Auricular hematoma: Let’s break down the words. Auricular is an adjective referring to the ear. “Hema” is a prefix referring to blood. “Toma” means swelling, and is the root for our word tumor.
Auricular (or aural) hematoma occurs when blood collects between the skin layers and cartilage of the flap of the ear, known as the pinna. Blood can be released when the ear is traumatized, such as an ear that’s itchy from infection, parasites or allergy. The patient scratches at the ears, or shakes his head in an effort to relieve the itchiness and the resulting pounding breaks a blood vessel inside the pinna.
Sometimes dogs and cats in automobile accidents suffer blows to the head, leading to hematoma of the ear.
There are a number of ways to repair auricular hematomas, mostly surgical. A non-surgical treatment has been described that involves high doses of corticosteroids, some administered into the hematoma and some oral. I have tried it a few times in cases where budgetary limitations excluded surgery, but have had little success.
A decade or so I published a variation of the traditional surgical repair that has given me impressive results while also reducing anesthesia and surgery time for most patients.
My modification of traditional technique is to first “support” the area that has not yet begun to swell by using surgical staples to stapling the “inside” (least-haired) layer of skin to the cartilage underneath. The amount of surgical time saved is dramatic, because the next step in closure of the hematoma is extremely tedious and time-consuming.
Now we drain the blood from the hematoma. Pet owners frequently ask why this step alone is not sufficient. The reason goes back to why the hematoma first developed. With the skin separated from the cartilage by the pressure of the bleeding, a space was created. When the body has space in it, the body is going to fill that space with something. If we simply drain the hematoma with a needle and syringe, bleeding may continue, and/or fluid will collect in the space unless the space is surgically obliterated. Therefore, even if the blood is removed, more must be done.
Removing the blood requires an incision the length of the swelling, which allows clots and fibrin threads to be removed effectively. A thorough cleaning reduces post-operative scarring of the pinna.
Surgical closure can now begin. Slowly and methodically sutures are placed from the least-haired side of the ear, through the skin and cartilage and through the skin on the other side. Then the same suture is passed back through the pinna, about ½ inch from the initial placement, and a knot is tied. The procedure is repeated again and again until the entire hematoma space is closed.
Cartilage is a relatively inactive tissue, healing slowly, so sutures and staples are left in for three to four weeks to allow complete attachment.
Ears are a very sensitive part of the body, so we prefer to remove the sutures and staples under general anesthesia so as to minimize discomfort.
It is imperative that the underlying cause of the incident be discovered and appropriately treated. We have covered the principles and importance of proper ear cleaning and proper ear treatment .
Your pet’s doctor would prefer to prevent ear problems rather than treat them. Your dog and cat’s comfort and health are his primary concerns. Clean your pet’s ears weekly and after every bath. When medication is dispensed for an ear problem follow the veterinarian’s instructions exactly to prevent pain and complications, including prevention of auricular hematoma. MMAHEM
My 10-year-old Rambo has an ear haematoma about 2 cm size. This is the 3rd time he got one, in spite of drainage with a syringe every time. Last time I gave him an antibiotic also. Can you please tell me conservative management this time with drug and please specify the dose of drugs.
Maybe you should make changes to the blog subject Auricular Hematoma In Dogs And Cats | MyPetsDoctor.com to more catching for your content you write. I liked the the writing however.
My 9 year old golden retriever just went through Auricular hematoma surgery as described above, with the incision in the middle and the sutures throughout the whole ear. These were left on for a little over two weeks. This was an expensive surgery and we did all the things our veterinarian told us to do. Four days after the sutures were removed-his hematoma is back! Same ear, same place! I cannot afford another surgery, so we have him on high doses of corticosteroids hoping this may treat it. Did my veterinarian make a mistake in surgery? What could be the reason of the quick return?
Sarah, the first time this happened to me I changed my protocol to leave the sutures in longer. Depending on the patient I leave them in 3-4 weeks. This happens rarely. Fortunately, that patient did not require additional surgery. Keep me posted on how your pooch does, I hope he’s fine with steroid treatment alone. Best wishes, Dr. Randolph.
PS: I have written a post about this complicating factor.
I have a Australian shepherd mixed-breed dog. She had her ear drained and X-ray film was sewn onto her ear flap as a splint. She has no ear problems like mites or infection they said possibly trauma has happened to her ear. But its been a month and it has refilled again. Is this going to be an on going process or should I just let it go? What should I do?
Lisa, I’m sorry your pet is having these complications, but she is going to need surgery either repeated or more aggressive. Take her back to see your pet’s doctor and have it taken care of. Please keep us posted on her healing and progress. Best wishes, Dr. Randolph.
I have a 8 yr old boxer, Tibbs, who has chronic, SEVERE allergies that result in yeast in his ears, secondary skin infections, hystiocytomas, etc. The visting veterinary dermatologist said that he is one of the worst cases she has seen. As you can imagine the allergies result in constant, severe itching. This results in his scratching his ears, shaking his head, chewing his feet. He has had 3 ear hematomas in his lifetime and his poor ears have severe scarring from past surgeries. He has developed in the past 2 days a hematoma in one ear. The hematoma is at the base of the ear, against the skull, Some of the swelling extends down into the outer ear. In the past veterinarians have used different surgical techniques. What would be the best method to repair the the hematoma with the least amount of discomfort and the least scarring given his history? He always breaks plastic Elizabethan collars, is there an alternative type of collar that is not plastic? My spouse reminded me that none of the previous surgeries included staples. He has received multiple dissolvable stitches and the stitches did not dissolve. The incisions that were made to drain the ear were made on the outside of the flap (the furry side) and the inside of the flap (the no-fur side). One veterinarian cut diamond shaped holes in the inside of the ear flap and sewed a piece of x-ray film to the outside of his ear. The diamond-shaped holes were too small, closed/stopped draining within 24hrs. His ears are thickened and do not grow hair in some places due to scarring. Post-surgery his ears have been wrapped tightly around a bandage which causes him severe pain once the anesthesia wears off. We remove the wrapping however he then spends as much time as possible shaking his head (blood and pus fly everywhere) and rubbing his face on the carpet. We need to act quickly AND more intelligently then with the past hematomas I think. Again thank you for any advice! Thank you for any advice you can offer!
That’s VERY unusual! In 30 years I don’t recall ever performing surgery on the same ear twice. Opposite ear on the same patient, frequently. The stapling technique I use wouldn’t help your Tibbs because he NEEDS that scarring to hold the three layers together to prevent future hematomas. I have seen some alternatives to traditional Elizabethan collars [here are a couple. I’m not recommending either, just something to look at] ( http://www.arcatapet.com/vendor.cfm?vendnum=414&Source=GA-Trimline ) ( http://www.bitenot.com/ ). I doubt the latter will help much if scratching with his foot is a problem. Ask the dermatologist if she thinks your dog is a candidate for Total Ear Canal Ablation. That would be admitting that we can’t get the ear infections under control, but dogs who suffer chronically from ear problems really suffer. As for surgical techniques, one is about as good as the other. To maximize the scarring and minimize the risk of future hematomas, after the incision is made the inside of the pinna needs to really be cleaned thoroughly and LOTS of sutures placed, pretty close together. I wish you the best and please keep us updated, Dr. Randolph.
Sir, WOULD U PLEASE PROVIDE A DIAGRAMATIC PROCEDURE OF SURGICAL MANAGEMENT OF EAR HAEMATOMA AS IT IS MY SEMINAR TOPIC. I’M FROM MATURA VETERINARY COLLEGE INTERNSHIP STUDENT,INDIA
I would love to, but I don’t have any scannable diagrams. If you provide me with a domestic FAX number (in the US) I could fax some textbook pages to you.
Best wishes, Dr. Randolph.
Took her to the veterinarian, and was thoroughly examined. They did blood work, and looked at the bumps. He told us she had abscesses that formed from maybe a thorn on a bush. She goes out in the lawn and likes to roll around and get sun. Nonetheless, she was started on antibiotics twice a day, and an antihistamine-based shampoo to wash her with. She is doing well. Thank you for your help.
You are very welcome and we are delighted that she didn’t have hematomas in multiple areas because that would have been REALLY serious. Multiple abscesses can be JUST as serious, so we’re glad you got her examined and proper treatment has begun. Thank you very much for the update, Dr. Randolph.
Can hematomas occur anywhere else on the skin besides the ear? My chihuahua had two bumps on her back near the neck and on the middle back. The first one appeared 3 days ago. They were not round, but looked like an elevated swollen area, like the hematoma on the ear. One bump formed a point that appeared dark purple/blackish. We think she scratched it because it began to drain on its own. What drained was thick blood, comparable to what drains from human pimple filled with blood. We put a warm compress to stimulate more draining. The area is still swollen and now red. It also looks like another one is forming towards the lower back above her leg. What is recommended we do?
Hematomas can occur ANYwhere on or in the body. “What is recommended we do?” Go immediately to your veterinarian, as these lesions may not even be hematomas and could easily be evidence of a dangerous infection, a clotting disorder or even cancer. Please keep us updated on your Chihuahua’s progress, as our readers and I will be eager to know her status.
I have a 15 year old Corgi who had an auricular hematoma approximatly 3 months ago. Due to his age and congestive heart failure he was not a candidate for surgery. The ear was drained with a syringe sucessfully – until last week. The hematoma returned and was again drained (and injected with corticosteroids) only to return the next day, again drained, and now, 4 days later, the ear is larger than ever. Is there any other non-surgical route that could be an option for treatment of this? He will be returning to the veterinarian again tomorrow and is becomming increasingly uncomfortable.
As I mentioned in the Auricular Hematoma article, in my hands, the success rate of corticosteroid treatment for auricular hematoma is very low. However, there is a technique of applying continuous suction, similar to a chest tube, that can continuously drain the space between skin and cartilage. It is a slow process, but requires only light to moderate sedation to install and some maintenance on your part to keep it clean. The device can even be “homemade” with syringes and tubing if your pet’s doctor is clever. Keep us posted, Dr. Randolph.
What is your post-operative care regimen for this type of surgery?
Care for an ear after aurcular hematoma surgery is pretty straightforward. If an infection has been diagnosed as the cause of the hematoma, treat the infection as directed. Most of these patients are also on systemic antibiotics, either orally or by use of Convenia long-acting antibiotic injection. Serum often “weeps” from the suture sites and can actually coat the pinna with a crust. Serum must not be allowed to accumulate, and hydrogen peroxide is usually adequate to remove it IF you keep up with daily cleaning. As stated in the Article, we prefer to remove sutures and staples under general anesthesia 3-4 weeks after surgery.