Dermatology - Ear Hematoma
An ear hematoma is a pocket of bloody fluid within the flap of the ear. It is an occasional problem of dogs and cats that occurs when the blood vessels in the flap of the ear become leaky.
CAUSES
There are plenty of theories, but we do not definitively know what causes ear hematomas. Only some patients that get hematomas have inflamed, infected ears but some don't. And ear infections in general are a very common problem in dogs, but the vast majority of them do not get hematomas. Even whether or not a patient is shaking their head or scratching at their ears doesn't appear to have a direct correlation to whether a patient develops a hematoma or not.
An important note is that an ear hematoma is a skin disease. Many pets with ear hematomas have other skin diseases, often allergic skin disease.
TREATMENT
There are almost as many treatment options as there are veterinarians. These options can basically be divided into: doing nothing; treating medically; and surgery. It is worth considering the pro and cons of these options:
DOING NOTHING: Eventually the fluid will reabsorb; this may take a week or it may take several months, but it will reabsorb. There might be a slightly greater risk that the ear will crumple a bit (cauliflower ear) as it heals compared with surgery, but, if this occurs, it is a cosmetic problem and not a health concern.
ASPIRATING (REMOVING THE CONTENTS WITH A SYRINGE AND NEEDLE): There is the immediate gratification of flattening the hematoma. But sometimes the blood has clotted or partially clotted and it cannot be aspirated. Additionally, aspiration does not eliminate the pocket, and it has a tendency to fill again. It will ultimately take just as short or long a time to heal as if nothing was done. There is also the risk of introducing infection into the pocket and turning the sterile hematoma into an infected abscess, even with careful technique and even with placing the patient on antibiotics after aspirating. If an abscess occurs it has to be treated surgically. It's likely obvious but we do not commonly choose this treatment, that said, for a very small percentage of hematoma patients it makes sense.
SURGERY: this is not as simple as lancing, draining and leaving the hematoma to heal. Instead, the hematoma is opened by removing a thin strip of skin and then the entire flap of the ear is quilted with stitches. The hematoma is immediately resolved because the pocket is eliminated, but there is still a chance it will refill. Ear hematoma surgery requires general anesthesia, and is somewhat costly because it is time consuming. Patients are usually uncomfortable for a week or two afterward, even with proper pain medication, and some of them require extensive head bandaging. Some patients heal very well, only to have the hematoma recurr.
LASER THERAPY: This is an adjunctive method of treating a hematoma and can be combined with some of the methods listed above. Laser therapy is the application of laser light to body tissues. It promotes healing in a variety of ways. The therapy requires a special laser instrument. It is not painful (human patients typically report it feels good, and many dogs and cats act as though it does) and each session only takes a few minutes. We often recommend the addition of laser therapy because it appears that laser therapy will speed the resolution of ear hematomas for some patients.
OUR RECOMMENDATIONS
We do not recommend surgery or aspirating for most patients; we reserve these treatments for the very small percentage of patients that are significantly uncomfortable because of the hematoma. Significant discomfort can be indicated by the pet holding its head persistently tilted to the side of the hematoma, frequently shaking its head and scratching its ear, lethargy, and loss of appetite.
For most patients we start medical treatment, and the most important treatment is time. It might take a hematoma 2 weeks or 6 months to resolve, and it might start to improve and then relapse. But, as long as the pet is not showing signs of significant discomfort, we rarely recommend transitioning to aspiration or surgery.
At YVC, medical treatment for a hematoma usually involves an initial course of oral anti-inflammatory medication. We are not expecting this to cure the hematoma; the goal is to quiet any inflammation and any discomfort associated with the problem. The other important part of medical treatment is management of any skin problems. In our experience, most pets that develop hematomas have chronic skin problems, like allergies, and hematomas can only be managed if these general skin problems are managed.
EXPECTATIONS AND PROGNOSIS
It has been many years since we have operated on an ear hematoma, so, in our experience, the chance of healing without surgery is excellent.
Statistically, across veterinary medicine (not just YVC) there is a small risk that an ear hematoma that has healed will re-occur days, weeks, months, or years later. There is also a risk that the pet will develop a hematoma in the opposite ear.
