A hematoma is an accumulation of blood and blood clots in a localized area. Ear hematomas are a common problem that affects dogs and cats. The ear is supplied with blood through a central artery that runs up the back portion of the “floppy” portion (pinna) of the ear. Frequently this blood vessel may be damaged by trauma and begin to bleed under the skin. This can occur from bite wounds, play chewing on the ear from other pets, banging the ear with a foot during itching or from shaking the ears violently in response to a foreign body in the ear such as a foxtail. The ear is constructed like a sandwich made of two layers of skin with cartilage in the center. When a blood vessel on the ear is damaged, it leaks into the space between the cartilage and the skin. The blood is being pumped into the ear under pressure and as it continues to enter the ear, its force pulls the skin off the cartilage. With time, the blood pocket grows until the pressure in the pocket is high enough to stop the blood from pumping into it. It is not uncommon for a hematoma to appear within a matter of hours.
How can our veterinarians treat a Hematoma?
Throughout the years many different approaches have been taken to treat hematomas. We know that simple drainage of the hematoma with a needle almost never works in clearing up the problem. This is due to the fact that the blood simple fills up the space once it has been drained. The most reliable treatment for this problem in our hands is surgery. During this procedure, your pet will be anesthetized. Then the ears will be thoroughly checked for infections or foreign materials stuck in them. Next, the hematoma will be opened along its length. The blood and clots are removed from the cavity. Then the cartilage is roughened with a scalpel blade to help allow the skin to stick back to it (much in the same way you sand a metal surface before painting it). Finally, the ear is sewn back together with stitches that go through both sides of the ears (similar to baseball glove stitching). The ear is then wrapped around the head for a period of two weeks to allow the skin and cartilage to heal back together. Generally we check the progress of the healing at one week and remove the sutures after two weeks. During that time, your pet will have to wear an Elizabethan protection collar to prevent damage to the surgical site. We will dispense antibiotics for you to administer at home.
What is the prognosis for recovery from a hematoma?
With appropriate surgical treatment and aftercare, the prognosis is very good in about 90% of the cases. Ten percent (10%) of the cases may have recurrence of the hematoma despite our best efforts. Frequently, the ear may develop scar tissue, which can cause the ear to become slightly disfigured. This is unpredictable and unavoidable. If there is recurrence of the hematoma during the first month post operatively, we will repeat the surgery at a 50% discount from the first surgery.
What can I expect in the future?
Pets that have hematomas once are prone to have them again. Many of these pets are in environments that promote the formation of hematomas due to the presence of other pets that bite them on the ears, or foxtails that get in the ears. Some of these pets have allergies (to pollens and weeds or to their food) that cause them to continually scratch their ears. In order to reduce the chances of recurrence, we encourage you to observe your pet regularly. Any excessive ear scratching or head shaking should be a signal to bring them in for evaluation immediately. Our veterinary team recommends weekly ear cleaning to help prevent infections. Please ask to view an instructional video that will teach you how to care for your pets ears.