Ear hematoma
AHEMATOMA is swelling created by bleeding inside a tissue or structure from damaged blood vessels. Ear hematoma (called aural hematoma) is swelling of the pinna or ear flap. There is a very distinct, and sometimes very large, swelling of the ear flap of your dog (sometimes cat). This swelling often causes the ear to stick out in a way it did not before. The ear flap swelling might feel like a water balloon, or it might be very tight and firm.
Vigorous, persistent head shaking is often cited as the cause, and sometimes these dogs continue shaking so that this is what is noticed first. However, there are many things which can cause a dog to shake its head (and ears), and sometimes the cause of the hematoma does not make the dog shake its head.
If the cause can be found then that doubles up on the treatment program. This means the swelling itself usually needs to be corrected with surgery, and the cause needs to be treated as well.
The swelling may be so large that the opening of the ear canal is blocked which will go on to create more problems. This blocking means increased heat and moisture, an environment perfect for infection, and the wax, dead cells and other debris normally accumulating have nowhere to go (normal ear function will move this debris to the opening of the ear canal). The extra weight of the earflap may be uncomfortable and may lead to a permanent change in how the ears are carried. Worse yet, if untreated, the pinna can develop cauliflower ear which is scar tissue that deforms the ear flap. Even though it doesn't look very nice, more importantly for the dog's ear health is keeping that canal open. Scar tissue will be a permanent block.
There are several situations where the hematoma should be repaired, these include:
■ The hematoma is so big that the opening of the ear canal is blocked. If this is the case, the ear cannot be evaluated for infection nor can any infection be treated. In this situation, the hematoma must be relieved before the ear canal can be accessed;
■ The hematoma is in a location where natural healing will create scarring in such a way that the ear canal will be permanently narrowed. A permanently narrow ear canal can predispose the patient to a lifetime of ear infections. This is particularly a problem in cats; and
■ To maximise the ability of the ear flap to stand up straight after hematoma resolution or to prevent excessive scarring in the ear flap for cosmetic reasons.
There are probably as many ways of correcting ear hematomas surgically as there are veterinarians. Sometimes there are good results using medical therapy along with aspiration (drawing out with needle and syringe), especially when the hematoma is small.
Disadvantages to this treatment include that it may introduce infection and may require multiple attempts. If the clot in the hematoma is already well organised and on its way to scarring, there may not be much fluid left to aspirate and the technique may not work at all. Usually surgical methods are utilised.
Most commonly, a surgical incision is made in the earflap with the animal under anesthesia. The hematoma is drained of fluid and blood clots. To prevent the hematoma from refilling with fluid, multiple sutures are placed in the hematoma. Sometimes bandages are applied post-operatively, sometimes not. Sutures are generally left in place for three weeks to allow good scarring to take place so that refilling will not occur. The earflap is essentially "quilted" to close any space where fluid might refill.
Usually there is a reason why a dog has been shaking his head: bacterial ear infection, ear mites or allergy are common causes. This means that the ear infection must be treated along with the hematoma. Sometimes ear shaking just happens and there is no underlying infection, but be prepared for the expense and trouble of treating an ear infection along with that of the hematoma.
If left alone, an ear hematoma will resolve by itself. The fluid will be re-absorbed back into the body and the earflap will no longer bulge. The problem is that a lot of scarring is associated with this process and the ear is often not cosmetically appealing (doesnt look good) afterwards (i.e. it becomes a "cauliflower" ear). Resolution of a large hematoma can take several months during which it may be uncomfortable for the pet.
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