A haematoma is swelling created by a broken blood vessel after bleeding has occurred inside a tissue. Hematomas can occur between the two layers of cartilage in the ear of dogs or cats if shaking their head breaks the blood vessels. The haematomas can be quite small or can take up the entire space of the outer ear and in some cases block the ear canal. The ear will appear swollen and fluid-filled and it may be uncomfortable or even painful. This most commonly occurs in dogs but occasionally in cats and is the equivalent of the “cauliflour” ears seen in rugby players whose ears rub in the scrum.
A dog or cat may shake their head and ear for a number of reasons so it’s important when addressing the haematoma that we consider the underlying cause of the head shaking. In many cases the haematoma is caused by an outer ear infection however water in the ears, itchy skin or allergies may also be the cause. In some cases we do not determine an underlying cause. If the cause is an ear infection, your pet will likely need microscopic evaluation of their ear contents and topical ear drops.
What do we do to relieve it?
There is no one proven method to treat these haematomas and most veterinarians have developed their own method that they feel provides the best results and lowest chance of reoccurrence. The following are some commonly performed procedures:
This simple procedure involves inserting a needle into the space to remove the fluid contents from the haematoma. The problem is that a space is left behind when the fluid is removed, and this space readily refills with more fluid, leading to temporary results. The benefits of the aspiration method are that it is inexpensive and relatively easy to perform (although many dogs will not tolerate it conscious), but the disadvantages are that it may introduce infection and may require multiple attempts. In some cases the fluid within the space has already clotted and removal is not possible. Where fluid removal is possible, some vets may elect to inject into the space an anti-inflammatory to help reduce the chance of reoccurrence.
Under general anaesthetic, an incision is made in the earflap (on the inside surface). The haematoma is drained of fluid and blood clots. To prevent the hematoma from refilling with fluid, multiple sutures are placed in the ear vertically to keep the cartilage flat. This sometimes involve a pad of some sort placed against the ear to absorb fluid. Sometimes bandages are applied post-operatively to stop the pet shaking the ear around. Sutures are generally left in place for 3 weeks to allow good scarring to take place so that refilling will not occur. The earflap is essentially quilted to close any space where fluid might refill however there is still a small chance of reoccurrence.
Haematomas will in time resolve by themselves as the fluid reabsorbs. This can leave the ear distorted and scarred and pain must be managed if the pet is uncomfortable. However this is certainly a viable option for patients at high anaesthetic risk or those with small haematomas.
Some vets may elect to use oral medications to reduce the inflammation in the ear. This has mixed results and may not work but is certainly an option to speed recovery when surgery is not viable.