Aural Hematomas (Swollen Ear Flaps)
by Roger Ross, DVM


Hematomas are blood clots.  In the case of ear
flap hematomas, for reasons that aren't exactly
clear, the fragile little capillary beds in the ear
flaps become inflamed or injured and leak
blood and/or serum into the space between
the skin and and the cartilage of the ear flap.
This makes the flap swell and is quite

This is a fairly common problem in both cats and dogs, but especially in Retrievers and dogs with floppy ear flaps. 

Often, but not always, there are underlying ear infections, ear mites, excessive wax, foxtails, porcupine quills, or chronic allergies that help explain why there is more than normal vascular pressure and irritation.  Frequent head shaking (due to itchy or painful ears) seems to be one possible underlying cause.

If left untreated, the ear will be painful and to different degrees is likely to scar up in what is referred to as a "cauliflower ear" or sometimes as a "boxer's ear"  This refers to human boxers (fighters), not the K-9 type of Boxer.

Treatment Options

There are 2 treatment options available at this time:
- Out patient lancing combined with medical treatment
- Surgery combined with medical treatment

Outpatient lancing combined with medical treatment:

The problem with this option is that it fails to work about 50% of the time.  A lot of my clients try this option first in an attempt to avoid the expense and minor risks of surgery, but I make sure they know there's a good chance they'll have to come back for more aggressive treatment soon.

Here's what to expect:

Step A.  We'll clean and shave the ear flap as need and apply a topical anesthetic to the ear flap to hopefully make lancing non painful.  Some dogs and cats also need a little sedative for this procedure.  Then we lance the ear with 2 small slits in the shape of a cross (to keep it from healing shut too fast) and if the hematoma is filled with liquid or semi clotted blood we drain the ear.  This is often a little dramatic.

Step B.  Underlying ear infections, mites, etc, if present are treated at the same time.  Also expect your vet to send home medications to ease the pain and irritation.  Your vet may also consider putting your pet on acepromazine (tranquilliers) for a short period for two reasons: to stop your pet from shaking his head so violently giving the ears a rest...and because one of the mild side effects of this particular tranquillizer is to lower the blood pressure to the extremities (in this case the ear flaps) which helps the problem to resolve.

Step C.  I like to use our therapy laser to improve venous drainage and to reduce the swelling and inflammation.  While the laser does help, I haven't had a successful case yet where the laser alone was adequate treatment.

Step D. Antihistamines, steroids, antibiotics, topical DMSO, bandages, cortisone injections into the ear are all used by veterinarians in an attempt to reduce the swelling and inflammation.  They sometimes work. 

But most cases require surgery.

Surgical Treatment

If medical treatment fails...or if the hematoma is too large to expect medical treatment to work well, your pet will need surgery.

There are quite a few different, and sometimes creative, techniques for this surgery, but all involve getting the clot out through slits or perforations, devising some sort of drainage, and suturing or tacking the ear flap skin down to the underlying cartilage until healing takes place. 

I usually leave the drains in place for 2-4 days and remove the sutures 14+ days after that.  I also treat these patients medically post surgery with antihistamines, short term prednisone, and pain medications in addition to treating any underlying ear infections etc.

Expect at least some scarring of the ear flap. but at least your pet will be comfortable again.

Also, don't be surprised if the other ear flap gets a hematoma within a year or so.  

On This Page:

A little about the common diseases and problems of ear flaps:
Aural Hematomas
Sunburn & Frost Bite
Ear Margin Dermatitis
Tumors and Cancers

.... And a comment on the
The BAER Hearing Test

On other pages
about ear problems:

About the treatment of ear infections and underlying ear allergies

Parasite problems of the ear: ear mites, demodex mites, sarcoptic mites, fly strike, and ticks
Diseases of the Ear Flaps

Aural Hematomas
Sunburn and Frostbite
Ear margin dermatitis
Tumors & Cancer
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Ear Margin Dermatitis

A fairly common problem we see in pets are ear flap edges that are damaged, crusty, flaky, tender, and prone to bleeding.

Here's a list of possible causes:

- Sarcoptic mange mites.  The best thing about this problem is that it's fairly easy to treat

- Dachshunds are prone to ear margin dermatitis for reasons unknown but must surely have a genetic component

- Poor circulation and vascular diseases often result in unhealthy ear edges so this condition is a flag for us to consider blood work, and to check the vessels in the retina for signs of high blood pressure and tortuous vessels.

- immune mediated disorders are probably a major cause and quite often steroid therapy is helpful

- insect bite hypersensitivity is another possible cause

- Fungal.  Fungal organism often grow on dead or unhealthy tissue but the fungus itself is probably not the reason the ear margins are unhealty in the first place.

The pet rat to your left has an ear hematoma, also known as an aural hematoma
Both the dog above and the cat below have typical aural hematomas.  Surgery is usually the best treatment option

Frost bite &Sunburn damage to the ear flap

There's not a lot to discuss here other than to make you aware that dogs and cats sometimes get terrible wounds from sunburn and frostbite.  Amputation of the ear tips or most of the ear flap is frequently needed. 

Consider applying sunscreen on your pet's ears.  Especially if your pet has white ears.

This cat had to have it's ear flaps amputated.   Cats (and dogs) with white ears are especially prone to sunburn wounds.
Injuries to the ear flap

Ear flaps are vulnerable to lots of injuries, bite wounds, tears, snags, bee stings and so forth.  Once injured, both dogs and cats often make the situation worse by constant scratching.  It's hard to resist.

Sometimes treating these injuries by cleaning and applying antibiotic gels or sprays, hydrocortisone cream, giving some benadryl and so forth is enough.
But many cases need the attention of a vet and quite often minor surgery.
The cat above has cancer.
The cat below has frostbite damage. They appear similar but of course the outcome is very different.