Aural Hematoma in Dogs: The Surprising Treatments Your Vet Won’t Tell You

If your dog has a swollen, blood-filled ear, it might be suffering from an aural hematoma. This painful condition often results from ear infections or trauma. While surgery is commonly advised, many vets don’t share newer, non-invasive treatments that are cheaper and easier on your pet. Here’s what you need to know about treating aural hematoma in dogs safely and effectively.

A surprising fact: only about 0.25% of dogs need treatment for aural hematomas yearly. These painful blood-filled swellings that appear on a dog’s ear flap can permanently deform into a “cauliflower ear” without proper treatment.

Bull Terriers and Golden Retrievers face higher risks of developing this condition. Your dog might be vulnerable, especially when they shake their head or scratch their ears too much. Research shows that 54.6% of aural hematoma cases happen with ear infections. Dogs that have V-shaped drop and semi-erect ears are more likely to develop this issue than those with pendulous ears.

Treatment choices range from needle aspiration to surgery, each with different approaches and costs. The outlook remains positive when veterinarians address the root causes properly. This piece explores the newest surgical options, possible home treatments, and typical costs to help you choose the best care plan for your four-legged companion.

Understanding Aural Hematoma in Dogs

The pinna (ear flap) in dogs is a vital part that helps them detect sound and maintain balance. This thin, cartilaginous structure can develop a painful condition called an aural hematoma – a blood-filled pocket that forms when blood vessels break inside the ear.

What happens inside the ear flap

A dog’s ear flap has a simple structure: a layer of cartilage between two skin layers. Blood vessels lie just under the skin and create a delicate network throughout the pinna. These blood vessels can break and separate the auricular cartilage from the skin during an aural hematoma.

- Advertisement -

Blood pools in this new space and creates what vets call a “water balloon within the earflap”. The buildup leads to swelling that feels soft and spongy. The swollen area feels warm at first, looks red, and causes your pet obvious pain.

Aural hematomas can vary in size based on how badly the vessels are damaged and how long they’ve been there. Some stay small, about the size of a grape, while others can grow as big as an orange. You’ll usually see the swelling most clearly on the inner surface of the pinna where it curves inward.

The blood breaks down into serum and clot parts over 10 days to 6 weeks if left untreated. Your pet’s body will eventually reabsorb this fluid, but the healing creates fibrosis – scarring that makes the ear thick and misshapen. Vets call this “cauliflower ear” because the pinna gets a wrinkled, irregular look.

The condition follows these steps:

1. Initial trauma causes blood vessel rupture
2. Blood pools between cartilage and skin layers
3. Swelling develops, creating a fluid-filled pocket
4. Without treatment, fibrosis occurs during healing
5. Contraction of fibrotic tissue results in permanent deformation

Early-stage hematomas contain a distinct sero-hemorrhagic, fibrotic-rich fluid when aspirated. This unique makeup helps vets distinguish aural hematomas from other ear problems.

Why it’s more common in dogs than cats

Dogs get aural hematomas by a lot more often than cats. Several reasons explain this difference.

The ear structure plays a big role. Many dogs have larger, drooping ears that hang far from their head, unlike cats’ smaller, upright ears. Dogs’ ear flaps hit their skull harder when they shake their heads, which makes blood vessel damage more likely.

The root causes of ear irritation differ between these pets. Dogs’ ear problems come from hypersensitivity reactions – mainly atopy and food allergies – in about 43% of otitis cases. These allergies make them itch intensely and shake their heads hard. Cats’ otitis comes from Otodectes cyanotis mites about 50% of the time, which causes less violent head shaking.

Some dog breeds get these hematomas more often than others. Research shows Labrador Retrievers and Golden Retrievers top the list of affected dogs. Older dogs with floppy ears also show up more in vet clinics with this condition.

The problem usually starts with ear canal irritation – often from an infection, allergy, foreign object, or parasites. The dog scratches too much or shakes its head violently. This makes the thin skin slide across the ear cartilage and breaks blood vessels.

Research points to more than just trauma as a cause. Some studies suggest immune system involvement might weaken ear cartilage. Scientists haven’t fully figured out the exact process yet, and multiple factors likely play a role.

Common Causes and Risk Factors

Aural hematomas don’t just appear without a reason. Learning about what causes these painful ear swellings helps us prevent and treat them better.

Head shaking and ear scratching

Dogs develop aural hematomas when they shake their heads too much or scratch their ears intensely. These actions damage the delicate tissues in the ear flap. The ear flap slaps against the dog’s skull when they shake violently, which traumatizes the blood vessels. Blood vessels rupture and hemorrhagic fluid builds up between the skin and cartilage.

Dogs shake their heads for several reasons:

• Foreign objects (dirt, grass awns, or insects) trapped in the ear canal
• Traumatic injuries like bite wounds or bee stings
• Parasitic infestations such as ear mites (though these are rare in dogs)
• Underlying infections or allergic conditions

Vets used to think head shaking alone caused these hematomas. Recent research points to something more complex. A new “cartilage-folding hypothesis” suggests that the ear flap folds repeatedly along cartilage lines. This creates chronic damage and weakness that ended up causing bleeding episodes. This theory explains why some ear shapes are more likely to develop problems whatever the head-shaking behavior.

Otitis externa and allergic skin disease

Ear infections are the biggest reason behind aural hematoma formation. Otitis externa (outer ear inflammation) shows up in 54.6% of aural hematoma cases. This strong connection shows why treating the underlying ear infection is vital for successful treatment.

Allergic skin conditions also play a big part, showing up in 11.3% of aural hematoma cases. Dogs with food allergies or atopic dermatitis have a higher risk because these conditions cause chronic inflammation and intense itching.

Hypersensitivity reactions in dogs—mostly atopy and food-related allergies—cause about 43% of all otitis cases. These allergic responses inflame the ear canal. Dogs then scratch and shake their heads because of the intense itching.

Treating these underlying conditions becomes essential not just to fix the current problem but to stop it from coming back. Untreated ear infections or allergies mean aural hematomas will likely return, even if the first hematoma heals well.

Breed and ear shape predispositions

Studies have found surprising breed patterns that challenge old ideas about ear shape and hematoma risk. Dogs with V-shaped drop ears and semi-erect ears have the highest risk of developing aural hematomas, not the floppy-eared breeds as once thought.

Dogs with V-shaped drop ears have 2.0 times the risk compared to breeds with erect ears. Semi-erect eared dogs face 1.6 times the risk. Dogs with floppy ears actually show lower risk (0.6 times compared to erect-eared breeds).

These breeds face the highest risk:

• Bull Terrier (7.4 times the risk of crossbred dogs)
• Saint Bernard (7.3 times the risk)
• French Bulldog (7.0 times the risk)
• Irish Staffordshire Bull Terrier (5.5 times the risk)
• English Bull Terrier (5.4 times the risk)
• Golden Retriever (4.6 times the risk)

Age and body weight affect risk by a lot. Large dogs over 40kg have 8.5 times the risk compared to dogs under 10kg. Risk grows with age, and peaks in dogs 10-12 years old who have 5.6 times higher risk than dogs under one year.

This age-related pattern suggests that cartilage changes from aging might contribute to cartilage disruption and hematoma formation. Research now shows that most aural hematomas occur within fractures and tears of the ear cartilage rather than just between skin layers.

Owners of high-risk breeds should watch for early signs and monitor their dogs closely. These steps help prevent the permanent “cauliflower ear” deformity that happens when aural hematomas go untreated.

Medical Management Options for Early Cases

Medical professionals prefer non-surgical treatments for aural hematomas when caught early. These options work well and cost less while causing minimal discomfort. Smaller or early-stage hematomas respond best to medical management. Veterinarians report excellent cosmetic results with these approaches.

Needle aspiration with triamcinolone injection

Vets often start with needle aspiration and steroid injection to treat aural hematomas in dogs. This simple procedure drains the blood-filled pocket with a 20-23 gage needle. The vet then injects a corticosteroid into the empty space.

The procedure works like this:

1. The vet cleans and disinfects the affected ear
2. They insert a 23- or 25-gage needle (or butterfly needle) into the hematoma
3. Blood and serum drain completely
4. The vet injects triamcinolone through the same needle

The amount of triamcinolone depends on the hematoma’s size. Vets use 0.5-2mg (0.05-0.20mL) of triamcinolone acetonide. Large hematomas that affect more than a third of the pinna need 2mg. Smaller ones get 0.5-1mg. Toy breeds should get no more than 1mg whatever the hematoma’s size.

Dogs might need weekly treatments for 1-3 weeks. Vets often add oral steroids to get better results. A study showed that 33% of cases came back within the first month after treatment. This happened mostly with bigger hematomas.

Oral corticosteroids: prednisone and prednisolone

Oral corticosteroids alone can treat aural hematomas without any needles. Recent research shows good results using just prednisolone or prednisone.

A newer study, published by researchers treating 24 dogs with oral prednisolone, showed great results. They gave 1mg/kg/day for 14 days, then 0.5mg/kg/day for another 14 days. The 28-day treatment helped 21 of 24 dogs (87.5%). These dogs’ conditions improved by at least 80%, and their ear thickness went down by half.

The treatment plan looks like this:

• First 14 days: 1mg/kg daily
• Next 14 days: 0.5mg/kg daily
• Doctors might lower the dose after 7 days if side effects get too strong

Steroids reduce inflammation in the pinna. This stops fluid from separating skin from cartilage. Common side effects include:

• Dogs drink and pee more
• More panting
• Bigger appetite
• Some dogs might get aggressive
• Stomach problems might occur

Side effects go away as the medication tapers off. Dogs should never take steroids with NSAIDs or aspirin.

Platelet-rich plasma (PRP) as a non-surgical option

PRP offers an innovative way to treat dog ear hematomas. This blood product contains concentrated platelets (3-5 times normal levels) and growth factors that help healing.

Making PRP involves:

1. Taking about 20mL of the dog’s blood
2. Using a centrifuge to concentrate platelets
3. Activating platelets so they release growth factors

The treatment happens this way:

1. The vet drains the hematoma using 20G needles
2. They inject 1-2mL of PRP through the same spot
3. Weekly checkups follow

PRP helps in several ways:

• Makes cells grow faster
• Reduces inflammation
• Helps new blood vessels form
• Speeds up tissue healing

PRP tackles both the hematoma and inflammation at once. Studies show excellent results – all treated cases healed without bad scarring or ear deformities. One study of 15 dogs showed healing took about 15.8 days with one treatment. Dogs needing two treatments healed in 24 days.

PRP has almost no side effects. If the problem comes back (which happened in about 30% of cases after 7 days), a second PRP treatment usually fixes it for good.

The key to preventing these problems from coming back lies in treating any underlying ear disease.

Surgical Techniques for Persistent or Large Hematomas

Dogs with persistent aural hematomas that don’t respond to medical treatments or large hematomas need surgical intervention. These procedures are a great way to get lasting results when done right. Let’s get into the most effective surgical approaches vets use today.

Linear incision with mattress sutures

Vets commonly use a surgical technique that creates an incision along the hematoma with strategic suture placement. I make either a longitudinal or S-shaped incision on the concave (inner) surface of the ear flap. The S-shaped incision works better especially when you have to prevent cosmetic deformities from contracture during healing.

After making the incision with a #15 scalpel blade, here are the steps I follow:

• Drain all blood and fluid from the hematoma cavity
• Clean really well with sterile saline
• Place nonabsorbable monofilament sutures (3-0 or 4-0 nylon) about 8-10mm apart
• Use either partial or full-thickness mattress patterns
• Leave the incision slightly open so drainage can continue

We placed mattress sutures parallel to the ear’s long axis to avoid damaging auricular blood vessels that could cause avascular necrosis. Dogs with really swollen pinnae need stenting of the sutures with soft material like latex tubing to prevent them from embedding in the skin.

Punch biopsy and CO2 laser fenestration

Punch biopsy technique gives excellent results with minimal scarring. I use 4-6mm dermal punches based on the dog’s size to create multiple small holes through the skin and one layer of cartilage on the medial aspect of the pinna. These punches go about 0.5-1cm apart across the hematoma. Each punch opening gets secured with monofilament sutures in a simple interrupted pattern.

Research shows this technique creates great cosmetic results with minimal scar tissue. Pet owners who care about their dog’s ear appearance after healing really appreciate this approach.

CO2 laser fenestration creates multiple small (1-2mm) openings over the hematoma surface, plus one larger (1cm) opening for primary drainage. The laser drains blood and encourages adhesions between tissue layers. A study of 10 ears treated with CO2 laser showed complete resolution in all cases. Owners rated the cosmetic results as excellent in three ears, good in five, and fair in two.

Closed suction and Penrose drain placement

Drain placement offers a less invasive option in cases where the ear’s appearance is vital. Closed-suction drains use negative pressure to remove fluid continuously while collapsing the dead space, which helps tissue layers stick together. These systems help measure fluid production but can be tricky to maintain.

Penrose drains offer simpler passive drainage. The process involves small stab incisions at both ends of the hematoma, cleaning out the cavity, then threading a 1/4″ Penrose drain through the hematoma. Both ends get secured with simple interrupted sutures.

A study of 53 cases treated with Penrose drainage showed recurrence in only 15% of animals, which were successfully managed through revision drainage. However, mild pinna thickening or poor ear carriage occurred in 34% of animals due to either chronic hematoma or longer drain placement time.

The success of any surgical approach depends on good post-operative care, including bandaging, preventing infection, and fixing the underlying cause to stop recurrence.

Post-Treatment Care and Recovery Timeline

Your dog’s recovery from aural hematoma depends heavily on proper aftercare. Most pets heal within two weeks when they get the right post-treatment care.

Bandaging and Elizabethan collar use

Your veterinarian will put a protective bandage over your dog’s ear and head right after treatment. The bandage helps apply gentle pressure, reduces trauma, and keeps the surgical site safe. Traditional surgical approaches need bandaging that includes both the head and affected pinna. Vets use cast padding, absorbent stretch conforming gauze, and self-adherent materials.

Elastic stockinette or custom-sized head wraps make replacement easier and let vets check sutures or drains without much trouble. These bandages stay in place for 1-2 weeks after drainage.

The Elizabethan collar (E-collar) is crucial to recovery. This device stops your dog from scratching the surgical site that could lead to inflammation, bleeding, loose sutures, or infection. Your dog must wear the E-collar at all times during recovery, even with bandages on.

Cleaning protocols and suture removal timing

Your vet will tell you how to keep the surgical site clean. The process usually involves:

• Daily cleaning with diluted chlorhexidine or sterile saline on a gauze sponge
• Gentle removal of clots and debris from incision sites
• Cleaning around the incision with small amounts of hydrogen peroxide if recommended

Vets remove drainage tubes or bandages after 3-14 days based on healing progress. Suture removal happens after 10-14 days if healing goes well. Notwithstanding that, severe cases might need some or all sutures to stay for up to three extra weeks.

Pain management and antibiotics

Your dog will feel some discomfort in the first few days after surgery. Vets usually prescribe:

• Oral NSAIDs like etodolac (10-15 mg/kg once daily) or carprofen (2.2 mg/kg twice daily) to manage pain and inflammation
• Opioid options including butorphanol (0.5-1 mg/kg three to four times daily) or tramadol (1-4 mg/kg two or three times daily)

Vets may prescribe antibiotics based on culture results or choose them to target common skin bacteria. Popular choices are amoxicillin-clavulanic acid (12.5 mg/kg twice daily) or cephalexin (22-35 mg/kg two to three times daily).

Note that treating any underlying ear disease is vital during recovery to stop it from coming back. Regular check-ups help your vet track healing progress and fix issues before they turn into complications.

Complications, Recurrence, and Cosmetic Outcomes

Your dog’s ears can develop permanent marks if aural hematomas don’t receive proper treatment. A clear picture of what it all means will help you know what to expect from different treatments.

Cauliflower ear and cartilage fibrosis

Dogs that don’t get proper treatment for aural hematomas usually develop a deformity known as “cauliflower ear.” The process follows a predictable path – fibrin forms and leads to fibrosis. The pinna thickens and contracts, which creates an irregular, crumpled look. The body reabsorbs leaked fluid during healing and produces fibrosis inside the pinna. Fibrotic tissues contract and create the distinctive folds we often see.

These untreated hematomas do more than just affect appearance – they cause real pain. The fluid-filled earflap becomes heavy and puts extra pressure on the ear. Chronic inflammation damages nearby tissues. Severe deformities can block the ear canal and create ongoing ear problems.

Recurrence due to untreated otitis

Hematomas will likely come back if you treat them without fixing what caused them. Dogs have good to excellent chances of recovery when vets address the root cause. The condition often returns, especially in cases of untreated otitis.

A vet should really check both ears after finding a hematoma in one. About 31% of dogs get multiple or new aural hematomas. Golden Retrievers and Labrador Retrievers run higher risks of developing new hematomas. Dogs with allergic dermatitis face similar risks.

Owner satisfaction and cosmetic results

Medical management gives excellent cosmetic results, while surgical approaches tend to work well too. Pet owners rated their satisfaction as excellent in 16% of cases, good in 56%, average in 26%, and poor in just 1.5% of cases.

Different surgical techniques give different cosmetic results. CO2 laser treatments earned excellent ratings for three ears, good for five ears, and fair for two ears. Polycaprolactone splint application showed impressive results – 90% of patients had no auricular changes after surgery.

Most problems come from delayed healing that affects appearance, hematomas that return because the root cause wasn’t fixed, or pinna damage from poorly placed sutures. Ears might thicken or wrinkle even with proper treatment. Vets should explain these possibilities to pet owners before starting treatment.

Conclusion

Aural hematomas are a common and manageable condition many dog owners face. This piece explores how these blood-filled swellings develop between the cartilage and skin of your dog’s ear flap. Dogs often develop them from shaking their heads or scratching too much because of ear problems.

Some breeds are at higher risk than others. Bull Terriers, Saint Bernards, and Golden Retrievers are by a lot more likely to develop these painful ear swellings. Dogs with V-shaped drop ears and semi-erect ears have higher odds compared to other ear types.

Treatment options range from simple procedures to surgery based on severity. Needle aspiration with triamcinolone injection is a great first option to treat smaller hematomas. Oral corticosteroids are a non-invasive alternative that work well, with success rates up to 87.5%. Platelet-rich plasma therapy has become an innovative option that gets more and thus encourages more natural healing without major side effects.

Large or stubborn hematomas need surgery. Linear incisions with mattress sutures are still the best approach. Punch biopsy and CO2 laser fenestration give excellent cosmetic results for owners concerned about appearance. Drain placement is another good option that has low chances of coming back.

Recovery success depends heavily on post-treatment care. Your dog needs proper bandaging, consistent E-collar use, and careful cleaning. Pain management usually continues for several days after treatment. Antibiotics might be needed if there’s risk of infection.

The biggest problem is treating why it happens in the first place. The hematoma will likely return if you don’t address ear infections or allergies, whatever treatment you choose.

Dogs with aural hematomas have great outcomes when both the swelling and its cause get proper treatment. Some ear thickening might happen even with the right treatment, but most owners are happy with how their pet’s ears look after vet care.

New ways to treat aural hematomas keep emerging. Quick action and talking to your vet as soon as you notice ear swelling will help your furry friend get the best possible outcome.

FAQs