Evil ear hematomas from hell

Patty Khuly, DVM
Published: May 27, 2008
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OMG! Is there nothing worse than an ear hematoma? I currently have three patients recovering from recent bouts of the bulbous earflap phenomenon knows as the “aural hematoma.” 

In these cases what happens is that the space between the cartilage of the ear and its overlying skin separates to accommodate the blood of a nearby ruptured vessel. In some pets it looks like a big bleb on the ear’s tip but in others it can reach near-balloon proportions.

Dogs get ‘em.

Cats get ‘em (though less frequently).

Even people get ‘em (rarely, thanks to our flat-against-our-skulls earflaps).

(poor kid)

Most of the time ear hematomas are considered a traumatic injury. The ear gets a vigorous shake and POP goes the vessel. Sometimes a nearby object (the wall, perhaps?) intervenes and the ear gets cracked against its surface, facilitating the unseen bleeding. Often there’s an ear infection occasioning the repetitive head-shaking, ear-flapping maneuvers which lead to the hematoma.

But there are other causes, too. Much less often, an ear hematoma can be a sign of a clotting disorder. Failure of the blood to clot normally can become evident via bruising. And an ear hematoma is simply one of the more dramatic manifestations of just that—a garden-variety bruise.

Problem is, most bruises take a reasonably long time to resolve. Because of the relatively large volumes of blood involved and the constant movement inherent to the area (especially in a long-eared dog’s anatomy), ear hematomas are especially slow-healers, regardless of its origin—more so if the underlying cause is not appropriately diagnosed and treated.

That’s why so many of you elect to have the ear surgically repaired. Though in most cases surgical repair is not strictly necessary, surgery is usually undertaken if a cosmetic outcome is desired or if the entire ear canal is occluded by the ballooning bulge of the hematoma . In these latter cases, healing of the infection (which most often leads to the problem in the first place) is made almost impossible by the size of the darn thing.

Though I relish removing all the squishy half-congealed blood and sewing up the ear quilting bee-style (one of perhaps a hundred different techniques used to treat aural hematomas), I detest the surgery’s aftermath: bandaging and rebandaging and bandaging again…

It’s a nightmare, not least for the pets whose ears have to suffer our ministrations for weeks on end. That’s why I do my best, if at all appropriate, to talk my clients out of it. “Just say no to surgery!” I’ve been known to beg.

Nonetheless, some of my clients are convinced this is an evil emergency. Should I not take my hard cold steel to the ear will it not engulf the head with its nastiness? Well…not usually…so let’s give it a few days…the ear’s not going anywhere, much though that balloon might indicate otherwise…