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 blood collects under the skin and causes the ear to become thickened. The swelling may involve the entire ear flap, or it may involve only one area. Aural Haematoma’s usually occur because of local irritation to some part of the ear. When something irritates the ear canal, the dog responds be scratching or shaking the head. Excessive shaking causes blood vessels to break, resulting in bleeding. An understanding of the ears anatomy makes the sequence of events more logical. The ear flap is composed of a layer of skin on each side of a layer of cartilage. The cartilage gives the ear flap its shape. Blood vesicles go from side to side by passing through the cartilage. Violent shaking causes the vesicles to break as the shin slides across the cartilage.
What are the treatment options?
1. Surgery: an incision is made over the swelling and the accumulated blood and clots are removed. The skin and cartilage layers are then stutred together in a series of sutures to force them to seal together. Sometimes a template is placed on the outer surface of the ear to keep the ear flat as it heals. Sutures are kept in for 4 weeks as cartilage takes longer than skin to scar. In this time we like to get the patient back weekly/fortnightly to check the healing progress. Surgery is the best chance of complete resolution.
2. Yunnan Bai Yao: This is a Chinese herbal formula in the form of oral tablets or powder that can sometimes help to reduce the swelling and irritation without surgery. It can help stop the bleeding, reduce swelling and chance of infection.
3. Nothing: The condition is certainly irritating and annoying for the dog but it is debatable as to whether it is painful (although in some cases it is obviously is). There may be disease of the ear canal (predisposing to a haematoma) which is painful and may require separate specific treatments. Over time, several months, the body will re-absorb the blood in the haematoma and the ear will heal, but the result will be a crumpled and distorted ear flap. Very large haematomas may not resolve.
4. Drainage: They can be drained if your dog is able to remain calm under a local anaesthetic and some pain relief and if the haematoma isn’t too large. It isn’t always a a viable option as it can be painful, it can induce infection (in an otherwise sterile environment) and some blood clots are often left behind. The reoccurrence rate is about 70% within a 14 days and the remaining 30% often in the following few months.
5. Natural anti-inflammatories and Pain Relief: PEA (palmitoylethanolamide) and APN’s herbal Inflammation support are a great combination to help with inflammation, infection and provide pain relief as your pet recovers.
What Next?
If you decide on surgery, you will be asked to fast your dog on the morning of the surgery and bring them in first thing on the arranged day. It is a day procedure and they should be fine to go home that evening. Your vet will likely provide you with antibiotics, anti-inflammatories and ear medication, if indicated to give at home. If you decide against surgery, it is important to make sure the initiating ear disease is addressed and treated. The ear canal disease can be more painful than the haematoma. This may mean drops or tablets and a recheck in 10-15 days time.