An ear hematoma is a pocket of blood within the flap of the ear. It is an occasional problem of dogs and cats. It occurs when the blood vessels in the flap of the ear break or become leaky.
There are plenty of theories, but we do not know what causes ear hematomas. Some patients that get hematomas have inflamed, infected ears and some don't; ear infections are a very common problem in dogs and the vast majority of them do not get hematomas. Some patients that get ear hematomas are shaking their heads but most are not. Some patients with ear hematomas have other skin diseases that might predispose them to the problem.
There are almost as many treatment options as there are veterinarians. These options range from doing nothing to medicine to surgery. It is worth considering the pro and cons of a few of these options:
DOING NOTHING: Eventually the fluid will reabsorb; this may take a week or it may take several months, but it will reabsorb. There might be a slightly greater risk that the ear will crumple a bit (cauliflower ear) as it heals compared with surgery, but, if this occurs, it is a cosmetic problem and not a health concern.
ASPIRATING (REMOVING THE CONTENTS WITH A SYRINGE AND NEEDLE): There is the immediate gratification of flattening the hematoma. Sometimes the blood has clotted or partially clotted and it cannot be aspirated. Aspiration does not eliminate the pocket, and it has a tendancy to fill again. It will ultimately take just as short or long a time to heal as if nothing was done. Introducing infection into the pocket and turning the sterile hematoma into an infected abscess is a risk, even with careful technique, and even with placing the patient on antibiotics after aspirating. If an abscess occurs it has to be treated surgically. We do not commonly choose this treatment, but for some patients it makes sense.
SURGERY (MANY DIFFERENT VERSIONS): The hematoma is immediately resolved because the pocket is eliminated, and the chance of it refilling is very slim. Any type of ear hematoma surgery requires general anesthesia, and is somewhat costly. Patients are usually uncomfortable for a week or two afterward, even with proper pain medication, and some of them require bandaging. Some patients heal very well, only to have the hematoma recurr.
A SPECIAL NOTE ABOUT LASER THERAPY: Laser therapy is the application of laser light to body tissues. It promotes healing in a variety of ways. The therapy requires a special laser instrument. It is not painful (human patients typically report it feels good, and many dogs and cats act as though it does) and each session only takes a few minutes. It appears that laser therapy will speed the resolution of ear hematomas for some patients.
We do not recommend surgery or aspirating for most patients; we reserve these treatments for patients that are significantly uncomfortable because of the hematoma.
For most patients we start medical treatment with anti-inflammatory medication and laser therapy, and without surgery or aspiration. If the pet becomes uncomfortable during this treatment we will re-consider surgery or aspiration.
We evaluate every patient individually; some pets benefit from diagnostic tests for and treatment of underlying skin problems.
EXPECTATIONS AND PROGNOSIS
It has been many years since we have operated on an ear hematoma, so, in our experience, the chance of healing without surgery is excellent.
Statistically, across veterinary medicine (not just YVC) there is a small risk that an ear hematoma will re-occur days, weeks, months, or years later.
Yarmouth Veterinary Center