Ear Hematomas

Buddy the Beagle was a serious repeat offender in the ear infection department. He had been diagnosed with allergies, a problem that manifested with itchy skin, and especially itchy skin inside his ear canals. When his ear canals became inflamed the normally mild-mannered yeast and bacteria that lived there in modest populations would start to reproduce enthusiastically in the suddenly hot, swampy environment, producing buckets of dark brown, smelly goo, and causing Buddy to start flapping his ears and digging at them with his feet. We kept on top of the problem with regular ear cleaning and medication for the skin and ears when he had a flare up, but this time there was something different going on. This time one of his ear flaps was very swollen and felt and looked a little like a water balloon. He clearly wanted to shake his head, but that ear was so sore that he couldn’t do much more than twitch.

Buddy had developed an ear hematoma, which is a common consequence of vigorous head shaking and ear flapping. The ear flaps in most domestic animals (and people) are made of skin covering two thin layers of cartilage lying on top of each other like the two pieces of bread in a sandwich. Running between the two layers of cartilage are small blood vessels. When the ears are flapped very hard it can cause the cartilage layers to shear across each other and that can tear the blood vessels that run between them. The leaking blood from the torn vessels creates a pool that fills the space between the two cartilage layers like a water balloon. Sometimes a bite wound or other trauma can cause the same problem, especially in shorter eared dogs or cats.

Ear hematomas are tender, like a really bad bruise. If the hematoma is not treated the normal progression for healing is that over the course of a few days the bleeding inside the ear flap will stop, then fibrin strands will form and adhere like cobwebs to the inside of the pocket, the body will start reabsorbing the blood and fluid, and in the final stages of the healing process, several uncomfortable weeks later, the fibrin strands will contract and collapse the pocket inward, crinkling the ear into a crumpled wad of scar tissue. In people a glancing blow from a boxer’s glove can cause a hematoma, and when it heals it results in what is commonly known as cauliflower ear or Boxer‘s ear.

It seems like poking a hole in the hematoma and letting the blood drain out would solve the problem quickly and easily, but drain holes quickly seal up and the pocket fills with fluid again without fail. The only way to really fix an ear hematoma is to anesthetize the patient, make a large incision to drain the blood, and put several stitches through the part of the ear where the pocket had formed, kind of like tying the layers of a quilt together, in order to keep it from being able to fill again. Stitches are usually left in for about 3 weeks. A repaired ear hematoma will usually heal much more quickly and although the ear flap may become slightly more thickened, it will almost always keep its normal shape.

Of course it is important to fix the problem that lead to all that ear flapping too, so medication for ear infections or removal of the grass seeds, ticks, tractor trailers, or whatever other odds and ends are causing the irritation needs to be done as well.

Buddy’s ear healed uneventfully after we fixed the hematoma and although he may not truly appreciate it himself, he got to avoid earning the nickname of “Crunch” for the rest of his dog life.