Ear infections are rough. They are itchy, painful, smelly, and oftentimes recurrent. My heart goes out to those dogs who are plagued by constant ear infections. 
Today we are going to take those ear infections one step further. What happens when your dog or cat is constantly shaking his head? Ear hematomas are a common side effect of ear infections. So, let’s talk about what they look like, how they happen, and what can be done to cure them.
A very common reason owners call to make an appointment with me is when their dog or cat’s ear has swelled and looks and feels like a pillow.
When the pet is brought in for an examination, I can tell just by the look and feel of the ear pinna (flap) that I am dealing with a hematoma. A hematoma is a pocket of blood. That nice flat ear flap is now swollen at just the tip, half of the ear, or sometimes the entire ear is affected.
Let’s step back for a minute and discuss some anatomy. How on earth would a dog or cat’s ear flap fill with blood?
As you know, we have blood vessels that travel all throughout the body, taking oxygen and nutrients to all of our tissues. Some blood vessels are small, and some are very large. The dog and cat ear has a pretty large vessel that runs from the base of the head to the tip of the ear. Off of the vessel are many smaller tributaries traveling to the rest of the ear flap.
The most common underlying cause of an ear hematoma is an ear infection. The constant shaking and scratching at the ears can lead to rupture of the large vessel. This leads to a leak, causing the ear pinna to fill with blood.
Blood will typically fill the affected portion of the ear within hours. Another cause of ear hematomas is an allergic reaction to an insect bite. This, too, can cause the whole face to be itchy, leading to head shaking and scratching. Finally, another common cause of ear hematomas is trauma. If a dog shakes his head too close to the wall, the ear may hit the wall leading to vessel rupture. Or, if your dog or cat is bitten in the ear, rupture of this vessel is also quite common.
So, your Veterinarian has diagnosed your dog or cat with an ear hematoma. What can be done to fix it? There are a couple methods in which we can fix this. Prior to addressing the hematoma, if there is an underlying infection in the ear, it must be treated. First, to fix the hematoma, we can “do nothing.”
Yep, it is definitely not the preferred method, but over the course of a month or so the ear will reabsorb the blood and the hematoma will be gone. The big downfall of this method is the appearance of the ear afterward. As the blood in the ear pinna begins to clot, it forms fibrous tissue, which leads to adhesions inside the pinna, which dramatically crinkles the ear pinna as it is healing. If the hematoma extends down close enough to the ear canal, this can block oxygen passage into the ear, leading to lifelong ear infections and debris accumulation.
Second, a cannula can be placed in the ear pinna. Some Veterinarians love this method, but I honestly despise it.
Basically, a teat cannula that would be used in a cow for mastitis, is inserted into the ear pinna with the capped end near the ear tip. You, as the pet owner, would need to uncap it and squeeze blood out of the ear pinna daily until the cannula is removed. No one enjoys doing this - it’s messy, and if the cap comes off and your dog shakes his head, there is blood EVERYWHERE. And, there’s a high chance for failure with this method.
The best option for correction of the hematoma is surgical repair. This method gives the best chance at correction with only one procedure, in the shortest amount of time, with the best appearance afterward. Once your pet is anesthetized, your Veterinarian will make a vertical incision down the inside portion of the ear flap over the length of the hematoma.
We flush out all of the blood and fibrin material from the pocket and then put in many sutures, through both surfaces of the ear pinna, to tack them back together. A very small opening is left along the length of the incision to allow any more blood to escape the area while the incision is healing over the next two to three weeks. I always place a head bandage for the first 24-36 hours after the procedure, and the pet must wear an e-collar until those sutures are removed. This prevents self-trauma and keeps the ear incision as clean as possible. While the ear may not look “perfect” afterward, some look pretty near perfect with this type of repair.
A very common reason owners call to make an appointment with me is when their dog or cat’s ear has swelled and looks and feels like a pillow.
Let’s step back for a minute and discuss some anatomy. How on earth would a dog or cat’s ear flap fill with blood?
The most common underlying cause of an ear hematoma is an ear infection. The constant shaking and scratching at the ears can lead to rupture of the large vessel. This leads to a leak, causing the ear pinna to fill with blood.
So, your Veterinarian has diagnosed your dog or cat with an ear hematoma. What can be done to fix it? There are a couple methods in which we can fix this. Prior to addressing the hematoma, if there is an underlying infection in the ear, it must be treated. First, to fix the hematoma, we can “do nothing.”
Second, a cannula can be placed in the ear pinna. Some Veterinarians love this method, but I honestly despise it.
The best option for correction of the hematoma is surgical repair. This method gives the best chance at correction with only one procedure, in the shortest amount of time, with the best appearance afterward. Once your pet is anesthetized, your Veterinarian will make a vertical incision down the inside portion of the ear flap over the length of the hematoma.
Many clients ask me why we can't just poke the "pillow" with a needle, remove the blood, and send the dog home. This is because we have done nothing to tack down the pocket, as in the surgical procedure above. If we just try to remove the blood without tacking, it will immediately fill again. So, if you suspect your dog or cat may have developed an ear hematoma, please schedule an exam with your Veterinarian today!
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