Aural haematomas are pretty common in dogs, and we sometimes see them in cats too. If a client rings for an appointment for their pet’s swollen ear, it’s probably an aural haematoma.  

What happens in an aural haematoma?

The clue is in the name; ‘aural’ means ear-related, whilst a ‘haematoma’ is a collection of blood somewhere inside the body that it shouldn’t be, often because of trauma. So, an aural haematoma is a collection of blood in the ear. 

The ear pinna, which is the outside ear flap, is made up of cartilage sandwiched between two pieces of skin. This is interwoven with blood vessels. With an aural haematoma, some of the blood vessels break open and bleed, allowing blood and tissue fluid to accumulate between the skin and the cartilage. This creates the typical soft, fluid swelling within the ear pinna that we associate with acute aural haematomas. 

In chronic or untreated aural haematomas, what can happen is that the fluid components eventually reabsorb, but some abnormal tissue or fibrin remains and the skin and cartilage knit back together with this fibrous scar tissue in between. This creates a misshapen ear pinna, not dissimilar to the so-called cauliflower ear that we may see in rugby players.

What causes an aural haematoma?

The blood vessels are broken by trauma, normally from excessive head-shaking, rubbing or scratching at the ear. Whenever we see a pet with an aural haematoma, we must look for the underlying cause, otherwise the problem is likely to recur despite appropriate treatment for the haematoma. 

Many pets have an associated ear infection (known as otitis) caused by bacteria, fungi, or parasites known as ear mites. That said, irritation can also be caused by an allergic skin disease or by a foreign body (often a grass awn) that’s gotten stuck in the ear canal. These all cause discomfort and irritation within the ear, which leads pets to vigorously shake their heads, rub and scratch at their ears. This self-trauma is what causes damage to the blood vessels, creating an aural haematoma. 

How can an aural haematoma be treated?

There are a number of ways to treat aural haematomas. These can be split into surgical and non-surgical solutions;

Non-surgical treatment options

Often we will try conservative treatments before resorting to surgery. However, conservative treatment is only really appropriate for small-sized haematomas the first time they’re seen. It involves draining the fluid out of the swelling and giving the pet an anti-inflammatory medication to see if we can get it to resolve on its own.

Some veterinarians will make a small cut in the swelling, drain it and place a catheter-type object to allow continued drainage at home. Often these aren’t entirely successful and we have to do surgery. 

Surgical treatment options

The surgical approach to aural haematoma differs between veterinarians because there are a number of ways to do the procedure. Normally we make an ‘S’-shaped incision on the underside of the ear pinna, over the swelling, and from here we can evacuate the haematoma contents. Then we place some form of stenting-type material to help close the skin back onto the cartilage and avoid pockets of fluid and blood reforming.

This material can vary between being a type of sponge, small pieces of plastic tubing, buttons, and other things, but they all do the same job. By suturing (stitching) these to the ear, we can get rid of any free space between the cartilage and the skin. This prevents the haematoma from reforming. They’re normally left in place for about 2 weeks and the pet will have to use a buster collar to avoid them from interfering with the wound. 

Even surgery isn’t always completely successful, especially if the underlying problem hasn’t been resolved. Occasionally further surgery is needed to repeat the procedure. 

What if it comes back?

Some pets unfortunately have chronic or repeated episodes of ear disease and can end up suffering from multiple haematomas. This is why it’s key to get the ear irritation under control. Using appropriate treatment for the ear infection, foreign bodies or allergic skin disease. If your pet has a swollen ear, it may well be a pesky aural haematoma. Be sure to get them checked out with your vet, so you can get to the root of the problem and treat it effectively. 

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