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Aural Haematoma

What is a haematoma of the ear, and how does it occur?

An aural (ear) haematoma is a collection of blood or serum, and sometimes a blood clot within the pinna or ear flap. The swelling may involve the entire ear flap or it may only involve one area. Aural haematomas usually occur as a result of irritation to some part of the ear. When something irritates the ear, the dog responds by scratching the ear or shaking its head. There are several delicate blood vessels between the inner cartilage core of the ear flap and the skin. Excessive shaking or scratching can cause these vessels to break, resulting in bleeding. This blood collects under the skin and forms a "haematoma", causing the ear flap to become thickened.

How is it treated?

There are three steps involved in treatment:

1. Under a general anaesthetic the blood is removed from the ear flap. This is accomplished by making an incision over the haematoma on the underside of the ear, which allows it to drain and any clotted material to be cleaned out.
2. The space where the blood accumulated is obliterated. Since the skin over the haematoma has been pushed away from the cartilage, it must be reattached to it to prevent another haematoma from occurring. This is accomplished by a series of stitches that are passed through the ear flap. The ear is sometimes also stabilised with a thick absorbent pad.
3. The cause of the problem is diagnosed and treated. This may be an ear infection, an injury to the ear or something stuck inside the ear canal, eg a grass seed. It is very important to identify and treat the cause of the haematoma to ensure the dog stops scratching the ear or shaking its head, which can cause further damage. Occasionally the reason for the haematoma is not obvious. This may be because the cause of the irritation is now gone, or the dog may have just knocked its ear to start the haematoma.

Why can't the haematoma simply be drained?

The blood and serum can sometimes be drained from the ear flap with a needle and syringe. However, because there is no pressure on the space inside the ear flap where the blood was, it quickly fills with blood and serum again, especially if a clot has already formed as this pushes the skin away from the cartilage.

What if the haematoma is not treated?

The body will eventually reabsorb the blood and fluid, but this can take some time and is painful and irritating to the dog. It also results in the ear flap becoming very scarred and deformed, causing a "Cauliflower ear".

Will I need to bring my dog back for further treatment?

The absorbent pad (if one is placed) and the sutures are usually removed after 2-3 weeks. The ear is usually checked once or twice before this to ensure it is healing adequately. During the healing time it is common to get some discharge of blood or fluid from the drainage holes or sutures in the ear. This should be cleaned away with warm salt water, being careful not to get any water inside the ear. Usually the dog will go home on antibiotics and sometimes ear drops as well. These should be given as directed. Once the haematoma has healed, it is unlikely that it will recur, but it is possible, particularly if the dog often gets ear infections.