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. 

Spring Time And The Parade of Pests In Search Of Your Pet

It is that time of year again.. Spring, when everything wakes up, takes a look around, and hunts down your cats and dogs to jump on and suck the goods out.

This little cuddle bug was a new resident of our local Humane Society. He was brought to us at the clinic because he had developed what we call bilateral aural hematomas. 

An aural (ear) hematoma (clotted blood) occurs because the ear pinna (flap) is a very thin delicate structure. Essentially it is just two pieces of skin, a thin layer of cartilage, and blood vessels in between.

Aural hematomas result when the ear flap is subjected to either a hard whack (like running into a tree, or getting bitten by an over aggressive littermate) or shaking the head so violently that the ear flaps become traumatized (think ear mites, allergies, ear infections). When the blood vessels between the skin and cartilage rupture and bleed there is very little pressure or tension to allow a clot to form. The ear flap fills with blood, blows up like a pillow, and remains this way until one of two things happen;

1. Enough time passes for the ear to reabsorb the blood. This causes the ear flap to become crinkled and deformed looking. (Which, by the way can cause subsequent increased susceptibility to ear infections as the ear canals become more closed off from the outside world). Think cauliflower ear in professional boxers/wrestlers.     OR,
2. The hematoma is corrected surgically to remove and provide continual drainage of the blood and  surgically replace the pinna flap in its normal position as it heals.

The best treatment option to avoid the ear flap from healing deformed (although this can still happen) is to surgically correct the hematoma.

There are a few surgical treatment options to correct these. The method chosen depends on;

1. Where the hemtoma is on the pinna.
2. What kind of ear pinna your pet has. Does it stand striaght up, or hang down.
3. How big the hematoma is.

If the hematoma is by the base of the ear we usually use the pie crusting technique. (See below).

For a floppy ear with a hematoma that extends to the bottom (tip) of the ear we use gravity to help keep the hematoma draining. For these I usually use a teat cannula. They are easier to place and leave a more cosmetically pleasing ear after it heals.

1. Place a teat cannula drain if the hematoma is at the bottom of a floppy ear. I place a small amount of lidocaine to numb the area. Make a small pinhole and place the teat cannula. I suture it in place, and instruct the owner to keep the cannula patent. After three weeks we remove the cannula.
   
2. Pie Crusting technique. This is done by making an incision to drain blood and then placing as many through and through sutures as possible to hold both of the sides of the pinna together (thereby placing tension between them, think of it like placing pressure on a bleeding wound).

This puppies ear hematoma is so large that we opted to place many sutures to hold both sides of the ear flap together. We were also concerned about the drain being managed, the puppy wearing an e-collar and the ears being as cosmetically pretty as possible. He does after all need to find a forever home.

Sometimes we place stents to keep the suture from growing into the skin as it heals.

How do you know that a puppy is healing?
They act like a puppy!

It is imperative to remember to keep the e-collar on as the ear heals.

Any scratching of the ears will make them bleed and potentially remove some of the sutures.

Remember this happened from trauma.

Related posts;

Aural Hematoma in a cat.

Aural Hematoma discussion by Mar Vista Animal Medical Center

Many Thanks to the doctors and staff of Jarrettsville Vet for providing such good care to the little ones of Harford County Humane Society.

If you are looking for a friend to help keep you happy, healthy, and give you unconditional love please visit the Harford County Humane Society. They have many wonderful cats, dogs, kittens and puppies just waiting for you to see the beauty in saving a life in need.

If you have any pet related questions you can find me and a whole slew of other dedicated pet lovers at Pawbly.com. The members of Pawbly are dedicated to helping pets, and it is free to use.

Or you can just visit Pawbly to share your pet's photos, your own personal pet experiences or just follow topics that interest you.

You can also find me on Twitter too @FreePetAdvice.

Enjoy the beautiful weather everyone! This is my beloved Wren, out for a little walk with mom in the daffodils. I just love her to pieces! And she is soo beautiful..