Aural Haematomas

What is it?

It is not uncommon for people to find that there is suddenly a large swelling in the ear flap of their dog or cat. These are usually soft, fluctuating and usually not painful. However, you may notice your pet shaking it's head or scratching it's ear more often. Sometimes they are small to begin with but grow steadily over a few days. Sometimes they involve the whole of the ear flap.

They are, in fact, large blood blisters in the middle of the ear flap. What happens is that a blood vessel ruptures where it comes out of the cartilage on the inside of the ear flap and bleeds into the space between the cartilage and the skin forming the swelling.

The Cause

It is not known why the blood vessel suddenly ruptures; sometimes it is associated with excessive shaking of the head or scratching the ear, for instance if there is an ear infection; however often there is no obvious cause. Some dogs, and especially some breeds, seem to be very prone to the condition for a period of their lives, usually when they are middle-aged. It is now felt that there is some form of allergic disease involved and it may be inherited. However until further research has been done we shall not know for certain.

The Long Term Effects

If the blood blister (haematoma) is left a clot forms which contracts as it shrinks. This contraction distorts the ear flap and the ear ends up looking crinkled. If the contraction is severe it will cause what used to be known as a cauliflower ear and will cause continual problems.

Treatment Options

Because of the long term discomfort that haematomas cause, we always recommend draining them. This can be done in several different ways all of which have different advantages and disadvantages. We try to use the method which is most suitable for each individual case.

After the haematoma has been drained it is necessary for the skin to re-attach itself firmly to the cartilage underneath and this can take several months. It is therefore not unusual to get further haematomas forming after the first one has healed. We have occasionally had three haematomas in the same ear, luckily this is very rare as it is very frustrating for dog, owner and veterinary surgeon.

Nowadays we usually treat initially by draining the haematoma through a needle with the animal sedated and then injecting a steroid drug into the space where the haematoma was to treat any allergic cause. We then check the ear a week to ten days later and see how much the haematoma has re-filled. If a lot of fluid has collected we will drain it again and then inject some more steroid.
If the haematoma keeps on filling up, then we usually have to operate under a general anaesthetic to open the haematoma and debride it's lining. We then stitch the skin and cartilage together for a couple of weeks and wait for the layers to attach firmly together.

The operation is quite painful and the wound takes several weeks to heal. It can also break down again forming another haematoma, which is again very frustrating. Years ago we have known this to happen up to three times but nowadays this is extremely rare.

Conclusion

As you can see from the above, this condition can cause a lot of problems and can be very frustrating to treat; luckily the new technique of draining the haematoma through a needle and injecting steroids causes very little discomfort, doesn't require a general anaesthetic and results in far fewer problems. However we will usually have to repeat it and do still get some crinkling of the ear flap in a few cases. This does not seem to cause any problems in the long term.

We have found over the years that we get more misunderstandings with this condition than with any other. Please, if you have any questions, do not hesitate to discuss them with us