Aural Hematoma in Cats

Key Takeaways

An aural hematoma is an accumulation of blood between the cartilage and skin of the ear. Aural hematomas in cats present with a visible thickening of the ear flap.

• Other symptoms include head shaking, scratching, and discharge from the ear canal

• Hematomas arise when a blood vessel ruptures, often occurring secondary to an ear infection, injury, or tumor

• Diagnosis is by physical examination

• Diagnostic imaging and cell samples from the ear canal may be taken to identify the underlying cause

• Treatment options include both non-surgical and surgical drainage of the hematoma alongside medical and surgical treatment of any underlying disease process to reduce recurrence

• Aural hematomas take several weeks to heal, but the prognosis is good

• Recurrence is the most common complication

A Closer Look: What is Aural Hematoma in Cats?

Aural hematomas are uncommon in cats and are usually markers of underlying ear disease such as infections, polyps, tumors, or ear mite infestations.

Aural hematomas are sometimes distressing when the pressure of blood build up within the ear is painful.

Risk Factors

Additional symptoms vary depending on the underlying cause. Ear mite infestation usually presents with excessive production of black, crusty ear wax. Ear polyps or tumors are sometimes visible in the ear.  Bacterial or fungal ear infections typically show redness, swelling, and foul-smelling, crusty discharge. 

Since the exact cause is not well understood, it is difficult to say which cats are most at risk. Since aural hematomas are associated with ear mites, polyps, and injuries, unvaccinated outdoor cats and those living in dense populations may be at higher risk.

Possible Causes

The exact cause of aural hematomas is not known, and may vary from case to case. A common hypothesis is that they occur secondary to ear injury.

Main Symptoms

Aural hematomas are self evident, appearing as a red or purple discoloration of the ear tissue. Other primary symptoms include:

• Visible swelling of the ear

• Head shaking

Scratching at the ear

Head tilt

Testing and Diagnosis

Diagnosis of aural hematoma is self evident. Further investigation involves identification of any potential underlying disease process:

• Physical examination including otoscopic examination of the ear canal

• Diagnostic imaging

• Microscopic evaluation of cells and debris from within the ear

• Tissue culture

• Sensitivity testing

Steps to Recovery

Treatment focuses on repair of the hematoma alongside management of any underlying causes. 

Surgery is usually required to drain the hematoma and tack the skin back down to the cartilage. Healing takes several weeks and recurrence is common. 

Non-surgical drainage may be attempted. Success with non-surgical procedures is more likely when: 

• Treatment is sought early

• Medications are infused into the hematoma directly

• Ear flapping can be prevented (taping, ear wraps)

• Drainage is repeated several times over the course of several weeks while the hematoma heals

Medication for underlying causes includes: 

• Antiparasitics

• Antibiotics

• Steroids

Prognosis varies according to severity. Small hematomas sometimes resolve spontaneously. It is very rare for a hematoma to heal when drained non-surgically only once. 

Hematomas usually take 6-8 weeks to heal and an e-collar is usually necessary during recovery. Aural hematomas that are not treated result in a thickened, misshapen ear known as a ‘cauliflower ear’.

Cases where the underlying trigger is not addressed are likely to recur.

Prevention

Prevention is possible with early control of underlying disease. Cats presenting with recurrent head shaking, scratching, or ear discharge require prompt veterinary treatment to reduce the formation of aural hematomas.

Routine prevention of ear mites may decrease the likelihood of ear hematoma formation.

Is Aural Hematoma Common in Cats?

Aural hematoma is uncommon in cats. When it does occur, 50% of cases occur alongside ear mite infestation

Typical Treatment

• Antiparasitics

• Antibiotics

• Steroids

• Surgical drainage

• Removal of blood clots

• Surgical fixation of skin to cartilage

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