Aural Hematoma in Dogs

An aural hematoma is a pocket of blood that gets trapped between the layers of tissue on the flap of a dog’s ear. This is caused by a blood vessel breaking and leaking blood into the surrounding tissues. As the fluid spreads out, it creates a spongy, pillow-like swelling.

Aural hematomas are usually associated with some form of injury, including bites and excessive scratching in response to irritation. The severity of an aural hematoma depends on its size and whether it is causing pain.

Small hematomas are usually not a problem and often resolve on their own.

In some cases, larger hematomas block the ear canal, making it difficult to diagnose and treat underlying conditions. During healing, scarring can create a permanently narrowed ear canal that predisposes the dog to further ear infections.

Left untreated, aural hematomas can permanently change the appearance of the ear. It is possible for an aural hematoma to become large enough to weigh the earflap down, changing the carriage of the ear permanently. In some cases, the pocket of skin left after the hematoma resolves looks baggy and wrinkled. This is referred to as a cauliflower ear.

Prognosis for aural hematomas is good, but recurrence is likely if underlying associated conditions such as ear mites or allergies are not addressed.

Aural hematomas are not life-threatening. They are often painful and in some cases change the appearance and positioning of the ear permanently. Prompt veterinary attention is required.

Dogs with food allergies, atopic dermatitis, bleeding disorders, or clotting disorders are at greater risk of aural hematoma. Certain conditions increase the fragility of blood vessels, such as Cushing’s disease, which increases the risk of aural hematomas in these patients.

The cause of the broken blood vessel leading to hematoma is typically traumatic injury such as a bite wound or damage to the tissue from excessive head shaking or scratching. Head shaking and scratching are typically responses to itchiness inside the ear canal.

The characteristic symptom of aural hematoma is the presence of a soft, fluid-filled swelling on the ear flap. They vary in size and can be painful.

Aural hematomas are self-evident and diagnosed on physical examination. Further diagnostics to identify underlying conditions such as ear mites or allergies include:

• Bloodwork
• Cytology
• Culture of ear canal discharge
• Allergy testing
• Skin scrape
• Food allergy diet trials

The goals of treatment are to minimize scarring, to speed healing, and to address and treat any underlying condition. In some cases, aural hematomas resolve on their own.

Medical management of some hematomas is possible. Treatments include:

• Corticosteroids
• Laser therapy
• Aspirating the fluid from the hematoma into a syringe to relieve pressure

In other cases, especially with larger aural hematomas, surgical treatment is necessary. Surgical treatments include:

• Draining the blood by a surgical incision
• Suturing the space left behind after the fluid is removed

For complete recovery and to avoid repeat incidence of aural hematoma, treating any underlying condition is necessary.

Dogs recovering from an aural hematoma often require use of a cone for several weeks to protect the damaged tissue.

Recovery takes several weeks. The prognosis with treatment is good. Recurrence is common, especially when the underlying cause is left untreated.

Prevention requires careful attention to ear health to avoid traumatic injuries. Treating the first signs of ear infection and ear mite infestation and avoiding altercations with other dogs and animals are also effective preventive strategies.

Aural hematomas are common in dogs.

• Benign neglect
• Corticosteroids
• Laser treatment
• Aspiration
• Surgical incision
• Suturing the disrupted skin
• Treatment of underlying conditions