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 in cats. Hematomas can occur at any age. It appears more common in hot humid climates than in cold, dry areas. This problem occurs when an itchy, infected ear cause the dog or cat to paw and shake its head. This pawing at an infected ear causes it to turn red as small blood vessels swell, and leak fluids. Dogs and cats shake their heads so violently that some of these small blood vessels burst discharging blood 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.
The condition is much more common in dogs than in cats. Dogs are usually brought to me soon after the swelling occurs. These dogs are not in acute pain but the heavy affected ear is shaken repeatedly in an attempt to dislodge the swelling. There is only one effective treatment at this time. It requires incising or lancing the swelling so all blood within it can exit. To do this, the dog is heavily sedated or placed on a general gas anesthetic.
The ear is shaven and scrubbed and a scalpel blade is used to make a long incision through the skin of the inner surface of the ear over the hematoma. After the blood and clots present are removed some veterinarians simply bandage the ear tightly wound over a tampon or role of gauze. I like to make a series of mattress sutures through the entire thickness of the ear to form a “quilt”. I use a slightly irritating suture material, chromic catgut. Each of my sutures will form a scar that bonds the three layers of the ear together, preventing reoccurrence. Because it is quite common for the second ear to form a hematoma at a later date, I always suture the “good” ear as well. I would insist on this being done. Mattress suturing the good ear also prevents the dog from concentrating its scratching activity on the damaged ear. Some of these dogs need to go home in a large restrictive plastic collar called an Elizabethan collar. This collar prevents the dog from pawing at its ears while they heal. I have found that a good tranquilizer (such as acepromazine given at 0.25mg to 0.5mg/pound up to four times a day) often eliminates the need for a restrictive collar. Once a week has passed, the danger of the dog rubbing and damaging its ear further is very slight – I have never seen it occur. I have also never had the problem reoccur on an ear that was properly sutured with mattress sutures.
Once the ear hematoma has healed, I concentrate on curing the ear infections, which are the underlying cause of the problem. This requires cleaning and flushing out the ear canals with a cerumenolytic (ear wax-dissolving) product and packing the ear with an antibiotic/corticosteroid cream. During my 35 years of treating this condition I have only seen four or five cases where chronic ear canal infections were not the root cause of the ear hematoma. In those cases, I attributed the problem to inherited bleeding tendencies (hemophilia or rat bait ingestion) or generalized itching (pruritis) due to fleas and allergies. The former I treat with vitamin K, the later with antihistamines, medicated shampoos and flea control products. A small minority of ear canal infections are stubborn and difficult to cure. These are infections that lie in the middle and inner ear, the space between the eardrum and the brain. These require prolonged antibiotic therapy based on bacterial antibiotic susceptibility and in rare cases, surgery to remove infected tissue.
Article submitted by: © Ron Hines DVM PhD