What is it?
An aural haematoma (sometimes called a "cauliflower ear"!) is like a bruise inside the ear. However, because of the location, the blood doesn't dissipate, but forms a large swelling between the layers of skin and cartilage inside the ear flap. In this sense, it's more like a blood blister, causing massive swelling and deformity of the affected ear or ears.
What causes it?
The most common cause is the dog shaking their head excessively - so it's worth thinking of the haematoma itself as a symptom rather than a disease in its own right. The most common causes are ear infections; ear mites; and foreign objects (like grass seeds) in the dog's ears. This makes them scratch at their ears and/or shake their heads, resulting in rupture of the fine blood vessels inside the ear flap.
What dogs are at risk?
Any dog may get an aural haematoma, but it is most common (and usually most severe) in dogs with long, floppy ears like Setters or Spaniels. These dogs are more likely to injure their ears when shaking, and are also slightly more likely to suffer from ear problems in the first place.
What are the symptoms?
It depends how severe it is. A mild case may just have a swelling (often reddish or blue-purple) on one part of the ear flap (pinna); whereas a more severe one might result in the whole ear flap blowing up like a balloon. The swelling may be soft or hard to the touch, depending on how recent the bleed is and how much the blood has clotted. Usually, they are uncomfortable initially but soon become painless.
How is it diagnosed?
The symptoms are pretty characteristic, but if in doubt, we can put a needle into the swelling and draw out some of the fluid - if it's blood, then the diagnosis is confirmed.
How can it be treated or managed?
Haematomas will usually subside on their own in a few days, but this often results in permanent scarring and deformity of the ear, so we usually recommend prompt treatment by a vet. There are several ways to approach this condition, depending on how severe it is, and how tolerant the dog is! The simplest is simply to drain out the blood with a needle and syringe (we can usually do this in the consult with the dog awake). However, it will usually refill, needing two, three or even four drainages before it stays down. Injecting a little bit of steroid medication into the ear after draining it does seem to reduce the chance of recurrence. In many cases, however, it is better to to treat the condition surgically. The dog is given an anaesthetic and when asleep, we open up their ear, remove all the fluid and clotted blood,and sew all the layers back together again. The ear is then bandaged up to the the head to keep it safe while it heals! Whichever course of treatment we use though, it's vital to investigate the underlying problem - which is why we'll always have a look down their ears (on BOTH sides!) before we let you leave.
Can it be prevented?
Rapid and effective treatment of ear infections and other diseases will in most cases prevent an aural haematoma from forming in the first place. If you have a dog with itchy ears, regular cleaning with a suitable ear-cleaner will often help too.