Ear Hematoma. The Complete Veterinarians Guide To Understanding, Treating and Avoiding Them.

I get these shaking head painful and swollen dog ear questions too often. Perhaps for me the 'old hat stuff' has progressed into dismay that I haven't adequately gotten the word out? Maybe the whole pet loving world doesn't know what an ear hematoma, or, aural hematoma is yet?

So here I go... pull out soapbox and cross fingers that I can spare a dog the excessive expense of an emergency visit, or, the worsening of a condition that allows the snowball to escalate in to needed a TECA (total ear canal ablation), and maybe even help a pet parent out there thwart a bug at the pass and save their pet from having an ear that resembles the one above.

If you think this is painful, you would be right! A hot, swollen, tender, blood filled pillow hanging off the side of your face blocking your ears from any kind of basic function, usually corking off infection inside your ears so it can stealthily fester and ferment while the world is far beyond reach, IS ouchy!

Note the perpendicular ear pinna and the head tilt.

I have seen many of these and in each case the degree of pinna damage, area of the swelling (base of ear or tip of ear), chronicity of disease (how many times has this ear flap been down this road?), and patient and client abilities and expectations.

I always discuss how the hematoma happened, or at least why I think it happened?

Possible causes include;

1. Ear Infection (about 40 % of the time). The ear is usually smelly and full of fluid, goopy soupy discharge, red, and painful. If your dog fits this description spend time talking to your vet about how the infection happened and how you can avoid it from happening again. Most of the repeat hematomas are infection or allergy. Your pet is very likely to be back here again. Avoid this if at all possible.

2. Allergies, about 40 % of the time. The ears are usually red but are not smelly or have any fluid in them. If your dog has allergies ask for a referral to a dermatologist sooner versus later.

3. Trauma, about 15 % of the time. The puppy and the adult dog are playing and the next thing you know someone needs an e-collar.

4. Idiopathic,, also known as, "we don't know?" I would guess these are about 2%

At the clinic I usually use a teat canula (this is what the dairy farmers place in the nipples of a diary cow with a clogged gland) to correct the severely swollen full pinna hematomas. For the very small fluid pockets at the ear base I remove the fluid and add a dilute steroid to stop the inflammatory process. For cats I use a through and through suture technique after an "S" incision is made on the medial side of the pinna.

This is what the ear looks like after three weeks of the canula being in place. The wrinkling and thickening of the ear pinna in these cases may be due to the chronicity of this ear hematoma, delay in seeking medical therapy, or not addressing the underlying problem adequately. This is why I advise getting these cases early and aggressively.

After 3 weeks the teat canula is removed. There should not be any discharge or swelling during the last week.

The ear is painful. We numb it with a local lidocaine block, but, we still place a muzzle.

The most important part of the treatment of an ear hematoma is to figure out what caused it. Both ears should be examined with an otoscope to look for infection, parasites, debris, polyps, and even tumors. I have found some crazy stuff in those ears, and every pet was telling me there was a problem by shaking, rubbing, or tilting their head to the side.

In many cases cytology of the ear may also be done. This allows us to diagnose the infection and more appropriately provide a focused treatment option.

The teat canula is sutured and glued into place. 

The end of the canula needs to be checked twice daily to make sure it doesn't get clogged. It is after all there to drain the fluid.

Daisy gives a shrug and smirk of disapproval.

Daisy is ready to go home.

A teat canula should stay in for three weeks. The e-collar should stay on for the first 3-5 days, and then if the head continues to shake, or the pet rubs or paws at the ear.

Here is the break down of Daisy's ear hematoma repair;
 Exam $50
 Aural Hematoma Repair $65
 Medications; NSAID and ear antibiotic $50
 E-collar $20
 Ear Cleaner $22
In most cases with client compliance we do not charge for re-checks or the canula removal.

For those pups who have itchy painful ears, or for those who have not progressed to hematomas (but are well on their way) I wrap the ear to the head. The disadvantage of this is if there is an infection in the ear. A wrapped ear needs air, monitoring, and care. Only wrap an ear that is NOT infected. And, be very careful to NOT cut these bandages off (you don't want to add injury to insult).

I always instruct my ear clients on how to clean their pets ears. Here is a video on how I recommend doing this. It should be quick, easy, stress and pain free. I also advise them on what to have ready at home if head shaking starts again. I typically advise keeping diphenhydramine on hand and starting to clean the ears as soon as a problem seems eminent. Red ears, head rubbing, pawing or scratching at the ears all indicate that it is time to look and smell under the hood.

Related blogs;

Ear Cleaning blog.

Ears; How to Treat 'Em Right.

There is a blog on cat (feline aural hematomas) here.

Another part of keeping ear healthy is removing excessive ear hair. Blog on Ear Hair Removal here.

If you have a pet question please find me on Pawbly.com. The Pawbly community is free for all to use. We hope to help pets in every walk of life and in every corner of the globe. If you don't have a pet question please just stop over and give a hello to someone in need of a friend or some free advice on how to care for their companions.

If you would like to meet me I am available for appointments at the clinic, Jarrettsville Vet, in Jarrettsville Maryland. Our prices are posted every year. Here is the 2016 Jarrettsville Vet Price Guide.

I am also on Twitter @FreePetAdvice. You can also find helpful tips and more videos on my YouTube channel. 

Damaged Ear Tip, Canine Bloody Ears. The at home fix.

This  is Meiko. He is a 3 year old Boxer who lives in a household of rough play and constant  activity.

One afternoon Meiko's dad arrived home from work to find the melee had proven too much for him. The result of the days playtime was a painful, red, bleeding, sore ear. Meiko did what all pets with painful ears do, he shook his head, a lot. Head shaking causes the ear pinna (ear flaps) to hit the side of the face and top of the head and this flailing motion ruptures the blood vessels in the ear and causes the ear tips to bleed. When you come home from work, not expecting more than a happy wagging pup to greet you and instead find yourself in the midst of a CSI gunshot victim scene the amount of splatter blood can catch you by surprise, never mind flat out alarm you.

Meiko and his dad arrived at the clinic a few minutes later. Head holding and ear shaking were met with firm discouraging "No's!"

Meiko's dad wanted two things;

1. Stop the bleeding

2. Close the wound that was causing the bleeding.

Perfectly understandable when the tiny blood splatter was flying around the room, walls, floors, ceilings, it was a perfect F=ma equation. Those tiny micr-droplets can soar great distances with just the right trajectory and acceleration.

There are moments in some examinations where the few seconds of collecting data require a few paused moments to gently break bad news. 

There I stood holding Meiko's face, gazed at his dads, and broke the news. These can be frustrating. He provided me a slightly sarcastic glance and I'm pretty sure he silently said "don't tell me something I don't want to hear."

It is difficult to treat these wounds. The more they shake the quicker they bleed. 

If you can't stop the head shaking the wound can't allow a blood clot to form and therefore it continues to bleed. Every head shake dislodges the clot and there it goes again bleeding.

The ear needs a few days of rest to let the wound heal.

Suturing it almost never works. It requires anesthesia, further trauma to the pinna edge and one hard head shake and you are back to square one.

So here's what we did for Meiko;

This is a two person job.

Assistant number one holds the dog. As you can see my technician is holding him in a sit position and holding the head still.

The treatment person does the following;

• We cleaned the ear edge. Warm surgical cleaner (or warm water with a tiny bit of soap  is also fine) for a few minutes was soaked on the open bleeding wound.
• I then took a non-stick absorbent pad with triple antibiotic ointment and folded it around the ear edge.
• Next, I wrapped the ear to the top of his head with self-stick bandage (we use Vetwrap, the veterinarians favorite bandage).
• Lastly, an e-collar to keep the feet and face rubbing from removing the bandage.

Important points;

• Do not apply the bandage too tight.
• Do not cut it off and cut the ear hidden underneath.
• Treat the underlying cause of the ear bleed. For Meiko the cause was rough play, but for some dogs they shake their heads due to allergies, ear infection, or foreign bodies in the ear.

Within about 3 days the bandage should be able to be removed and the ear should finish healing over the next 10-14 days.

Related Blogs;

Living with  Bleeding on the Edge.

If you have a pet related question, or dilemma, you can find a whole bunch of helpful pet loving people at Pawbly,com. Pawbly is free to use and open to anyone who loves pets. Please join us in helping pets around the world by sharing your pet knowledge and expertise.

I can also be found on Twitter @FreePetAdvice, or at the clinic, Jarrettsville Vet, in Jarrettsville, Maryland.

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.