An aural (ear) hematoma is a collection of blood, serum, or a clotted blood within the pinna (earflap). When present, the pinna will be very thick. The swelling may involve the entire pinna or it may involve only one area.

The earflap is composed of a two layers of skin surrounding a layer of cartilage. The cartilage gives the earflap its shape. Blood vessels go from side-to-side by passing through the cartilage. Violent shaking can cause the vessels to break as the skin slides across the cartilage; however, in some cases, the cause remains undetermined.

Causes/Transmission
The cause of aural hematomas is unknown. Vigorous shaking of the head and ears has been thought to be responsible, yet a large percentage of affected dogs develop hematomas without shaking their head. Disease of the ear canal is also considered to play a role, but not all dogs with aural hematomas have ear disease (otitis).

Clinical Signs
Most dogs with an aural hematoma have a history of head shaking. Debris or odor may occur in the ear canal if an infection is present. However, the most consistent clinical sign is a thickened earflap.

Diagnosis
A physical examination of the earflap is usually all that is needed to make the diagnosis.

Treatment
There are two approaches to treatment: a medical approach and a surgical approach

Medical Treatment
This is the simplest and least invasive procedure; however, it is only successful 50% of the time.

The blood in the earflap is aspirated with a syringe and needle. One of several medications, often a cortisone-type drug, is injected into the space from which the blood was taken. The dog is checked in 3-7 days to assess the outcome of treatment. If an ear infection is present, it is also treated.

Surgical Treatment
The blood is removed from the pinna. This is accomplished by making an incision along the length of the hematoma and placing sutures thru both side of the ear to “tack down” the swelling. The ear is stabilized to prevent further damage by laying it on top of the dog’s head and bandaging in place. Although the bandage may be somewhat cumbersome, it will prevent further damage to the pinna and allow proper healing to progress.

The cause of the problem is diagnosed and treated. If an infection is present, medication is dispensed to treat it. However, some dogs have no infection but have foreign material (a tick, piece of grass, etc.) lodged in the ear canal. If so, the foreign material is removed. It is also possible that a foreign body initiated the shaking but was later dislodged. If that occurs, and no infection is present, further treatment of the ear canal is not needed.

The bandage is generally removed in about 3-5 days. The sutures are removed in 10-14 days.

If an infection was present, it will be necessary to recheck the ear canal to be sure that the infection is gone. Otherwise, another hematoma may occur. Also, scarring may cause the ear to be slightly deformed for the rest of the dog’s life.

Prognosis

Usually the prognosis is good for recovery, but it is not uncommon for the hematoma to recur at least once.