Ear problems in dogs- Hematoma


Hematoma of ear

Question: Dr. Mike I have a Dob/Shephard mix who is 13. She has cronic ear problems.

I do wash with peroxide solution and medicate with otomax. I infection is allergy related.

She will not go into a car or even out of the yard without having a near panic attact. We cannot get her to a vet.

She has developed an ear hemotobin (I call it pillow ear) I know surgery is recommended to release the blood buildup but the stress of going to the vet maybe too much for her.

Is there anything I can do to releave the ear, warm or cold compresses . Will the blood re-absorbed back into the system?

Answer: D-

There are two major problems with ear hematomas. 1) They seem to hurt pretty badly in some cases. In others this doesn't appear to be true. 2) They cause scarring when they heal that can crumple the ear. This is not just a cosmetic issue because if the crumpling obstructs or alters the ear canal it can lead to a situation in which ear infections are very hard to control.

So we recommend surgery to relieve the pain as quickly as possible when the ear seems to hurt a great deal and when the hematoma is large enough that it really looks like it won't heal without significant scarring, even with medical treatment.

We are perfectly willing to treat hematomas medically if neither of these things is a problem.

We treat any ear infection that is present (many times there is not an ear infection). We put the dog on prednisone (other corticosteroids will work) for 30 days, or until the ear heals, whichever happens first. We use about 0.5mg/kg of prednisone once a day for 5 to 7 days, then every other day until 2 or 3 doses after the ear has healed. This usually is sufficient to prevent severe crumpling of the ear but some scarring or crumpling may occur, but only enough to be a cosmetic problem. The blood is reabsorbed by the dog's body.

The major problem with medical treatment is that about 10 to 20% of the hematomas will recur later with medical treatment. The recurrence rate is much less with surgery. We have repeated the medical treatment two or three times in a few cases and it has continued to control the scarring each time, so it can be repeated if necessary.

Some vets have success putting a teat canula or other drainage device into a small puncture wound in the ear and then having the client massage the fluid out of the ear daily. This has not been very successful for us, but I know veterinarians who claim to have good success doing this and I have no reason at all to doubt their claims. It just hasn't worked well for us.

Mike Richards, DVM 9/14/2001

Puffy ear in Golden Retriever - Hematoma

Question: Dear Dr. Mike:

My dog Frisco, a 9 ½ year old sf golden retriever, has a puffy right ear flap from the middle of the ear down towards the end. It is not hard or lumpy, but an even puffiness. The swelling seems to be on the outside of the ear, versus the inside. The inside looks completely normal. She has no pain and it isn't bothering her, but it is noticeably thicker that the left ear flap.

Should I be concerned? Vanessa

Answer: Vanessa-

This puffiness is most likely to be due to a hematoma in this ear flap. Hematomas are collections of blood. They are common in ears because there doesn't seem to be anything in the ear to generate enough pressure to stop bleeding until the ear swells enough with blood. Ear infections, ear mites, fly bite irritation, mosquito bites, allergies and immune mediated diseases have all been implicated as underlying causes for this problem. Anything that causes the dog to flap its ears can make this happen and it appears to occur spontaneously in a number of dogs.

Small hematomas may heal without a problem but any hematoma has the potential to cause scarring of the ear, which can result in a crumpled looking ear. If the scarring is severe it can partially obstruct the ear canal, which can be a serious complication if ear infections occur. Large hematomas should be treated surgically or medically.

Surgery usually involves making an incision on the inner aspect of the ear and draining the blood, removing any blood clots that are left and then suturing the two sides of the ear together by putting sutures all the way through it, in a "mattress" pattern. Sometimes it is possible just to place a drain and massage the blood out of the ear daily until it heals.

Medical treatment is accomplished by giving a cortisone product, such as prednisone, to control the itching and scarring and waiting for the ear to heal, which might take a month or more. It may be necessary to use an antibiotic at the same time and it is always important to identify and eliminate any underlying cause, such as fleas or ear mites.

It would be a good idea to let your vet take a look at this and help you decide which form of treatment is best.

Mike Richards, DVM 7/4/2000

