“Can you hear me now?”
Sambucca Moroney is a 2 year old mixed breed dog who presented to the Rt 516 Animal Hospital for what the owner feared was a large tumor in his right ear which developed overnight. His exam revealed a young healthy dog with a right ear that was swollen approximately 4 times the normal size. It felt much like a filled water balloon and was warm and painful to the touch. There was also a pungent odor emanating from the inner ear canal. The owner also reported that Sambucca had recently been rubbing his head along the carpeted floor and pawing at his ears.
Much to the relief of his owner, Sambucca‘s ear was not a tumor but instead was a condition known as an aural hematoma. Aural means “pertaining to the ear or hearing” and a hematoma is a “pocket or swelling of blood”; basically, Sambucca had a large blood blister in his ear flap. Aural hematomas can occur in dogs or cats who sustain injuries to the capillaries or blood vessels located between the 2 flaps of cartilage which make up the outer ear. The injury can be secondary to rough play, a traumatic injury such as a bite, or most commonly as sequela to an ear infection, also known as otitis.
Pets can develop ear infections from bacteria, yeast, ear mites, or a combination of these. The infectious agents can be due to allergies, excessive hair in the ears, inadequately dried ears after bathing or swimming, or due to lack of circulation in pendulous, heavy-eared breeds. Otitis tends to be very pruritic (itchy) and the pet’s shaking, scratching, rubbing and pawing can cause the hematoma to form. It can occur in either ear (even an un-infected one) or both and can involve a small portion or the entire pinna (outer ear flap).
Addressing large aural hematomas consists of surgically correcting the ear swelling, identifying the underlying cause, and treating. There are many variations of surgical technique. The overall goal is to release the blood trapped in the ear’s pocket and to tack the two sides back together. Sambucca was taken to surgery and an S-shaped incision was made on the inner surface of his ear flap. After flushing the fluid and clots out, many strategically placed stitches are used to suture the 2 layers back. A bandage was placed on his head and the stitches were removed after 3 weeks. During that time, Sambucca’s owner treated his bacterial ear infection with the prescribed antibiotics and ear cleaner. At a 1 month check-up, Sambucca’s ear looked great and the infection was resolved.
Some owners choose not to surgically correct aural hematomas. With smaller hematomas this is acceptable as long as the ear infection is treated and a pain medication is provided. However, the smaller hematomas can sometimes still grow into larger ones which need surgery. With large unaddressed hematomas, the fluid will eventually reabsorb but will result in a deformed and scarred ear often referred to as a “cauliflower ear”. Surgical intervention is preferable because it alleviates the discomfort immediately and is more cosmetic in appearance.
If you notice your pet scratching at its ear or shaking its head, take him to your veterinarian to check for otitis. Delaying this can unfortunately result in aural hematoma formation and therefore a much larger problem than initially anticipated.