Aural Haematoma

by Dr. Francesca Matthews


What is an aural haematoma?


You have all seen rugby players with thickened and swollen ears. These are all the results of aural haematomas. The rugby player has had trauma to his (or her) ear, which results in bleeding between the skin and cartilage of the ear. The blood clots will eventually resolve and what is left is a less swollen but thickened and disfigured ear.

In dogs, aural haematomas are very similar. They are a collection of blood under the skin in the pinna or ear flap. They blood in the pinna is often clotted. The ear flap becomes very swollen and in dogs that normally have upright ears, the weight of the blood in the skin flap may cause the ear to flop.

The aural haematoma may be in a very small localised area on the pinna or involve the entire pinna.


Image source wikimedia commons

What causes an aural haematoma?


An aural haematoma in a dog is usually caused by vigorous shaking of the head. This shaking causes the small blood vessels in the ear to break resulting in bleeding into the ear flap or pinna.

The vigorous head shaking is usually caused by a problem with the dogs ear, whether that be a foreign body in the ear, such as a barley grass seed, or an ear infection that has not been treated.

As part of treatment for an aural haematoma, the underlying problem must be treated too.

What treatment is available?


Treatment will usually involve sedation or a full anaesthetic. The cause of the aural haematoma needs to be diagnosed and treated. This means the ear canal is searched for signs of foreign bodies like grass seeds which are removed and infection. If infection is present the ear canal must be flushed and cleaned and then appropriate treatment for otitis externa instigated.

The aural haematoma then needs to be treated. If you just stick a needle in the swelling and drain the fluid, in 99% of cases the swelling will reoccur because the space remains in the flap of the ear for more bleeding or fluid accumulation to occur. What is usually preferred is that once the blood is removed that the ear is sutured together to occlude the space where more fluid could accumulate. There are several ways that veterinarians will do this and they all achieve the same outcome.

Once the ear flap is sutured together (usually with an aural haematoma pad, tubing, or piece of old x-ray film or similar to secure the sutures to), the head will be bandaged. Bandages stay on for a few days and the ear will be checked by the veterinarian on removal. Suture removal will be at least 2 or 3 weeks after surgery (sutures are left in aural haematomas longer than usual to ensure adequate time has elapsed for the space in the ear pinna where the blood accumulated to close).

At revisits the veterinarian will ensure that the original cause of the haematoma (if it is something ongoing like an infection) is resolving with prescribed treatment too.

Do I need to treat an aural haematoma?


Without surgical treatment the aural haematoma is likely to settle down and the blood clot resolve, however your dog will be left with a fatter and more misshapen ear than if surgery is undertaken. Also the weight of the ear pinna full of fluid cause discomfort to the dog and may in itself cause further problem and without surgery may need draining several times.

The other problem is that of course the primary reason for the development of the aural haematoma must be dealt with, otherwise the condition will continue to get worse and this causes pain and discomfort to the dog. This will need medical treatment.

We recommend you seek our advice on each individual case.

Will an aural haematoma recur?


There are no guarantees that an aural haematoma will not recur. Once an aural haematoma is fully healed it is less likely to occur in the same place as the original one, due to the formation of scar tissue, but it could occur in another place.

The best way to prevent recurrence is to ensure that you monitor early for and pick up any problems that are likely to result in head shaking such as ear infections and avoid areas where objects such as barley grasses may be found. Also it is a good idea to groom your dog thoroughly for items in the coat after every outing that could migrate to the ear.

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