Goals of Treating Aural Hematomas
The goals of treating aural hematomas are to drain the blood-filled pocket, facilitate ongoing drainage until the inner layers of the ear flap can re-connect, promote adhesion of the epithelium and cartilage by promoting direct skin-to-cartilage contact, and prevent or at least minimize ear deformity and scarring.
The most definitive way to treat an aural hematoma is to drain it surgically, flush the incision site thoroughly with sterile saline and then place several mattress sutures to bring the affected tissue layers into direct contact and eliminate the pocket that formerly was filled with blood. The success rate of this surgery may be improved if the veterinarian also places a temporary drain, to allow for continuous drainage as necessary for the wound to heal. Glucocorticoid drugs can be injected into the pocket to minimize inflammation and promote healing. A short course of oral anti-inflammatory glucocorticoids is often added to the post-operative treatment protocol. Some veterinarians may opt to only insert a self-retaining drain into the hematoma. This will allow the fluid to drain and can promote controlled scar formation. Whichever technique is used, the affected ear should be bandaged close to the dog’s head to prevent further damage and to allow adhesion of the tissues inside the ear flap to occur. This typically takes 2 to 3 weeks, at a minimum.
Draining the hematoma simply by aspirating the blood through a needle and syringe is rarely effective in the long run.
Left untreated, aural hematomas can cause scarring and deformity of the affected ear, sometimes referred to as “cauliflower ear.” Of course, surgical correction will only be successful if the underlying cause of trauma to the ear is identified and eliminated. Without alleviating the dog’s itchiness and discomfort, self-trauma will recur, as will the hematoma. With appropriate surgical treatment and proper immobilization of the ear to allow tissue adhesion and healing to occur, the prognosis for full recovery without recurrence is good to excellent.