There’s something freaky about seeing your dog’s formerly floppy ear become enlarged and painful. Ear hematomas (AKA aural hematomas) can develop overnight, and the severe ones can be quite uncomfortable. But how does it happen?
The typical dog with an ear hematoma (pronounced HE-ma-TOH-ma) has floppy ears that can really get going when he shakes his head. He also likely has an ear infection, and it probably isn’t his first, giving him a reason to shake his head often. When he flaps that ear just right (or maybe it hits a piece of furniture) a tiny blood vessel inside the ear can break.
Ears are very full of blood vessels. Anyone whose dog has cut their ear, or gotten into a fight where an ear got bit can attest – the amount of blood that comes out can look like a massacre happened! Ears can bleed… a LOT. Well, with a hematoma, all that blood is kept inside the ear. Think of an envelope that is flat, but as you stuff it, it no longer is flat. Well, as that blood vessel leaks and oozes, the ear flap (called the pinna) fills with blood. It can be a small area that feels squishy, or it can be the entire ear feeling like a water balloon.
In vet school we were taught to treat these surgically, and immediately. I stayed late many nights repairing these surgically. The procedure is simple, yet tedious. We slice an incision on the underside of the ear, drain out the blood, and then suture the two layers of the ear to make it flat again…and keep it that way. It takes many small stitches, placed individually, all across the ear pinna (that floppy part). Some vets place plastic tubing or even buttons to make the sutures easier to take out afterwards (because there’s usually 10-20 of them!). If a dog has had the hematoma for a few days, they are not a candidate for surgery, because the blood has clotted/solidified, and we won’t be able to get it out to sew the ear layers shut.
Thankfully, that surgery is no longer the trend. (I don’t know any vets that enjoy that surgery nor miss it!) In mild cases, simply giving it time, sometimes an anti-inflammatory, is all we need to let the blood reabsorb. Sometimes the ear may crinkle or scar, which we call cauliflowering… I have no idea why we call it that. So if your dog has a promising modeling career, then the surgery might be for him. Otherwise, the ear having a little bit of a stiff part isn’t the end of the world. The kids on the playground won’t make fun of him, promise. And cats can get ear hematomas too (usually secondary to ear mites – those suckers ITCH!) I’ve never heard of the surgery being performed on a cat. Their ear pinna is not floppy, it’s smaller, and really can’t fill up like a dachshund ear can. Yet, I’ve seen many stray cats whose ears have the characteristic kink (cauliflowering) from hematomas that developed and self-resolved months/years ago.
In severe cases, where the ear pinna is full, warm, heavy, and painful (like a piece of fruit hanging on the side of their head), we will still do the surgery. Why not just drain the blood and call it a day? I know some vets that do. Problem is, that blood vessel is going to keep oozing, and the ear will fill right back up, usually in a matter of hours. Sometimes the veterinarian will inject a steroid into the ear which calms things down. I personally haven’t done this, but have friends who swear by it.
In cats and dogs whose ears are not severe, we typically offer oral anti-inflammatories and let the body reabsorb the blood. It typically takes a few days, depending on severity. Perhaps more importantly, we’ll need to treat the ear infection. If the dog is going to keep shaking his head, the hematoma could get worse, or he could get one in the other ear! Remember, these hematomas start from a blood vessel breaking when the dog shakes their head (or the cat scratches its ear). If there are ear mites present (more common in cats, especially outdoor ones), or an infection, we need to treat it so the ear no longer itches, and therefore is no longer scratched or shaken. Your veterinarian will likely take a sample of the ear good, the provide an appropriate treatment based on what is living in your dog’s ear. (here’s the article about ear goo samples).
Bottom line, ear hematomas can be uncomfortable if severe, but are never life threatening. Stay calm, but get your dog to the vet as soon as you can, simply to provide some comfort.