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Ear Hematomas In Your Dog And Cat

Why It Happened - What To Do

Aural Hematoma


Ron Hines DVM PhD

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Ear Hematomas or blood blisters are quite common in floppy-eared dogs such as hounds, spaniels and setters. They occur less frequently in dogs with erect ears and more rarely in cats.

Hematomas can occur at any age. This problem usually occurs when an itchy, infected ear causes the pet to paw and shake its head.

Pawing at the flap of an infected ear canal causes the ear flap to turn red and puffy as small blood vessels swell, and leak fluids. When dogs and cats then shake their heads violently, some of these small blood vessels burst. This allows blood to penetrate between the skin of the inner surface of the ear and the cartilage which forms the ear structure.

The whole process can occur in a matter of hours forming a balloon-like swelling on the inner surface of the ear.

Why Did This Happen To My Pet?

Although you noticed the swelling come up suddenly, the problem that caused it was probably a long time in the making. Over 90% of pets with this problem have a chronic ear infection.

Chronic ear infections have a number of causes.

Ear Mites:

The most common cause in younger pets are ear mite-related. Ear mites are passed down to puppies and kittens from their parents. They can also be transferred from pet to pet by intimate contact. These mites cause intense itching and secondary ear infections. But by the time the problem is noticed, the mites may no longer be present. They thrive in a dry ear canal. When a bacterial or fungal infection develops, most of the mites die off.

Ear Shape and Conformation:

Large, floppy ears snap like bullwhips when the dog shakes it's head. This easily ruptures the delicate blood vessels of the ear allowing blood to seep out and form the hematoma. Gravity also works against drainage of blood and serum from these ears. Floppy ears also keep air from circulating within the ear canal increasing the chance of infection.

Skin Allergies:

Generalized allergic itching in dogs is usually caused by the same airborne allergens that cause sneezing and stuffy nose in humans. The ear canal is lined with modified skin. If the pet's skin itches, its ears will itch also. Dogs with skin allergies traumatize themselves, allowing unhealthy bacteria to invade the skin surface. This causes their musty odor. These same bacteria can also colonize their ear canals.

Stings And Bites:

This is not a common cause of ear hematomas. Although the ear may swell after a sting, it usually goes down within 24 hours. A period of itchiness follows the initial pain and a few high-strung pets will paw the ear violently enough to cause a hematoma.

Foreign Objects In The Ear Canal:

There are a few geographical areas where grass seeds occasionally get into a pet's ear and cause irritation leading to self-trauma and hematoma. Some grass seeds that have caused this problem are foxtail, speargrasses, buzzard grasses, and feathergrasses

Is This Problem Painful to My Pet?

The problems is annoying to your pet, but the hematoma is not painful. Your pet feels like something is clinging to its ear that might be shaken or pawed off. However, the more shaking and pawing, the larger the blood-filled blister becomes.

How Will My Veterinarian Treat This Problem?

Ear surgery is the only procedure that gives consistently good results. No dog or cat has diet from an ear hematoma and it's ear will not drop off. With time, the pet's body will absorb the blood and the ear will shrivel into a permanent cauliflower-like structure.

Surgery To Cure Hematoma:

The ear is composed of three layers. An outer skin with fur, a cartilaginous layer that supports the structure of the ear and an inner skin layer. The cavity that has formed and filled with blood is between the inner skin surface and the cartilage structure.

Ear hematoma surgery has two goals. The first is to remove all the blood that fills the hematoma cavity. This cavity should not be there. It formed as the blood worked its way between the layers. Once the inner skin layer has been cut with a scalpel, the blood will flow out freely. The portions that have clotted are also easily removed. The incision is done while the pet is on a general anesthetic or heavily sedated. The hair of the ear is usually shaven and the ear is scrubbed well with a disinfectant solution.

The second goal is more important and harder. If the skin incision heals before the layers of the ear bond and scar together, the hematoma will re-form. If the bond and scaring are insufficient, it is common for a new hematoma to develop at a later date.

Some veterinarians simply bandage the ear tightly over a tampon or role of gauze and allow it to heal. I do not favor this because of the high number of relapses that occur. A much safer method is to place a number of braided or chromic sutures through the ear in a mattress pattern. This causes permanent scaring similar to that which occurs when your ears are pierced. If these sutures are placed over the entire surface of the ear - hematomas can never again form.

If the ear canal of the unaffected ear is also inflamed, it is wise to suture both ears while the pet is anesthetized because it is common for the second ear to form a hematoma later. Suturing the unaffected ear also prevents the pet from concentrating its post-surgical scratching activity on the damaged ear.

It is best to place these dogs or cats in a large restrictive plastic collar called an Elizabethan collar. This collar prevents them from pawing at their ears while they heal.

How Can I Prevent Hematomas From Happening Again?

If a sufficient number of sutures are placed in the ear, a hematoma should never reform. But the ear canal problem (otitis) that caused it is still there. Treating the otitis is very important. Even if a hematoma never forms again, more serious things can happen. One of them is a middle or inner ear infection affecting your pets balance. These infections can become life-threatening if they are neglected.

Ear infections, like sinus infections in humans rarely ever go away forever. Once the lining of the ear canal has been inflamed for a long period, the diameter of the canal is permanently narrowed and the characteristics and the lining and of the ear wax produced is permanently changes. So your pet's ears will need preventive maintenance and ,perhaps, future treatment from time to time.

There are many medications designed for long-term ear care:

Medications that acidify the ear canal:

These products are helpful in suppressing bacteria and fungus. Many of these contain boric acid or acidic acid.

Medications that contain antibiotics:

These products can be helpful during flare-ups. They should not be used for more than a week or two because the bacteria will become resistant to them. When that happens, they will not work in the future.

Medications that contain corticosteroids:

These medications often also contain antibiotics. They take the heat and pain out of ear infections and decrease swelling. They should not be used continuously over long periods.

Medications that dissolve ear wax (ceruminolytic agents).

These products may not be any more effective than mixtures of vinegar, alcohol and water. I do not recommend cleaning your pets ears with home made brews. It is easy to mix them too strong and scald the ear lining. They can also leaves the ear canals damp and subject to yeast and bacterial growth. It is also very easy to injure your pet's ear canals if you place any object in them.

Mineral oil or unscented baby oil is a safer way to clean your pet's ears. Fill the canals and then gently massage the base of the ears. Let your pet shake its head. Then remove any debris that is brought to the surface with a cotton ball. Repeat the procedure until no more material appears. Bland oils also kill ear mites.

Many of the products that veterinarians sell are "shotgun medications". That is, they contain all of the above ingredients. They work quite well, initially. However, with time, the organisms living in your pet's ear canals get used to them. Try never using more than one or two tubes or bottles of any specific product containing antibiotics. When you run out of it, ask for one with different ingredients. After several different brands and formulations, go back to the original one. In this way, all the products should retain their original effectiveness for your pet.