An aural hematoma is a painful swelling of a pet’s ear from buildup of fluid when the ear flap is damaged. It is not uncommon for ear infections to cause a pet to shake its head back and forth, leading to a swollen ear flap, also known as an aural hematoma. Golden retrievers, labrador retrievers, and dogs with allergies are at a higher risk for developing one or even multiple aural hematomas. Since these can be treated with several different methods, Dr. Brittany Lancellotti, veterinary dermatologist, discusses the risks and benefits to treatment options based on recent studies.
Welcome, everyone, to today’s episode of Your Vet Wants You To Know. Over the past few episodes, we’ve been learning all about ears and ear infections. I wanted to take a few minutes to discuss something that I occasionally see, related to ear infections- aural hematomas.
What is an aural hematoma?
[00:01:49] An aural hematoma is a buildup of bloody fluid within the ear flap. And I want to give you some definitions, so that you can follow along. ‘Aural’ means relating to the ear. It sounds like ‘oral,’ meaning the mouth, but this is ‘au’ instead of ‘o.’ Hematoma means a swelling made up of blood. So an aural hematoma is a swelling of blood in the ear.
[00:02:14] In this situation, it’s not exactly blood. Most often, the fluid that collects in the ear is usually just inflammatory fluid mixed in with some blood, giving it that bloody color. And that’s why it’s so important, for part of our treatment plan, to include bringing down the inflammation so that there’s less fluid being made.
[00:02:34] The most common place for this to occur is the ear flap, also known as the pinna. In one study, 80% of dogs with aural hematomas had pendulous (long and floppy) ears. The majority of these dogs that had aural hematomas were over 18 kilograms (40 lbs). If you think about this, it makes sense. What type of dog is going to be the most likely to really do some damage to their ear flaps when they’re whacking their heads back and forth because their ears are bothering them?
Why do dogs get aural hematomas?
[00:03:09] There may be an underlying component to how fragile the cartilage in the ear flap is because it’s the breaks and the cartilage that trigger that fluid to start building up. Basically, something makes these dogs shake their heads (sometimes just mildly, because of fragile cartilage to begin with), and when that cartilage breaks, the fluid has no place to go except between the cartilage and the skin, creating this squishy, painful bulge in the ear.
[00:03:36] Over 2/3 of dogs with aural hematomas also have secondary ear infections with either bacteria or yeast, or combination of the two. So it’s really important for your vet to be able to diagnose and treat those infections. Dr. Meagan Painter (from The Allergic Dog) just did several discussions on ear infections, so if you haven’t already, take a moment to go back and listen to episodes 44 and 45, if you really want to learn more about understanding the primary ear disease and how to get control of the ear infections. Also, Dr. Ashley Bourgeois (from The Derm Vet) does a great explanation on what cytology is (in episode 46) and how it helps us to be able to provide relief. This may or may not have been published research, but it’s my personal experience that the majority of ear infections develop at 2:00 AM, when you’re trying to sleep and your dog starts whacking its ears back and forth like a windmill. Thank you, Russell Sprout, my own personal allergic dog.
Does your dog need to see a vet for an aural hematoma?
[00:04:31] There are several reasons to treat aural hematomas when they develop. Firstly, the longer the fluid causes severe swelling, the more pain and scarring occurs. This can also make it more likely for recurrence of hematomas in the future, so it’s ideal to treat as quickly as you notice that squishy fluid building up in the ear flap, working with your veterinarian to figure out why this happened in the first. Episodes 1-8 of the podcast are all about allergies. Plus, there’s a free allergies toolkit on the website that will help you come up with a great management plan, with your veterinarian, for your allergic dog.
How are aural hematomas treated?
Our strategy when approaching hematomas should be three components.
- Decrease swelling. We want that inflammatory fluid to stop being made.
- Provide drainage. We want that fluid out of the ear flap.
- Promote adhesions. We want the skin to stick to the underlying cartilage again.
Steroids decrease swelling in aural hematomas
[00:05:35] So let’s talk about each one of these three approaches. First, we’re going to decrease swelling. And this is typically done using steroids, such as Prednisone, Dexamethazone, Triamcinolone, Medrol- lots of different steroids are available. If you want to hear more about steroids, Dr. Curtis Plowgian and I discussed steroids, in detail, in episode 6. Steroids help bring down inflammation, so this helps us to stop the buildup of more fluid. Steroids can be used orally (by mouth), injectably (your vet may give an injection in the clinic), or topically (steroid may be given into the ear). Often, it could be a combination of these.
How is fluid removed from a dog's ear?
[00:06:14] Next, we’re going to provide drainage, which can be done through several different techniques. I’m going to mostly focus on two that were recently evaluated in a large study, published in the journal of the American Veterinary Medical Association’s first supplemental issue. If you’re a vet listening and you want to check out that study, it will be listed in the references on the webpage, along with the transcript for today. There are risks and benefits to each method of providing drainage, which we will discuss. Ultimately, the technique used is determined by the individual pet, so it’s important to come up with a specific plan with your veterinarian.
Aural hematoma drain with steroid infusion technique
With a local corticosteroid infusion method, we’re going to insert a catheter with a needle into the ear flap, to allow all of the fluid to be drained out of that ear. Then, while keeping the needle in the ear, we’re going to use that to inject a steroid directly between the skin and the underlying cartilage. Then, we’ll place a close-fitting bandage around the ear and press it against the head, to promote adhesion between the skin and the underlying cartilage while the ear heals.
What are the risks and benefits to draining and steroid infusion?
[00:07:23] There are lots of benefits to this particular method. There’s no sedation or anesthesia needed. And for the majority of animals with hematomas, this procedure is really well-tolerated. I will often use lidocaine, on top of the skin, to numb where I’m going to make my poke, but honestly, it’s a very small needle and most animals don’t react when we place it in there. Some pets, especially those who are fearful, anxious or stressed, may actually do better with sedation, anyway. That may be something that your veterinarian recommends, even with this local corticosteroid infusion method.
[00:07:56] There are some risks associated with the draining. The ear may fill back up with fluid and it may be helpful to have your vet recheck your dog every 2-3 days, to see if the fluid needs to be drained again. In that study I mentioned, Some pets treated with this method, had recurrence of the hematoma within the first month. And the majority of those happened within the first few days, from the first time that the hematoma was drained. Make sure you ask your veterinarian how soon they want to see your pet back, to make sure that there’s not fluid that needs to be drained again.
Multiple drainage holes: A surgical approach to hematomas.
[00:08:29] The other technique for draining these hematomas is with multiple drainage holes. This is a surgical procedure to help drain the fluid. While the animal is sedated or under anesthesia, small holes are made on one side of the ear flap so that the fluid can continuously drain out. Then, a suture is used to make stitches across the ear flap. This will promote healing between the skin and the underlying cartilage, so that tissue can adhere to each other. After the procedure, a bandage is usually placed, which your veterinarian should change every 2-3 days for about a week. Then, the sutures are left in the ear for about 2 weeks.
[00:09:09] The benefit of doing the multiple drainage holes is that there is a very low rate of recurrence, with only about 4% of dogs developing another hematoma after the first month. Most of the time, those small holes are well-healed within the first week of the procedure. Because these typically heal well, there’s usually minimal scarring of the ear after the stitches come out. This gives us the best chance to promote adhesion between the skin and the cartilage, because those stitches are holding these tissues together while they heal.
[00:09:40] There are risks and drawbacks associated with multiple drainage holes. The cost and the anesthesia are two main drawbacks. Because hematomas often occur in middle-aged to older dogs, there may be risks associated with sedating or anesthetizing them. So you should talk to your veterinarian about how sedation or anesthesia might be tolerated by your particular pet. Anytime we use sedation or anesthesia, it increases our cost of treatment. And the skill of your veterinarian involved in creating those drainage holes and placing the stitches also adds to the cost. Overall, the long-term outcome for both methods is good. 31% of the dogs in this study had multiple hematomas or developed new hematomas. So keep in mind, this may not be the only time that your animal develops one of these.
Which dogs are at risk for aural hematomas?
[00:10:27] Dogs with allergies are at a much higher risk of developing multiple or new hematomas. And if you’ve got yourself a Labrador or a Golden Retriever, they are also at high risk. They are two of our most common breeds associated with allergies, so we have to be really careful with ear infections in these pups. Overall, surgical placement of drainage holes and sutures provides better resolution, but the drainage and infusion of steroids may be more convenient and cost-effective for some owners. The majority of dogs treated by draining and infusing a steroid need to be treated more than once, but only 2% of dogs need to be drained so many times that it requires switching to the surgical procedure.
[00:11:10] So now that you know the different techniques, talk to your veterinarian about which one they recommend for your pet and how to get the best outcome, long-term, so that you can prevent recurrence. Keep in mind, if there is an infection in the ears that caused the shaking to begin with, that also needs to be treated. And because one of the most common primary diseases to cause ear infections is allergies, and allergies are a life long disease, if you have a pet with allergies, it would be a great idea for you to find a veterinary dermatologist. While you’re waiting to get in to see your dermatologist, go back and listen to episodes 1-8 of the Your Vet Wants You To Know podcast for more information about allergies and the different treatment options available, so that you’re prepared for your dermatology appointment.
Scratching the Itch
[00:12:00] I like to end each episode with a segment that I call Scratching The Itch. This is a segment that is designed to highlight something- whether it’s a website, a product, or human interest story- that just provides relief or makes you feel good. Hence, ‘scratching the itch.’ For today’s Scratching The Itch, I would like to highlight a product that helps with aural hematomas called the No Flap Ear Wrap. If your animal has developed an aural hematoma and you are waiting to get in to see your veterinarian, do not hesitate. I would highly recommend that you order a No Flap Ear Wrap, because after the procedure, whether it’s draining and infusing a steroid or multiple drainage holes with a surgical procedure, that No Flap Ear Wrap is going to be hugely helpful in keeping the ear pinned against the head, so that it can promote adhesion of the skin to the underlying cartilage. This is an excellent tool for you, should you ever find yourself in a situation where your animal has developed an aural hematoma.
[00:12:59] If your pet has had an aural hematoma, I would encourage you to visit our Facebook group, Your Vet Wants You To Know, and share your story with the other pet owners there, whom are interested in more information about caring for their pet’s health. If you found value in today’s episode, and you want more information about how to care for your pet’s health, I would encourage you to hit the subscribe button on Apple Podcasts, so that you can stay up to date with the episodes. You’re also welcome to reach out to me and let me know what you’d like to hear about. You can or follow us on Instagram and Facebook and reach out to us there. Thanks for joining. I look forward to your next visit with Your Vet Wants You To Know.
Itoh, Teruo, Atsuko Kojimoto, Kentaro Kojima, Kazuhiro Mikawa, and Hiroki Shii. “Surgical creation of multiple drainage holes versus local injection of corticosteroids for treatment of aural hematomas in dogs: 51 dogs with 71 aural hematomas (2000–2017)”. Journal of the American Veterinary Medical Association 260.S1 (2022): S15-S23.