Few maladies impress my clients quite like a pendulous ear swollen to ten times its legal limit. That’s what most ear hematomas look like when they arrive. Parents newly initiated to the charms of this disorder are invariably impressed—and, dare I say it—overly concerned.

Of course the pet is stressed and uncomfortable, though perhaps only marginally more so than just before the ear was hit or shaken hard enough to burst some of the ear-flap’s vascular plumbing. It’s this leaky pipe in the space between the ear cartilage and the skin that’s to blame for the bubble of blood that makes an ear swell so prodigiously. And the ear was usually uncomfortable to begin with, thus occasioning the vigorous flapping that ended up in this skin and cartilage-bounded blood-balloon.

Last week’s patient was fairly typical of these cases. Her pendulous black Lab ears had been bothering her for days with the same summer concern that dogs her every year: allergies yielding to external ear infections. Such infections are more itchy and chronically persnickety than outright painful (unlike the ouchy middle ear infections parents fear in their human offspring). But a few firm flaps (or one good whap against a wall) and now she has a blood blister worthy of veterinary attention.

Mom’s reaction was also typical: “I came home from work and there it was! I can’t believe she’d been suffering all day like that!” Meanwhile, little Miss Blackie was happily showing off her submissive grin and wagging her butt in undeterred Labrador enthusiasm. The bulge hanging off the side of her head could have been a Santa hat for all she cared. (That’s a Lab for you.)

Now it was time to disabuse Mom of the notion that said bulge might imminently explode (as a neighbor had cautioned her might transpire were she to ignore the impending doom implied by the swelling).

After talking her down from the ledge (no, it’s not any more painful than the superficial ear infection she’s had for a few days now and no, it’s not going to explode in a shower of bloody fluid all over your white furniture—I promise) and treating the ear infection, I then gave her the option of having it surgically reduced (most commonly this involves slicing the ear neatly, extracting the fluid then quilting down the layers over the affected ear) or living with the consequences (a slow return to relative flatness with some crinkling of the ear as it heals).

So you know, most cases find me trying my best to talk people into living with the ear-bubble as it slowly recedes into its less-than-perfect end-state. That’s because the alternative is one of a couple different surgical procedures with a series of frequent bandagings and rebandagings that sometimes go on for a couple of weeks. It’s a pain—quite literally—for a sensitive, post surgical ear to have to undergo such attention. But most people fear the thought of an ugly ear more than they can imagine the stress and pain of an ear in bondage.

The decision often comes down to cosmetics (and human stress over the sight of a pet’s current discomfort), which is why I find that many vets don’t even offer the alternative of leaving the ear to its own physiologic devices. But you should know that most ear hematoma cases can do well without surgery.

Having suffered this condition multiple times with my long-lost Agatha (a boxer who saw me through vet school), it irks me a little that hematomas are almost invariably treated surgically. The first episode found me repairing the ear with painful consequences. The two following episodes healed blissfully (though somewhat less attractively) on their own. Given a choice, I’d opt always for less pain, more crinkling.

Indeed there are some times when the ear’s swelling is so severe that it makes treating the itchy infection difficult without surgery (this seems especially true for cat ear hematomas). And there are other cases where the inciting cause is not trauma or ear infection. A blood clotting problem combined with a simple bump to the ear can also make ear hematomas happen. Surgery in these cases is contraindicated.

So next time you’re faced with the itch and stress of Miss Blackie’s condition, consider all your alternatives. Every vet’s going to have a different take, no doubt, but as always, you should listen to your options, ask good questions and never listen to your neighbor—that ear’s not going to explode (I promise).