Affected Animals:
Dogs or cats

Overview: When a dog has a painful or itchy ear, it may swing its head about or scratch its ear to alleviate the discomfort. This behavior can cause trauma to the dog's pinna, or earflap, that can add even more irritation to the ear.

An aural, or ear, hematoma is a swelling in the earflap resulting from an injury. When the tiny blood vessels in the ear's cartilage rupture and bleed, the hematoma -- a firm, fluid-filled swelling -- will appear within the dog's ear. The examining veterinarian will be able to treat this hematoma by any of several procedures that drain the fluid. Minor surgery may be required.

Clinical Signs:
The pinna of the ear will have a soft, fluid filled, fixed swelling on the inside or concave side that can vary in size. The swelling may be warm to the touch. Usually there is an underlying allergy or ear disease, called otitis, that can have many different causes.

Symptoms:
The flap of the ear will have a firm swelling on its inside that may be red and warm to the touch. The swelling can sometimes be at the base of the ear. Many dogs with this condition have a history of ear problems or infections.

Description:
An ear hematoma is a firm, fluid-filled, swollen mass that is visible on the inside of the earflap. Usually, a dog will get an ear hematoma from shaking its head or scratching its ear because it has an underlying allergy or ear disease.

Diagnosis:
The veterinarian will be able to diagnose an aural hematoma upon observation of a swelling in the pinna or flap of the ear. An aspirate, which involves withdrawing fluid from the swollen area into a syringe and looking at it under a microscope, may be performed during the examination. The presence of blood in this fluid will confirm an aural hematoma.

Prognosis:
The prognosis is excellent for the correction of the hematoma. However, unless the underlying cause of the irritation to the ears is controlled, it is possible that another hematoma will develop at a later time.

Transmission or Cause:
The cause is due most commonly to self-inflicted trauma such as scratching and shaking of the head. This behavior causes the tiny blood vessels of the ear to rupture and hemorrhage under the skin forming a pocket of blood within the earflap. Allergies, an infection or inflammation of the ear, the presence of a foreign body, or ear parasites all cause pain, itchiness or irritation that a dog would seek to alleviate by head shaking or scratching.

Treatment: There are several procedures for treating aural hematomas; the veterinarian's approach to the problem will depend on the severity of the dog's condition. One method for correction -- which requires that the dog be sedated lightly -- is placing a drain, called a teat cannula, securely into the tip of the ear and allowing the ear to drain from the cannula for a period of three weeks. The ear eventually seals back together as the owner "milks the fluid" from the hematoma through the cannula each day.

Another method, performed under general anesthesia, involves making a surgical incision into the swelling on the ear, allowing the fluid to drain. Then, multiple sutures will be stitched into the ear to seal it back together. Approximately seven to 10 days following the procedure, after the ear has drained and healed fully, the sutures will be removed.

Failure to treat a hematoma can lead to enlargement of the swelling to encompass the entire earflap. Also, scar tissue formation within the hematoma will result in a severely wrinkled, thickened earflap that will predispose the dog to further ear problems.

Prevention:
To help prevent aural hematoma formation, it is essential that the veterinarian determine what is causing the irritation that is making the dog shake its head or scratch its ears. A thorough examination of the ears will be necessary. The veterinarian may use an otoscope to look down into the ear canals to determine the presence of a foreign body or inflammation in the ears. Ear swabs often are taken and the material is evaluated under the microscope to look for causes of otitis such as yeast, ear mites, or bacteria. Allergies also can cause irritation to the ears. Wounds of the pinna or earflap should be treated to prevent trauma to the ear caused by shaking and scratching.