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