Aural hematomas are not particularly difficult to diagnose. However, they must be distinguished from an abscess, seroma or soft tissue neoplasia (cancer) for an appropriate treatment protocol to be determined. The diagnostic process really is focused on identifying the reason for the dog’s head-shaking and/or ear-scratching; the hematoma itself can be identified visually and by taking a fine needle aspirate to confirm that the fluid in the pocket is blood.
When presented with a dog that has a localized swelling on the inner aspect of the ear flap, most veterinarians will perform routine blood work – including a complete blood count and a serum biochemistry profile – and submit a urine sample for a urinalysis. If the only medical problem is an aural hematoma, the results of those tests will be unremarkable. Of course, a thorough history will be taken, with particular emphasis on any recent trauma to the dog’s head.
The next step is to conduct a thorough examination of the ears, which often requires administration of heavy sedation or even general anesthesia. This is called an “otic examination.” The veterinarian will be looking for signs of inflammation and/or infection in the ear canal, which might be causing the dog discomfort and be the reason for its head-shaking and ear-scratching behaviors. She will also look for evidence of parasitic infection and for foreign bodies, such as grass awns, lodged in the ear canal. Blood samples may be submitted to assess thyroid function, and food trials or skin tests can be performed to identify food or other allergies that may be contributing to the dog’s condition. Advanced testing may include computed tomography (CT scan) or skull radiographs (X-rays), to assess whether a middle or inner-ear infection is present.
The hematoma itself is quite easy for a veterinarian to diagnose. It is more difficult to track down the underlying cause of the trauma that led to the focal accumulation of blood.