I had a neutered barn cat who was attacked by a tom cat. The farm vet took care of the cats and dogs and I asked him about the ear. He gave me something topical and, if I remember correctly, some ear drops. I never knew 'til now what was really wrong. Poor kitty.

    Y'all come by now,
    BrownDog's Human

    ReplyDelete
  2. My cat has had 2 surgeries in 3 weeks for the same ear hematoma. After the seemingly successful surgery, the bandage was removed (2 weeks later) and the Vet said it looked great. However, my cat came home and kept shaking his head. The next morning, to our horror, his ear was as swollen as it was during day 1. The Vet said he could see no reason for it, as the ears seem fine. (Even though he is constantly shaking his head) he sent out a biopsy, and we are waiting for the results. My cat is 14 and even with his bandage and cone on he is shaking his head often. I have a feeling this vet might not be as qualified as he should be in this area, should I get a second opinion? I'm so frustrated.

    ReplyDelete
    Replies
    1. I know it can be frustrating but try to be calm and patient. I have had more than one cat in my lifetime visit me for recurrent ear hematomas. In some cases it is just allergies and a steroid injection will stop them.. In others it was a polyp, wound, parasite, or even something like high blood pressure causing vision loss.
      best of luck.
      I hope your kitty is better soon

      Delete
  3. So now that my cat has a second hematoma, after having surgery on the first last year that didn't work and cost more than I could afford, shall I just put her to sleep? I will not take her to the vet for this; if there is any other option, will you tell me, please?

    ReplyDelete
    Replies
    1. hello,
      I cannot imagine that a hematoma could ever be bad enough to warrant euthanasia. Please find me at Pawbly.com and ask your question there. I can offer lots of advice and hopeful encouragement to try to provide options. Pawbly is free to use and monitored by lots of experts who can offer assistance.

      Delete
  4. My dog gets repeat ear hematomas and I'm not sure how to stop it. He constantly shakes his head and we've taken him to the vet, got them drained and he doesn't ever have mites. He has another one and we can't afford to take him to the vet right now. I believe that our vet said that these will go away on their own in about 6 weeks. Is this true? I feel horrible and don't know what to do. I can't afford a vet bill but seeing him like this over and over kills me. It seems like he gets them every 2-3 months. The last time he did get over it but now it's huge. I'm giving him antibiotics we had left over from one of the previous times. Is this okay? And how in the world can I prevent them? He shakes his head as a "affirmation" (wanna go outside? Hungry, etc. He shakes his head side to side) and our other dog does it, it seems like a learned trait from her but she never gets them!

    ReplyDelete
    Replies
    1. Hello,
      I have two cases like this that I am managing right now. I think that both of these dogs have allergies and not infection, that is causing them to shake their heads. If the fluid is not drained the ear will heal but it will be a deformed pinna and this may exacerbate future problems. In some cases I just drain the ear and infuse a steroid if money is tight. I do this for about $75. and then ask about trying something for allergies or anxiety. I also like the "No flap ear wrap" available online.

      Delete
  5. My dog has an ear hematoma and had surgery a week and a half ago. How will I know if it's coming back again? It seems like he has a small bump toward the bottom of the last suture that feels a little hardened/squishy, could that just be scar tissue forming?

    ReplyDelete
    Replies
    1. hello,
      yes it can be either. your vet might need to recheck the ear to see how it is healing/resolving

      Delete