"Can’t you just drain it?"
That’s the most common reaction I get from owners whenever I describe the surgery I recommend to deal with aural hematomas in dogs. I don’t blame them. The procedure sounds like a pretty grisly way to deal with what is a relatively harmless pocket of blood that has collected between the layers of tissue in a dog’s pinna (ear flap).
The problem is, if I just drain the aural hematoma, it’s almost assuredly coming back, and if we do nothing and the body successfully resorbs the blood clot, the ear may be dramatically disfigured. Plus, that heavy, blood-filled pinna has to be uncomfortable. If I had something like that hanging off of my head, I’d want my doctor to fix it ASAP.
I treat hematomas in the following manner:
1. Make an S-shaped incision over the swollen, blood-filled area (under anesthesia, of course).
2. Remove the clots and liquids that have accumulated there.
3. Place multiple sutures through the ear to hold the tissues together.
4. Leave the incision open so that any new bleeding that occurs can easily drain.
5. Bandage the ear to put pressure on the area and absorb any drainage that does continue.
An E-collar is usually necessary to keep dogs from messing with the bandage and prematurely removing sutures. The bandages can usually be taken off a couple of days after surgery and the sutures removed 10 to 14 days later as long as everything seems to have healed well.
This procedure is almost always effective at permanently tacking together the layers of tissue that make up the pinna so that in the future, blood doesn’t have any space in which to collect.
I recently read about a new method of dealing with aural hematomas that offers an interesting first-line alternative to surgical repair. A veterinarian sedated the dog, drained the hematoma, flushed out the pocket to remove any remaining debris, and then injected the area with the corticosteroid methylprednisolone acetate. If the hematoma was still present a week later, the procedure was repeated. Any hematomas that had not resolved within 15 days of presentation were treated surgically. Eighteen of the nineteen dogs included in the study responded to this less traumatic method of treatment, although six had relapses within three months.
However the hematoma is treated, its cause also must be addressed. Typically, aural hematomas form because a blood vessel has broken within the pinna as a result of vigorous head shaking or ear scratching. Ear infections, ear mite infestations, foreign bodies within the ear canal, and allergies are all common underlying causes of aural hematoma formation.
I’d be willing to try this new way of dealing with aural hematomas, but if the condition did recur, my recommendation would certainly be surgery. I’m interested in what owners think. Would you rather have a definitive surgery up front knowing it may not have been necessary, or try the less invasive method first with the knowledge that surgery may still be required in a few weeks?
Dr. Jennifer Coates
Aural Hematoma in Dogs: Evaluation of a Simplified Medical Treatment Using In Situ Methylprednisolone Acetate. WCVD Capsules. Clinician’s Brief. Nov 2012.