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November 28, 2006

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Kim

I have a 9 year old Weimaraner that just had surgery the 6th time in 1 year for recurrent aural hematomas. Everytime the vet corrects it, the next day, the ear blows up in a different spot. We have spent at least $200-$300 per surgery and are at our wits end. We love this dog, but can't continue to shell out the tremendous amount of money to correct this problem. She NEVER has ear infections and does not have a clotting disorder. Do you have any other suggestions for us? I will be mentioning the use of prednisone to the vet to see if we can try that. Thanks!

Dr. Everett Mobley

I cannot really speak to cases that I have not examined. I have re-edited the post with additional information on the drainage tube procedure. I have sent Kim a more detailed personal reply.
TEM,DVM

jason

hi i have a pit bull terrier that we just saved from being destroyed and she has aural hematoma we just noticed last week,it is pretty big now. and i just got laidoff from work im kicking myself not being able to afford a vet right now,is there anything i can try to do at home to help.i feel like a scumbag not being able to go to the vet right away.it doesnt seem to hurt her iv been puttin hot compresses on and i tryed a needle but she wasnt to keen of the idea .will this blister kill her.i could never live with myself if that happined.could you give me some options please!!!!!

Doc

Dear Jason,

No this will not kill her. It's like a big blood blister. It is uncomfortable from the pressure. Sticking a needle in it is not a good idea. It will just fill up again, and you could easily introduce germs. A blood-filled cavity is not a good place to add germs, as it would be a wonderful place for them to grow. Then you would have a nasty infection instead of just the pressure.

Heat opens blood vessels and would make them leak more. Cold causes them to close up and leak less. When something first happens, cold is best to prevent further leakage. Use a therapeutic cold pack, or just a rag soaked in ice water. Apply for 10 to 15 minutes at a time, resoaking the rag as necessary. Do not use ice directly, as it is too cold.

When the problem is a week old or more, heat may help to break up the clots and enhance resorption, but may also re-start the bleeding.

The pressure is what causes the discomfort, but additional head-shaking makes it worse. If she would let you put a soft bandage to put the ear over the top of her head, that might let things start to resolve.

If there is no ear infection that needs to be treated, the hematoma will eventually resolve. It may take several weeks, however, and the ear will look sort of "wadded up" when it finally heals with scar tissue between the ear layers. It won't be pretty, but when the pressure is gone, it won't be painful either.

Best of luck, and thanks for reading and writing.

Julius

Hi- My dog recently developed an aural hematoma and I immediately brought him into my vet for an exam. The first thing our vet recommended recommended was to aspirate the hematoma with a syringe. She informed me that this was only going to be a 30% success rate. We waited a few days and sure enough the pinna filled right back up again. I spoke with my vet about other options and she mentioned to either aspirate again or insert a drain with minor surgery- stating surgery would yield a 90% success rate. I opted for surgery since it seemed like my best option at the point. Like an earlier post I wish my vet would have sat me down to explain what to expect post surgery. We went ahead with the surgery and the outcome was nothing like what I expected. I brought him back to the vet 4 days post surgery because I noticed a slight odor from the bandage. The bandage was removed by a technician and she cut the tip of my dog's ear by accident. The surgery site showed signs of slight infection plus the new wound created by the technician caused my dog to go onto an antibiotic. The wound was rebandaged and a couple of days later my dog was somehow able to remove his bandage and cause a mess. A few days have gone by and I notice he is doing excessive head shaking and pawing at his 'bad' ear. I also noticed that his ear seems to be filled up again. What are my options now? My vet seems to treat me like an overconcerned parent but I really don't feel like I'm getting much direction here. Should we aspirate again? I definitely don't want to put him through surgery again. What if I leave it alone and put cold compresses on it daily?

Doc

I can really only give you general advice, here, as I
mentioned in another post.

http://www.yourpetsbestfriend.com/your_pets_best_friend/2007/10/second-opinions.html

That being said, if the hematoma is full, it needs to
get un-full. I am not visualizing how the ear is
bandaged. Usually when surgery has been performed,
there is either a pretty good-sized opening or a
drainage tube so that fluid does not re-accumulate.
If there is such an opening, it is common to prescribe
antibiotics until things are closed up again. Bloody
fluid is a great place for germs to grow. You are
already on antibiotics because of the unfortunate
un-bandaging accident, so stay on them. If your dog
is not receiving any type of pain medicine, I think it
would be good to ask your veterinarian about getting
some. If the ear is swollen, it's under pressure,
which means it's uncomfortable at best.

I would be very hesitant to recommend the prednisone
treatment at this point, since you have wounds to deal
with and the prednisone suppresses the body's
defenses. It is possible that the small teat-tube
surgery (simple insertion of the small drain tube, as
illustrated in the post) may be helpful at this point.
Also, aspirating (sucking out) the fluid and using a
compression bandage may be an option.

The bottom line is that the doctor who is on the scene
is in a better position to know what is going on. I
can understand that you are not happy with the results
to date. If you feel that you and your veterinarian
are not communicating well, you need to let him/her
know that. Simply say that you don't understand what
to expect and what the options are, and you need some
help to see the big picture.

You could also consider asking him/her to refer you to
another doctor for a second opinion. Personally, I'd
much rather give a copy of the medical record to the
client and give him a list of other doctors I respect,
than to just have him pick someone at random out of
the phonebook.

I hope this is helpful. Thanks for reading and
writing.

Stacy G

It looks as though my dog has an aural hematoma. She has always had itchy ears and sometimes gets infections. I know the hematomas can go away on their own but there is also surgery for treatment. Is there any benefit to the surgery other than the prevention of malformation? Can i treat the infection if present and hope the hematoma will go away? How do i know if there is a chance of rupture?

Doc

I will answer your questions as best I can.

"She has always had itchy ears and sometimes gets infections." This is something that needs to be addressed. It would be a good idea to investigate possible underlying causes for this, like allergic problems.

"I know the hematomas can go away on their own" This is a very slow process - weeks to months.

"Is there any benefit to the surgery other than the prevention of malformation?" As long as the ear is swollen, it is under pressure, which means that it is painful. Whether the pressure is relieved by surgical drainage, a drain tube, or treatment with prednisone, it IS important to relieve the pressure so that the dog won't be painful. Just treating the infection in the ear canal won't do that.

"Can i treat the infection if present and hope the hematoma will go away?" Your dog will be painful for a longer period of time.

"How do i know if there is a chance of rupture?" Rupture is not likely to occur.

Your dog will get better sooner if she receives care from your veterinarian.

Thanks for reading and writing.

Tim

Hi Doc -

Great information. While there are many sites that offer information on the subject, in my opinion there are none that explain the cause and subsequent treatment options as well.

Of course on to my question . . . I have a lab who has undergone two previous "quilting" surgeries for aural hematomas and now we may be going in for number 3. There is a spot on her left ear that was not quilted as it was not affected by her previous hematomas. The area is not too large and the chance for it to spread is minimal (or so we've) been told due to the prior surgeries.

At this time the hematoma is not filled - there is some puffiness, but the area is not completely filled with any fluid. To avoid putting her through another extensive surgery I was wondering on your thoughts of treating her with prednisone.

I understand that it is very difficult to give an opinion without actually seeing the dog, however any insight you may be able to provide would be greatly appreciated.

Teri Owens

Our Basset Hound is 9 or 10 yrs. old. He was a rescue and the sweetest dog in the world. On Thanksgiving, he was playing with a couple of other smaller dogs and all of the sudden, this hematoma shows up on his ear. We took him to the vet on Saturday morning,and they drained it (22cc'c)and put him on prednisone (10mg. twice per day). The hematoma filled back up after 10 days and we chose to drain again (34cc's) and the vet doubled the dose of prednisone and perscribed it for a longer period of time. The vet is recommending the surgery, if this does not work. My
questions are: Can we continue draining and allow the prednisone treatment to work? Could there be complications from continuing to do it this way? The vet did mention something about inserting a tube, but really recommends the surgery where they would puncture the ear with holes and stitch in a quilted pattern. I am really unsure of which way to go, the surgery seems so invasive and with extensive recovery time.
The vet also mentioned that if the hematoma was caused by trauma, which we are not sure how it happened, that really the only thing to fix it is the surgery. What is your opinion on that statement?

Thank You, I got a lot out of your answers.

Teri Owens

Doc

Tim,
Since the hematoma is small, I don't think it would hurt your veterinarian's feelings to just ASK about the prednisone. Of course, we all cringe when a client says "I was looking on the internet, and...". There may be reasons why they are not comfortable with this approach for your dog. It is also possible that they have not tried it for any of their patients. I can tell you that it was a bit of a leap of faith the first time I tried it. It's by no means guaranteed to be successful, but it is worth investigating.

Thanks for reading and writing

Doc

Teri,

I hope I can help with your questions.

"Can we continue draining and allow the prednisone treatment to work?" Yes, providing that it actually does work. If you're not seeing improvement with the higher doses in a week or so, it's probably not going to work.

"Could there be complications from continuing to do it this way?" Yes. Everytime you poke a hole into a cavity filled with bloody fluid, you risk starting an infection there. Also, prednisone is not without side-effects.

"The vet did mention something about inserting a tube, but really recommends the surgery where they would puncture the ear with holes and stitch in a quilted pattern." The tube surgery is really rapid and fairly inexpensive. If it doesn't work, you can still go to the more extensive surgery, should it be needed.

"I am really unsure of which way to go" No kidding. Any time you find fifteen different ways to do something, it lets you know that there is not one best way for every patient.

"The vet also mentioned that if the hematoma was caused by trauma, which we are not sure how it happened, that really the only thing to fix it is the surgery. What is your opinion on that statement?" I agree that surgery may be necessary.

It sounds to me like your veterinarian is being thorough, giving you options, and doing his best to advise you as to what he feels will give your dog its best outcome.

Good luck, and thanks for reading and writing.

Jackie

I have a Calico cat that had a ear hematoma surgically removed today. The tube is in her ear but her ear is quite swolen again and she's bleeding through the incision the tube is in. is this normal? How do I relieve the pressure from the blood building up in her ear?

Doc

It sounds like the drain tube may be clogged. You should contact your veterinarian. The solution may be something as simple as taking a small needle and un-clogging the tube. DO call your veterinarian.

Thanks for reading and writing.

Laurie

What is a good way to bandage dogs ears after arual hemotoma surgery, my dog has been shaking head and very stressed since she has come home 2 days ago I am afraid that the stress can't be good for her she is 12 and in general good health but the vet tech has practicaly her whole head taped up very tight

Doc

Head bandaging is difficult. I have used ether to make the tape really sticky, then used the tape to make a "handle" from the end of the ear. The handle gets taped down to the dog's head. You need padding both under the ear and over it.

You really do want to immobilize the ear for a while so that shaking of the head doesn't spray blood everywhere, and you don't want them to scratch it.

It is certainly true that some dogs are distressed by the mere presence of a bandage. However, I would also be concerned that your dog's pain is not fully controlled. You should contact your veterinarian and ask if he/she can add some additional pain medications, and possibly a mild sedative for a few days.

I hope this is helpful.

Thanks for reading and writing.

Tom Nelson

My older dog (11) has what seems to be an aural hematoma on his ear. I suspect this as he had one on the other ear, although not throughout the entire ear flap like this one. I have elected to just let the swelling go down on it's own. I was also curious as whether there is something I could give for pain whether over the counter or prescription, until the swelling goes down? The dog seems to be in some discomfort by this.

Also, would repeated ice packs help with swelling?

Thanks, Tom

Swade's Mom

Hi Doc,

After doing extensive research, I finally came across your article. My dog, Swade, a 6-year old pitbull mix has gone through 3 hematomas back to back. Two occurred in the same ear and the most recent was in the other ear. All were treated with a drainage tube.

I've gone to 2 different vets and have been trying to find out the CAUSE of his hematomas. He does not have any ear infections, all vets have confirmed this. One technician at the vet office suggested it may be a food allergy. I did happen to change his diet about 4 months ago right around the time of his first hematoma. I have since then switched him back and been giving him vitamins daily.

No one has been able to explain the cause and I've been dishing out hundreds of dollars getting his ear drained. I'm really interested in learning more about prednisone and mostly on the cause of his reoccuring hematomas. There must be a reason. Is it a clotting problem? Both vets said there's no way to isolate the cause and that it could reoccur... sounds like I'd have to keep paying them.

To give you more history on my dog, he's never had any issues like this before. He was neutered in September... the hematomas started in october. He stays outside in the backyard until I come home. He used to sleep outside at night as well until back in August. Could it be something in my house that he is allergic to? I'm so frustrated at the incompetence of these vets. After questioning one extensively, he suggested I give my dog claritin. While I could do so, I still don't know why he is having these issues? Now, his original ear (the one that had healed back in January) looks like it might become a hematoma yet again. There are 2 small blisters right next to each other and one was bleeding.

I'm really hoping you can shed some light on this for me and at least point me in the right direction so I can learn more. As I said, you're the first I've come across that's noticed the lack of an ear infection. I live in Atlanta so if you know of a good vet, please let me know. I really appreciate your time.

Thanks,
Swade's mom

Doc

Hello, Tom,

It is possible that the ice-packs will help slow the swelling. Cold causes blood vessels to constrict, tightening them down, slowing leakage (conversely, heat causes them to open up). Be sure and use a therapeutic cold pack, or a rag soaked in ice water. Ice applied directly is just too cold and should not be used.

OTC pain relievers can be used, but they do have their pitfalls. Aspirin causes mild stomach bleeding, but can be used short term, one regular strength aspirin tablet per forty pounds of body weight, given two or three times daily. Tylenol can also be used short term at a similar dose rate.

Ibuprofen and naproxen are unpredictable, possibly causing severe bleeding ulcers, and I would not recommend them at all for your dog.

Your veterinarian can help you with more effective, safer alternatives for long-term pain control.

Thanks for reading and writing

Doc

Hello, Swade's Mom,

I am sorry that you have had such difficulty with your dog. From your description, he does sound like a possible candidate for prednisone therapy. Until I ran across this idea on Veterinary Information Network, it would never have occurred to me to try immunosuppressive doses of prednisone to treat this blood vessel leakage. These large doses of prednisone can have their own side-effects, so the treatment is far from perfect, even when it works.

While most of us cringe when a client says "I read on the internet...", you might at least mention it to your regular veterinarian.

I am sure that there are many good veterinarians in Atlanta, but I do not know any personally. You might consider a trip over to the veterinary school at Athens. I'll bet they have a veterinary dermatologist there.

Good luck with your dog. Thanks for reading and writing.

Tracy

My 17 yr.old cat has developed a hematoma on its ear. He has been completely deaf for over a year, thus the scratching of the ears. My problem is this, financially I just do not have the money to get him treated (which kills me, but living in Maine with the high oil prices etc...we are having all we can do to get by)is there anything I can to at home to make him more comfortable? I have been trying to keep the outside clean with peroxide, which he does not seem to mind. He has been eating, going to the bathroom, sleeps a lot (nothing new at his age). I hope you can help put my mind at rest and help me help my cat. Thanks!

Doc

Dear Tracy,

I wish that I had a good suggestion for you. Sometimes we recommend pain control if nothing else is feasible. Unfortunately, cats do not tolerate any over-the-counter pain medicines. Tylenol (acetaminophen) is unpredictable, and can cause massive hemolysis (rupturing of the red blood cells) and death. A healthy, ten-pound cat can tolerate one baby aspirin once every 48 hours. I would not recommend this for your cat, due partly to the age, and partly because aspirin inhibits platelet function. The hematoma could conceivably get worse, even if the aspirin didn't cause other problems (which it very well may, especially in such an ancient cat).

Your cat may or may not be a candidate for the prednisone treatment. If she has an ear infection, I guarantee you that it is constantly painful. Even without an ear infection, the hematoma is under pressure, which is uncomfortable at best.

If your cat does not have an ear infection, the prednisone treatment is very inexpensive. I urge you to get her looked at by a veterinarian.

Good luck, and thanks for reading and writing.

Julie

Hi,
First of all I want to thank you for your site as it has been very helpful.

Our 12 year old lab just had a drain placed today to drain his hematoma...(and he is so much more content now). He is also being treated for a mild yeast infection in both ears, which we are giving him ear drops for. My concern is that he wasn't given any other oral antibiotics. I am worried about the drain becoming infected. Is just daily cleaning with peroxide going to be enough? Thanks

Doc

In regard to just cleaning the drain versus systemic antibiotics:
If your pet's doctor has had good luck with that, then more power to him. I have always been afraid of leaving that bloody hole open, so have given the antibiotics. I do not have any research to support my position. Your dog may do just fine, and antibiotics DO have the potential for side effects. I would recommend that you keep it clean, and monitor for swelling, or for a change in the character of the drainage. Stay in touch with your veterinarian. The doctor who is seeing your pet is the best person to advise you.

Thanks for reading and writing.

Golden Retriever Mom

Dear Doc,

This was exactly the procedure they used on my Golden Retriever. He was healing very well. After they took the drainage tube out I just keep on cleaning the incision and making sure to drain out any fluid. He finished his 10 days of antibiotic (clavamox) and antiinflammatories (Previcox) and 3 days later he stated producing a lot more fluid than before, the wound closed, filled up again and he was in pain. I had to rush to the vet. They reopened the incision and took out a little abscess. they put him back again on antibiotics for another 10 days(now Antirobe) and 10 more days of Previcox. It has been now 4 days. every day a lot of transparent yellowish fluid comes out. Last night the wound closed up again and I can not get the fluid out. I can see it starting to fill back up again. He still has over one week of this new antibiotic to go. What should I do? Can you please give me some advise? should I wait couple of days and see if it stops filling up? or should I rush again to the vet?

Also his ear infection has not heal either. First they gave him synotic and conofite drops for 14 days. when he finished they did another culture and now he needed Baytril drops for another 14 days.

I have spent over $1,000 and after 3 weeks he is still not well. I would appreciate any advise you can give me. Does all of this sound normal? I have followed the vets instructions very carefully but I am getting frustrated and very broke. I am scared I take him back and maybe he needs another drainage tube and its going to cost a lot more money again.

Thank you so much in advance,

Golden Mom.

Doc

I can appreciate your frustration in this case. It does not sound straightforward. I am not really in a position to evaluate or prescribe for you. It is possible that you will need to see a veterinary dermatologist.

Having said that, I do have a couple of thoughts. Has your dog had any previous allergic problems? It sounds like there is a lot of inflammation present. Golden Retrievers are certainly prone to allergic problems. Many ear infections are secondary to allergic problems. If I were looking at a dog with a lot of ear inflammation, I would certainly consider treatment with corticosteroids at a dose that would suppress allergic reactions. If the hematoma by chance involves vasculitis, then high doses of cortisone can stop the fluid leakage. You would definitely have to let the Previcox wash out for a couple of days before starting the cortisone.

Again, it is not possible for me to give you an accurate long-distance assessment. The doctors who are seeing the dog have a better basis to recommend treatment.

Good luck with your dog.

Golden Retriever Mom

Dear Doc,

Thank you very much for your prompt response. I had placed a call to his practice and I have an appointment tomorrow Monday at 10am. His vet is on vacation so another Vet will be seeing him which also makes me a bit nervous.

To answer your question, my 9 year Golden has always had perfect health. No history of allergies and this is the very first ear infection / serious health concern. Never needed more than his yearly check up.

The vet mentioned over the phone that the culture for the ear bacteria came back (which they never called to notify me) and to stop immediately the antibiotic Antirobe (which I probably could have stop earlier if they had called) as this bacteria would be immune to it as well as the very first antibitic he initially took Clamavox. He offered reimbursement for the Antirobe. What I do not understand is why they prescribed antibiotic and drops without having made this culture on the first place (initially they just did a cytoloty for the ear smear). They only did a bacteria culture 2 weeks after they found out the first treatment for the ear infection did not work. Is that normal procedure? or I just had to pay for countless drugs for them to run the experiment? they said that the first drops cured yeast but that somehow bacteria took over...

He explained just as you did that pretty much every vet has different ways to treat Aural Hematomas. He advised me to stop food and water after midnight in case he considers he will need surgery tomorrow morning when he sees him. I am very scared, I guess surgery will be another huge bill.

I will ask the vet tomorrow about vasculitis. I do not think they mentioned this before.

Thank you very much. I greatly appreciate you help and time and I congratulate you for your great devotion in helping us all.

Golden Mom

Doc

I would say that it is not standard practice to culture ears on the first visit. Really resistant bacteria are fortunately not very common, so we frequently treat with a broad-spectrum topical the first time out. If we don't get the expected results, then a culture may be indicated.

Even though your dog does not have previous histories of allergy, he may have an allergic component now. Also, with these bad ears, cortisone often has a better anti-inflammatory effect than the NSAIDs like Previcox (which IS a good drug, generally speaking).

Good luck!

Peg

Hi,

I am so grateful to have found your site and hope you can help.

My cat has developed an aural hematoma and it appears very large. He seems ok and is eating, going to the bathroom, purring, etc., though he seems understandably uncomfortable. He recently had surgery on his leg and I am hesitant about putting him through more, not to mention the cost factor. I hate to even say it, but I simply cannot afford it.

My questions are: Is it safe to let the hematoma go away on its own and will it most definitely go away over time? I feel like a horrible person to say I cannot afford to have this treated, but its the truth. Is there any topical steroid I can use to make the swelling go down, it common for there to be alot of swelling and how long before I can see swelling go away? I'm afraid of this bursting. Thanks for any advice.

Doc

Hello, Peg,

I'm sorry you're in such a frustrating situation.

"Is it safe to let the hematoma go away on its own and will it most definitely go away over time?" Eventually, the body will close off the leak. The pressure that makes that ballooned-up ear so uncomfortable is also gong to stop the leak... eventually. When that happens, the blood in the swelling will organize into a clot. The body will finally dissolve and get rid of the clot. The ear flap will heal, but it will be pretty wadded-up-looking. The scar-tissue will really wrinkle it (think about the old time pugilist's "cauliflower ear").

"Is there any topical steroid I can use to make the swelling go down?" Nope.

"How long before I can see swelling go away?" Weeks to months.

"I'm afraid of this bursting." It won't. It will just be darn uncomfortable for quite a while. It is important to be sure that the underlying cause is not an infection in the ear canal. That is REALLY painful.

Thanks for reading and writing.

Gwyn

I just discover your website while doing research one the aural hematoma. My 9 year old german shephard/huskie mix just had surgery on Saturday. When we brought her home she looked like a nightmare. It made my 2 1/2 year old daughter cry. They did not put a bandage on her ear, just fitted her with an extremely large e-collar. We ended up on Sunday morning replacing the large e-collar with an inflatable collar. The poor dog couldn't even walk without tripping on the collar! I had to take it off so she could walk up and down stairs, eat, drink, anything! If I wouldn't have put the inflatable on her I probably would have stayed home from work to make sure that she didn't hurt herself in the monster collar she was fitted with. The problem is that the inflatable isn't really big enough to protect the ear if she decides to start scratching.

I guess my ultimate question is whether it is common not to bandage the ear after the surgery. It just seems like with an open wound like that it would be easily infected. plus, we have two other dogs in the house who are sniffing at it, as the wound is seeping a little.

Thanks for listening.

Doc

Hello, Gwen,

Without seeing the surgical procedure, I do not know whether a bandage is needed or not. The bandage can function to keep light pressure on the ear (to minimize swelling from fluid accumulation), to protect the ear from additional trauma, or to immobilize the ear to keep the dog from shaking it and spraying drainage everywhere. Leaving an opening in a major hematoma surgery IS routine to allow fluids to escape. Many doctors would have the dog on antibiotics while the wound is open, and pain medication is essential for several days.

It is best to address your concerns with your dog's regular doctor. Sometimes they believe that they have answered all your questions. If you don't call, they assume everything is okay. Call them.

Good luck, and thanks for reading and writing.

Peg, again

Hello again,

I wrote you a few days ago in regards to my cat's large hematoma and you were so kind as to respond. As an update, I brought him to the vet and just picked him up today. After discussing options, I decided to have the drain placed in his ear and we subsequently learned that the hematoma was caused by ear mites. Who knew? He is all black, so its difficult to see down there though I check periodically. With that said, if you could tolerate another question or two concerning two things, my mind would be put at ease: The elisabethian collar - he hates it. He is trying to get it off and the vet insisted on him keeping it on. I am trying my best to keep it tight (but comfortable) but I know he's going to get it off his neck. What options do I have here and would it be horrendous if it was off? Second question is in regards to my instruction to 'drain' the drain myself daily. Is this the norm? If so, how much pressure do I place on it, and where do I start the pressure point? These are both things I forgot to ask the vet before I left this evening. Doc, if you could help me once more (or maybe thrice more!!) , I would be so grateful!

Doc

Hello, Peg,

No offense, but why not call your doctor back? I'm sure he/she would be glad to help you. People are often afraid of looking dumb, but, jeez, it's easy for us doctors to get in a hurry and leave something out of an explanation. That means that WE are the ones who messed up, not you.

As to the E-collar, its purpose is to keep the cat from removing the drain prematurely. If you don't want to have the cat sedated again to replace the drain, try your best to cope with it. I really don't know a good alternative, short of you holding his hands for a week or so.

As to "draining the drain", the drainage tube can become clogged. We use a rigid tube and often send home a needle to insert in the middle of the tube to unclog it. Since cat ears stand up instead of hanging down like a dog's ear, gravity doesn't help so much in draining the fluid. That is why you would "milk" the ear to removed the fluid that is accumulating. It shouldn't take much pressure to milk all the fluid through the drain. If it takes much pressure the drain is blocked and you need to call your doctor. Start at the base of the ear and milk/squeeze gently toward the tube opening. I would probably do this two or three times daily.

Seriously, I think that your doctor would be happier if you got your questions clarified, rather than showing up a week later with a poor result (but you didn't bother him/her with questions).

Layla's Mom

Hi,

My dog, 3 year old Maltese, has an aural hematoma. Well, I freaked out last wednesday and I took her to a 24hr clinic, and they drained it. It came back, not surprisingly. She has no sign of infection at all, per 2 vets.

I went to my regular vet today, and he said that he doesn't want to operate on it because it's not big enough(or football shaped, as he said). He said it will hopefully go away on it's own if she stops shaking her head and scratching her ears.

Is this s good idea? I just don't want it to get to the point where it is uncomfortable for her. She is a small dog, and i worry!! I also wonder why she's scratching...i gave her flea and tick meds..but maybe an allergy? She does lick her paws on occasion to the extent where i have to tell her to stop.

Do you think it will go away on it's own? I just don't want to have to spend more money if it gets huge and does need surgery.

THANK YOU SO MUCH!!!!!

Layla's Mom

I just wanted to make a note...i read my post and the last sentence doesn't sound right..i meant...i heard that it costs a lot more $$$$ if you wait til the hematoma gets bigger(makes it harder to operate?)..i have no problem spending $ on my dog at all..i want whats best for her because i love her so much!..but if i can cut the costs now a little and get surgery asap, it might be better for my financial situation! thanks again!

Doc

Hello, L.M.,

I see your dilemma. It's too little to do surgery, so if it doesn't recover spontaneously and gets much bigger, then she can have surgery. In the meantime, she's still uncomfortable and you don't WANT it to get bigger.

With no evidence of an ear infection, you do indeed need to look for another reason for her head-shaking (besides the discomfort of a swollen ear, that is). The major foot-licking does suggest the possibility of an allergy. There is also the possibility that her hematoma is due to an immune-mediated vasculitis, as I discussed in the original post. Using prednisone (a synthetic from of cortisone) may address both those causes.

I guess I'm not optimistic that your dog will "just quit" shaking head and scratching her ears. Even if the original inciting cause has gone, the pressure of the ear swelling continues to cause discomfort.

If you haven't told your veterinarian about the foot-chewing, he/she may be missing that piece of the puzzle.

As always, the doctor who is actually seeing your pet is in a better position to judge the situation than I am. Do be sure to share all your information with him/her, and update him/her on your dog's progress (or lack of it).

Good luck, and thanks for reading and writing.

Scout

Hi Doc -

My 7yr old choc lab has gotten two ear infections in the last 4 months - I'm pretty sure due to water not drying up in there after swimming in the lake. My fault, I know. This last time I let the ear infection go longer than I should have, and he developed an aural hematoma. Started out small, now is about half the size of the inner ear. He's on an oral and topical treatment for the infection - vet said it was my call whether or not to do surgery. I'm leaning towards not, esp after hearing about all of the horror stories about them coming back. The cold compress seems to be helping his discomfort, so thanks for that suggestion.

Any other things I can do to try to prevent this from happening again? I'm going to keep him out of the water for a while, and will be sure to check his ears daily. Do you think the ear infections could be caused by allergies though? He has been licking his paws a lot lately, and the vet said he could do a blood test to find out for sure. I've heard otc Benadryl can be given to dogs (he weighs 75lbs) to help with allergies.

Any suggestions?

Doc

Hello, Scout,

Allergies can definitely predispose dogs toward getting recurring ear infections. Even food allergies can do so. Weirdly enough, sometimes only one ear is affected, even though the underlying cause is an allergic reaction. That makes no sense to me, but it is assuredly so.

In your case, treating as an allergy could really be helpful. We often use corticosteroids (like prednisone) to calm the patient's allergy. Prednisone at higher doses sometimes causes the hematoma to resolve without surgery.

Benadryl may help calm his itching (it works in no more than 20% of dogs), or it may make him too sleepy to scratch (the same drug is sold as a sleep aid). It won't do anything for the hematoma, and the prednisone might. I've had good luck with a lot of them, and don't put in near the number of drains that I used to. You might discuss a short-term trial therapy with the prednisone ( it does have side-effects).

Thanks for reading and writing.

Penny

Hi apparently from what I am reading my cat has an aural hematoma. I do not know if this is from digging at her ear or we kinda tripped over eachother this morning (I have a walker from a recent hip replacement)anyway her ear looks like a balloon and I feel awful. Probably not as bad as she. I cant drive to a vet at this point and do not have money right now because of my surgery. Any ideas what I can do for my dear dear furry girl? I have had her for 14 years and she has never had this problem before. I feel terrible! Can you help us?
Thank You
Penny & Scarlett

Doc

Hello, Penny,

I wish that I could give you a good home remedy for the hematoma, but I fear that there isn't one. Cats don't tolerate many over-the-counter pain medications. An average size adult cat can tolerate one baby aspirin about once every 3 days, but this would inhibit platelet function, making the hematoma more likely to bleed and enlarge, so I can't recommend that. Other NSAIDs are not safe in cats, and tylenol is not safe in cats.

It is possible that a cold compress will help with the discomfort. Cold makes blood vessels shrink, slowing bleeding and oozing. Heat opens blood vessels, making the hematoma potentially worse in the early stages.

Heat can help circulation, but should not be applied while the hematoma still contains a lot of fluid.

Cold compress for 10 to 20 minutes three times daily for about 3 days. Wait 3 days, and then consider warm compresses three times daily.

Your cat really needs to go to the doctor.

Susan

Hello, I have a GSD with the hemotoma. It came out of nowhere. She does not have any mites or ear infection. She is 8 years old. My question is, will these eventually go away on their own and how long can that take? I cannot afford the $400 surgery and my vet will not drain it because he says that doesn't work.

Doc

Hello, Susan,

Eventually, the hematomas do resolve. However, this can take many weeks and the pressure is uncomfortable for the dog in the meantime. Also, the ear will be considerably deformed in most cases.

If your dog's ears are clean and there is no history of ear trauma, you might consider asking your veterinarian if he has ever treated these for vasculitis.

There are some dogs that will respond dramatically to just medical therapy.

As I cannot see your dog, I can only give you general answers. The doctor on site is best qualified to make recommendations on the case.

Thanks for reading and writing.

Kayla Crabtree

Doc,
I took my lab to the vet today to get surgery on his ear. He had a large hematoma that took up his whole ear. We had put this surgery off for quite a while b/c we were hoping that it would heal on its own and b/c of money issues. We finally got to the point where we had to do something b/c it wasn't getting better, only worse. So he had his surgery and the Dr. called me right after. He said that there was barley any blood at all in the ear. He said it was mostly tissue. In all of his years in practice he said he has never seen this. He said that he cut some of the tissue out but it is still quite large. He was also telling me that the stitches might loosen up as well w/ the healing process. Have you ever had this happen to you? I just feel so bad for putting it off for so long. Will his ear always be a lot thicker than normal? The Dr. said he got the ear down to half the size it was when I brought him in. It was probably 3 inches thick when I took him to the vet. I am just worried that the tisue will continue to thicken. Is that true?

Doc

Hello, Kayla,

I have never encountered such a problem, myself, either. It would have been ideal to biopsy the tissue at the time of removal, but you mentioned that money is a concern, and that would be an extra expense, to be sure.

If I were looking at something like you describe, I would probably be taking pictures and consulting with a veterinary dermatologist.

I really could not predict what this is going to do. I would suspect that the ear will always be abnormal. Scar tissue shrinks as it matures. This may thin things a little, but it also has a tendency to make them pucker, producing the "cauliflower ear" of the pugilist.

Your veterinarian is really the best person to advise you here.

Thanks for reading and writing.

Eli

Hi,
I was very happy to find information here about a problem that tortures my family all this year. (Sorry for the English, I am not native, I live in Bulgaria). Yesterday, it was the 6th time when aural hematoma occurred in my 1-year siamese cat (once the right year and 5 times on the left one!). The single surgery of the right year was 100% successful and the pinna healed completely with a small deformation. But the other... every time the bloody blister occurred more closely to the base of the ear and suturing became more and more difficult because of ear "geometry". I must note that I am working a a veterinary medicine faculty and I am sure to receive the best possible service, but my colleagues surgeons are already very concerned about stopping the hematomas to appear. The cat has no other ear problems, is very calm and even allows suturing without being anesthesized...

Any suggestions from you are very, very welcome!
P.S. Could inbreeding be possibly involved in the etiology of the condition?

Doc

Hello, Eli,

I am not aware of any research looking at genetics in regard to aural hematoma formation.

If your cat does not have evidence of infections or inflammation in the ear canals, this may be a case where corticosteroid therapy would be helpful.

As I noted in the original post, while the underlying reasons have yet to be found, there are many animals with this problem where the leaking blood vessel appears to be caused by the body's own defenses attacking the vessel.

I have been surprised at how many animals have responded to treatment with immunosuppressive doses of some type of cortisone.

I am no expert in this, but I am told that when using oral corticosteroids, that cats do better with prednisolone than with prednisone. An immunosuppressive dose of 2mg/kg once daily has shrunk several of these hematomas for me. I only use this high dose until the hematoma shrinks. Then the dose is tapered down gradually over a period of several weeks.

I was initially skeptical of this form of treatment for aural hematomas, but with the multiple recurrences that you are seeing, you might ask your veterinarians to investigate this avenue. Your veterinarian is actually seeing the patient and is best equipped to evaluate the case and prescribe treatment.

Good luck with your cat.

Fawn

I have a 7 year old pitbull/mastif mix who I rescued a year ago. When I got him he had just had a surgery done for a hematoma on one ear which was never well taken care of afterwards but hasn't caused him much problem. He shakes his head and scratches at his ears constantly, mainly when he gets excited or is stressed out. A couple days ago I noticed his other ear was swollen up like a balloon. I had to go to work right away and while I was gone my roommate decided to make a 1/2 inch cut in his ear (without my permision and without me knowing!!) and now I am not sure what to do. I don't get paid for a few more days and have no money until then. I have been cleaning the wound often and as best as I can but he is obviously in a lot of pain and the whole situation worries me. What more can I be doing to help him and make sure he is alright until I can get him in to see a vet?
Any advice would be greatly appreciated!

Doc

Hello, Fawn,

I can't really prescribe "over the phone" for you, but I can give you some general suggestions.

The dog certainly needs some type of pain control. Ibuprofen and naproxen (Advil and Aleve) are not very safe in dogs, and I would not use them. Aspirin can be given to dogs (one regular tablet per forty pounds of body weight), but it inhibits platelet function, so you would have more bleeding, and I would not give aspirin in this case.

It is usually safe to use one regular-strength Tylenol per forty pounds of body weight given three times daily for short-term pain relief.

Keeping the wound clean with mild soap and water is good.

You really do need to get your dog to your veterinarian.

Brian

Hello,
I need some insight and advice, perhaps you can help. We have a Golden Retriever, female, 9 years old, 90 lbs. 6 weeks ago I discovered a balloon ear on our dog. She was shaking and scratching frequently a day or two before. To make a long story short...I took to her to see the Vet. I was told that Sam had an Aural Hematoma and an ear infection. The Doc suggested meds for the infection. She gave me three options for the Hematoma.
1. Aspiration
2. Teat Cannula
3. Surgery

I was told that options 1&2 had a possibility of recurrence. I was told that option 3 (surgery) would permanently fix the problem and the hematoma would not return.
We opted for option 3.
ChaChing!! I was told that Surgery, post op and healing were a success. However, yesterday the Hematoma returned. My dog is miserable and I am a little miffed. Can you give me some guidance on the next step to take?

Doc

Hello, Brian,

"I was told that Sam had an Aural Hematoma and an ear infection. The Doc suggested meds for the infection." When there is an ear infection, you surely need to handle that. It is painful for the dog, whether or not you have a hematoma. Pain also causes more head-shaking, which worsens the hematoma.

"She gave me three options for the Hematoma. 1. Aspiration 2. Teat Cannula 3. Surgery" These would be the standard options. I only use the prednisone therapy when there is no evidence of ear infection, suggesting that the hematoma was not a result of trauma. Aspiration almost never works, even when accompanied by wrapping the ear to keep it from refilling.

The teat cannula method worked for me in 90% of cases (before I started using prednisone therapy as first line). I like it. The major surgery option is so...MAJOR.

"I was told that options 1&2 had a possibility of recurrence. I was told that option 3 (surgery) would permanently fix the problem and the hematoma would not return." When 1&2 don't work (and neither does pred) the old major surgery is the only option left. The problem is this: there is no way to guarantee the hematoma will not return. That was a slip-up in communication. Even when surgery is the best option, there can be no guarantee that the problem will not recur. It doesn't matter who does the surgery, or how great they are. We are dealing with a biological system and you can't predict the outcome 100%. All you can do is your best.

I really cannot speak to what would have looked like the best option. Your veterinarian was seeing the dog and was best situated to evaluate the problem. That Monday-morning-quarterback thing is just not meaningful.

Having said that, I can understand your disappointment. You were not prepared for a possible treatment failure (regardless of the dollars). Unfortunately, I cannot just ask people to slip me an extra hundred for the guarantee (like buying the extended warranty). There just are no guarantees possible.

Golden retrievers often have allergy problems. The insides of their ears can itch, even when there is no infection. Also, the allergy can cause conditions inside the ear canal to favor the development of yeast infections. Finally, it is possible that your dog does have the immune-mediated vasculitis that would respond to prednisone therapy.

I would advise you to avoid getting confrontational with your doctor. First, I believe that they did their best to help your dog. Second, when you put people on the defensive, they GET DEFENSIVE. Now they are just defending their position instead of working with you.

A lot of doctors hate being jammed up with a bunch of crap clients have pulled off the internet. However, after the dog has been re-evaluated for presence (or absence) of a new ear infection, you might bring up the question of underlying allergic problems or immune-mediated vasculitis.

Thanks for reading and writing.

Brian

Doc,
Great advice and thank you for your quick response. Your insight and suggestions have been most helpful.
Thanks again!

Brian

Amber

I have a yellow lab who has developed an aural hematoma that hasn't gotten too out of hand yet. I would like to try the prednisone option with him but cannot find a vet to help me go that route. I am a Doctor of Pharmacy, so I am not a typical vet owner who is going to oversose or misuse the medication so I don't know why I can't find a vet to help me at least try this option instead of jumping to surgery right away. Please e-mail me so that maybe we can talk about this option and if you know any vets that would be willing to help out the unconventional way. Thanks, Amber

Doc

Hello, Amber,

While I respect and can appreciate your expertise as a pharmacist, you must know that it is both illegal and inappropriate for me to prescribe for a patient I have not examined. Aside from the fact that I could easily make an inaccurate diagnosis over the phone, the law is very clear in requiring a "doctor-client-patient relationship". If some unforeseen complication developed, how would I deal with it?

I wish that I had better advice for you than to to "keep calling", but I really don't know how to put you in touch with someone in this way. I can only advise you to ask more friends about their veterinarians. When you speak to someone, you might even start with "I know that you probably cringe when someone tells you that they read it on the internet, but would you be willing to explore this option for me?"

Good luck.

Lori Smith

We adopted a 7 year old weimaraner from a weim rescue organization yesterday. She had been starved and neglected before the rescue organization got her, and she came to them with a large aural hematoma. We have no way of knowing how old the hematoma is, only that they found her this way in August. She spent a month in veterinary care for the starvation issue and is now back up to 80 pounds and regrowing her coat, but she still has a hard lump in the bottom of her ear, and the ear is quite crinkled up. We've gotten conflicting answers as to whether it did have surgery or it didn't, but since there's still a lump, our question is whether there's anything that can be done to repair the damage to her ear at this point, or whether the scar tissue will soften up over time. It doesn't seem to hurt her at all. She does scratch at her ears, but she that may be due to a food allergy. She's been on Z/D prescription diet with brewer's yeast and benadryl twice a day for that. I guess the real question is whether anything can be done for the look of her ear after it's already crinkled up?

Doc

Hello, Lori,

With a long-term problem like this old hematoma, it is unlikely that you can do a lot to improve the cosmetics. This is equivalent to the "cauliflower ear" of the old time boxers who got their heads punched a lot.

This appearance can result whether you have had surgery of not, but it sounds more like "not". The body's attempt to resolve the hematoma has produced scar tissue, which shrinks as it matures, crinkling the ear into a hard knot. It is possible that a board-certified surgeon might improve it some, but I wouldn't count on anything pretty.

The most important thing now is to be sure that the ear canals are open, and not inflamed. Until you have things on an even keel, I'd ask your veterinarian to check the ears monthly, at least.

The wadded-up ear isn't pretty, but probably not uncomfortable. An inflamed ear canal is definitely uncomfortable.

Thanks for reading and writing.

Jeremy

Hi doc,
I just happened to come across this site as I am researching my dogs hematoma. Not two or three days ago I noticed it. It was very small and after a few days I could tell it was getting smaller. But this morning I woke up to a slight whimpering and discovered my dogs ear to be completely limp and swollen. I am worried cause money is a struggle right now but here huge went from almost nothing to a monster swell. I guess I have no choice but to take her in I am so worried she is such a beautiful dog and I just pray that her ear wont be permanentely disfigured. Thanks for reading.

Doc

Hello, Jeremy,

Since the ear has just recently blown up hugely, the odds are good that treatment will allow it to heal without a lot of disfiguring.

The longer it goes untreated, the more likelihood there is that the scarring will wad it up.

Many hematoma cases have a small degree of scarring, no matter how fast and aggressively they are treated.

Good luck

Jeremy

I just had one last question for you thanks for responding. Today is wed and the vet said he cant get me in until tuesday for the actual surgery. Should I wait tell then? Will it make a huge diffrence in her ears. And last I have been doing research and learned there is a laser treatement available but it costs more. Is it worth it to go this road or should I stay on the original path? Thanks so much again!

Doc

Hello, Jeremy,

I really haven't had any experience with laser treatment of the hematoma, so I cannot speak to that. Laser treatment can seal leaking blood vessels and in some surgeries (like cat declaws) creates less post-operative pain.

Due to charring of the wound edges, there are some surgeries where healing might actually be slower.

Your doctor probably has a lot more experience with the techniques that are successful in his hands. I don't think that the wait of several days will make a huge difference in your outcome.

It is important that you are comfortable with your doctor, and ask him any questions that you have.

Good luck

sandi

Dear Doc,
Thank you so much for having this blog! It is so helpful to read what others have experienced with their pets and your thoughtful responses. AS for me, I have an 11 yr old wonderful Weim who first had a left aural hematoma last July. Reilly had surgery and it was almost 4 months before his ear healed. He was on antibiotics and several courses of steroids. Even after the wound healed, I to had to aspirate fluid daily from small pockets that would develop in his ear where there were not stitches. We had about a month of peace and then he developed a hematoma in his other ear.This one initially started out in the mid area.He has been on a 2 week course of steroids (Medrox)and the fluid is now in the bottom of his ear flap. Since recovery from his previous surgery was so lengthy, I opted (for now) to aspirate the fluid which was initally serosanguinous, then frank blood and now serosanguinous again. I withdraw about 9 to 15 cc twice a day and the fluid fills up quickly.
I want to avoid a second surgery because of Reilly's age, heart murmur, traumatic recovery for both him (and me), keeping his ear wrapped & head collared and cost.. I am wondering if it is now time to change course and have the surgery...My vet has been supportive of my choices-he said he has never had a situation where the owner was willing to aspirate daily so this is a bit of an experiment from his point of view.I am willing to continue with with this present course for another month or so and see how things go. Either way, the surgery or BID needle sticks, are uncomfortable for Reilly.
I am wondering if you have any thoughts or suggestions that may help me and Reilly now and/or in the future?

Many Thanks,
Sandi

Doc

Hello, Sandi,

My concern with the daily or twice daily needle sticks would be that there is always the possiblity of introducing contamination. Then you have bacteria in a pocket of bloody fluid. It sounds like you are being very careful to maintain sterile technique, or this would have happened long ago.

In re the oral steroid use, you have to use pretty high doses, like immunosuppressive doses, not just anti-inflammatory doses if you are going to be successful with that approach. You might discuss that with your veterinarian.

If you are aspirating that often to remove fluid, I'm wondering if you are also doing anything to try to eliminate the pocket. I've had poor luck with wrapping the ear around some kind of padded core, but I wasn't able to change it and drain it daily, either. Keeping the ear wrapped around some sort of padded core to eliminate the dead space should slow the refilling. If it refills just a little, as you change your bandage daily, then you could aspirate that.

Again, you might discuss that with your veterinarian, also.

If the dog is traumatizing the ear at all, I would consider an e-collar, and some type of pain medication, like Tramadol. Again, discuss this with your veterinarian.

Good luck.

Paula

Thanks for your postings. I just noticed my 5 year old Golden Retriever had a lump on her ear yesterday. We researched on the web and "Google diagnosed" her problem as being an aural hematoma. She doesn't seem too bothered by it. Here is my problem - we spoke with the vet prior to going in about him billing us and her pet insurance which he agreed to over the phone. Once in the office he said that he would need the money upfront and that we would need to file with the insurance - he wants $800 for the operation - which we don't have right now. How quickly do we need to act? As she is a Golden with furry ears would any scarring be noticeable - right now if you just looked at her you wouldn't really notice anything. Also, the vet warned of the hematoma rupturing - is this common? What can we do to avoid this. Thank-you in advance for your help!

 Doc

Hello, Paula,

It is highly unlikely that the hematoma will rupture. It may become much larger, and be very uncomfortable. Also, if the underlying cause is an ear infection, that is also painful. Your dog should at least have the ears checked.

The scarring actually tends to "wad up" the ear into a crinkled shape.

You may not need extensive surgery, but the dog should be examined.

Sorry to be so late with my reply, but my community has been without power since 1/27/09.

Good luck

Vela's mom

Dear Dr Mobley,

A doctor myself (although my practice is limited to humans) I freely admit that I am committing the cardinal sin of using the internet as a medical reference. I am, however, very limited in my ability to see a vet at this moment as I am at sea on a Navy cruiser. My cherished pup is home with my dog sitter who adores her and will do anything to help her. As such I will, with my head down, admit that I taught him how to drain the heamtoma and provided him with the necessary equipment. (He demonstrated excellent sterile technique)

Vela, my dog is a 10 year old mix that looks like a white shepard but only weighs 50 pounds. In the days preceding my deployment, she developed a painless, nonfluctuant swelling in her ear. I took her to a nearby Army base (we are stationed in Japan) to the vet's office. I explained that I was preparing for deployment and stressed that I was looking for definitive treatment. He drained it on the spot and provided me with addtional butterfly needles and syringes and told me that my sitter could bring her in any morning at 0830 for repeat procedure "if it recurs". In that my sitter is also active duty and not on the Army base, I elected to have one of my med techs come by and I taught them both how to drain it themselves.

(I really can't believe that I am admitting to all of this.)

I did contact a Japanese vet that the base vet recommended (his surgical days are booked through 25MAR09) only to find that the DVM was on emergency leave until 22MAR09 and the vet techs wanted me to bring her in anyways. I declined as they are not English speaking and the dificulty of finding a translator to go in with me just to confirm that the doctor is gone and all they can do is precisely what I am already doing... the view wasn't going to be worth the climb.

Vela is an otherwise healthy dog and the vet confirmed that she did not have any other ear pathology on the primary visit. He told me that this would go away with repeated drainings and that if it was still there when he had surgical availability he would be happy to perform the "quilting procedure."

I have been getting daily reports that she is doing well, although she continues to produce about 3cc/day. She tolerates the draining very well (she trusts her pack implicitly and is very calm and compliant). The fluid is serosanguinous. Her energy level is reportedly at it's normal high level and her appetite is likewise normal. My fiancee returned to Japan last night from the Philippines and my current dilemma is: is the depot steroid worth a trial or should we seek surgery? If we should seek surgery, is this a "the sooner the better" scenario (requiring a great deal of research and the need for translators) or is it something that will not have a worse outcome if we continue to drain it until the Army vet is available? My third question is: What is the likelihood htat the ear will regain it's normal erect posture?

I sincerely appreciate this service that you provide and the knowledge I have gained from reading the article and subsequent posts.

By the way, nice bike... you should bring it to Japan... we do a lot of riding here as well. Lots os HOG members here.

Doc

Hello, Vela's Mom,

The veterinarian on post has seen the dog and I haven't, but I have never seen one of these resolve just with repeated drainage. The pocket refills rapidly, as there is still a leaking blood vessel and a dead space to fill.

I have (rarely) had success by draining and wrapping the ear pinna around a soft core (like a rolled-up paper towel) to provide a little pressure that eliminates the dead space while the leaky vessel heals.

I rarely use depot steroids in dogs. I do use immunosuppressive doses of oral prednisone until the swelling resolves, then tapering the dose at two week intervals until we are down to 1/2mg per pound every 48 hours to finish. This works in a surprising number cases, but the dog needs to be monitored and the veterinarian needs to be on board with this approach. Steroids are not innocuous drugs.

Vis a vis the quilting surgery, and "the sooner the better", long-term drainage may introduce contamination. Long-term filling with serum is eventually going to build up fibrinous material. I suspect that this will make cicatrizing deformity ("Cauliflower ear") more likely and more noticeable. Some "crinkling" of the ear is quite common with this more radical surgery.

Therefore, with more extensive surgery, the ear may very well stand erect, but possibly not in its previous smooth curvature.

When the steroids are successful in resolving the vasculitis that is causing the leak, those ears have returned to normal configuration.

I'm sorry that you are having to handle this "long distance". Please remember that my advice is by necessity of a general nature only. The veterinarian who is attending your dog is the best one to inform you as to the individual case.

Good luck.

Terri

Hello.
I have a 4.5 yr old Red Heeler.. in Novemeber I had her to the vet for a hematoma in her left ear. It didn't seem to bother her unless i was trying to touch it. She has never had a problem with shaking her head or anything of the such and the vet had said that both of her ears looked free of infections. She happens to play rather rough while throwing frisbees or tennis balls. and also like to put her nose under our back fence. The vet suggested that it was just from hitting her ear too hard. At the time, the vet had given me an option to just have it drained (less costly) or to have surgery (sky high). I opted for the less expensive procedure. My heeler had been fine ever since until last week. The Hematoma has come back, which was expected. However, this week, her other ear now has the same thing!!!

I had recently priced the cost to have surgery and deeming that it would take approx 1 hr... the surgery will be $750. That was before her other ear became swollen. Not really something I can afford.

I've been doing some googling and have read that the hematomas may resolve on their own in 4-6 weeks. I know that they are uncomfortable and probably painful when i try to feel them, but as long as they aren't bothered, will they really go away without having to have surgery?! Also, i know that her ear will already remain floppy regardless of surgery or no surgery, but can or will "cauliflower ear" become any type of medical issue she'd have to see the vet for? The ears are slightly warm to touch, but not necessarily hot as described that would lead me to believe she suddenly has any infections. Her ears are not something i've ever had any trouble with before this.

Any suggestions?

Doc

Hello, Terri,

When a hematoma resolves without intervention, it does not usually just disappear. You start with bloody fluid accumulating between the ear cartilage and the inner ear skin. These two layers are usually tightly adhered to one another, so this creates an abnormal pocket of space (filled with fluid).

Some of this fluid will form fibrin clots, which eventually will stop the leak. It also will form lumps in the abnormal pocket. When the leak is finally stopped, the fluid will be reabsorbed rapidly by the body. The lumps will take much longer to be reabsorbed.

As the inner ear skin finally re-adheres to the cartilage, it will not be stuck smoothly to its original location. The final healing process will crinkle up the (now thickened) ear. This is the "cauliflower ear". It is unsightly, but not painful.

While the ear is ballooned with fluid, however, it is under pressure, and pressure is uncomfortable. Ever had a "blood blister"? I have to feel like the dog is having discomfort while that thing is swollen. How painful? For how long? I can't say.

Your dog is one that I would investigate the possibility of having immune-mediated vasculitis as the cause. A significant number of these dogs have dramatic responses to high doses of prednisone. You might ask your veterinarian about this.

I hope is is helpful to you. Talk to your veterinarian about your concerns.

Good luck.

Harriet

Dear Doc,

Thank you so much for your wonderful source of information! Our 9 year old Rhodesian Ridgeback Kip had surgery on March 11 for a large aural hematoma (the entire pinna was swollen up like a balloon). On March 27 the stitches were were taken out. An incision on the underside of the ear has closed up since then and stopped draining serum, and the hematoma is starting to fill up again. I took him to the vet 2 days ago and the vet's advice was to leave it alone at this stage as Kip was not troubled by it. Since then it has grown bigger, and I personally doubt that it will resolve by itself. I am concerned that it will soon be really big again. Kip is still not particularly troubled by it. Do you recommend intervention as soon as possible, or, given that he does not appear to be in pain, do you recommend waiting to see how big it will become, and whether it might slowly be reabsorbed?

Kind regards,

Harriet

Doc

Hello, Harriet,

This is a case where it is really impossible for me to give you good advice. Since the ear has changed since your veterinarian saw it, it would be best for you to give him/her that information.

Generally speaking, when these are left to resolve on their own, there is more scarring and wrinkling of the ear. If the dog is not uncomfortable and you are okay with that, then it's okay to let it go.

This is a case where the doctor "on the ground" is in a much better position to advise you. If you are not happy with his advice, tell him/her that you need more information and clarification. If it is still not forthcoming, tell him that you'd really like to do more. If he/she is not interested, you could ask for a referral to a specialist.

FIRST give your regular doctor some feedback and the opportunity to communicate.

Sincerely,
Everett Mobley, D.V.M.

Lisa

Hi
I have a 14 year old Golden Retriever, who's ion very good condition for his age, slight arthritis etc but nothing major.
However he now has an aural haemotoma, (he has an appointment with the vet tomorrow). He shakes his head occasionally, not excessively, maybe three times a day. I wonder, considering his age, would the vet decide against surgery?

Doc

Hello, Lisa,

As always, your veterinarian is in the best position to make this judgment, as he/she can see the dog and I cannot.

Generally speaking, I prefer to be as conservative as possible. If non-surgical remedies work, then great. If they don't, then we proceed to surgery.

Any time that you find fifteen different ways of doing something, it should be obvious that there is no one best way that works for every case. If there were, that's what everybody would do.

I am glad that you are taking your dog in to see the doctor. The head shaking could be from an ear canal problem or just from the discomfort of the swollen ear.

Certainly with a fourteen years old dog we have more concerns about anesthesia than with a younger dog. However, when it's a "have-to" case, we go ahead. We certainly don't want the dog to be in constant pain.

With an older patient like this, we would want to do some pre-op risk factor assessment. Do some bloodwork, get a chest X-ray, maybe an ECG, as well. We'd put in an I.V. catheter and have him on a slow I.V. drip to support him during surgery and be ready to perform more intensive support if needed.

Good luck.

laser hair removal montclair

Very informative blog i had a same problem before, my ear also have a blood swelling and i don't know how to controlled it,so im going on the specialist for the operation for now i alright. How i wish i saw this post earlier because it important to taper the dosage off slowly. If you stop as soon as the ear swelling goes down, it's very likely to recur rapidly.

by: sphin

Dawn Lepine

Hello, I have a 7 year old lab who has an aural hematoma. It is not severe (yet). I took him to a local vet who charged me $118 to asperate it. He also gave me Methylprednisolone and dosage information which I forgot to write down and is not on the container. I tried calling the vet but they closed at 11am for the holiday weekend and will not open until Tuesday. Could you please give me an idea of what his dosage might be? He weighs 73 lbs, he is 7 years old?

Doc

Hello, Dawn,

I don't know that I can help you much, as I don't use the drug much myself, and not at all for this condition. I certainly cannot prescribe for your dog at "long distance".

From Plumb's Veterinary Drug Handbook, sixth edition, page 603:
For labeled uses:
Oral:
Dogs weighing 40 - 80 pounds: 4 to 8 mg.
These total daily doses should be divided and given 6 to 10 hours apart.

The drug is supplied in a variety of strengths with tablets available in 2mg, 4mg, 8mg, 16mg, 24mg and 32mg.

I'm sorry that the labeling doesn't give you all the information that you need. Can you leave a message on your veterinarian's answering machine? Many times, we have to visit the clinic even when it is closed, and you might get a call back.

Good luck.

Iesha

Hi what is the cost of aural hematoma treatments? I have a maltipoo dog.

Doc

Hello, Lesha,

The cost of treatment really varies. A course of prednisone therapy might be less than $20, plus the cost of an examination and consulation. Placing a tube drain is pretty inexpensive, unless the dog requires sedation, $25 to $50, (plus exam, etc.)

If extensive surgery is required, then you may have pre-anesthetic testing needed, plus the surgery itself. That could run $200 to $300 easily.

This really varies with what the dog requires, what level of medicine a clinic is practicing, the geographic area and so forth. More support personnel means better care, but more overhead, necessitating higher fees.

You get what you pay for.

Thanks for reading and writing.

Everett Mobley, D.V.M.

Shiloh

My dog is a 12 year old female pit bull. My Vet has prescribed Prednisone 2(20mg) pills every 12 hours along with carafate (1gram). On one web site the dogs recommended dose was 0.5mg of Prednisone once daily. Is 40 mg of pred. every 12 hours too much. Please help I'm supposed to start the medicine tomorrow.

Doc

Hello, Shiloh,

Since we are using the prednisone to treat the problem as though it is an auto-immune disorder (the body's own defenses attaching itself), we use immuno-suppressive doses. This would be one to two milligrams per pound daily. I usually start with 1mg/pound once daily, which would be 40mg for a forty-pound dog, but it can take more.

Your veterinarian has also prescribed Carafate (generic is sucralfate). This compound forms a gel that patches into any ulcers in the stomach lining. High doses of cortisone occasionally predispose the dog to ulcer formation, and your doctor is trying to protect against this.

It sounds as though your doctor is being pretty conscientious. You should share your concerns with him/her. Also ask him/her what to expect if the dog is having problems with treatment, and when to get the dog rechecked, and so forth.

Prednisone is a synthetic form of cortisone and it is a potent drug. Even when the patient does well on it, there are side-effects to deal with , and after taking high doses for a while, you have to taper off slowly. You cannot safely quit "cold turkey" if you have been taking big doses for a long time (weeks).

Stay in close touch with your veterinarian. He/she is best equipped to help you, as he/she is actually seeing your dog.

Good luck.

Tammie Faircloth

My Scottish Terrier received a small bite on the ear by a raccoon, I immediately gave him a bath and got him to the vets. His vaccination had expired so I now have him at an in home voluntary quarantine. I am very confident that he is free from the disease but the bite has caused some major problems. The vet seemed reluctant at first to prescribe antibiotics but after 48 hours and a very swollen ear he started the medicine a couple of days ago. It seems to have helped it is not as painful but the hematoma is so large the ear is drooped over. It does not appear to be draining anymore but a large 'pocket' is still there. Is there a home remedy that I can use to get it to drain? I was using warm Epsom salt poultices, peroxide, neosporin, etc. Any advice would be greatly appreciated. Thank You.

Sasha

My 9 year old lab appears to have an Aural Hematoma. I noticed it about a week ago, it was the size of a dime. He did have a yeast infection in his ears about a month ago. The infection cleared up wonderfully, during that time though there was a lot of excessive ear shaking. As well he, being a lab, is a water dog and naturally will shake those water filled ears. Since noticing the start of it I immediatly began to limit his activities that would make him shake more and started apply a cold cloth to his ears about four times a day. I also spoke with my great uncle who happens to be a retired vet. He said that it could dissipate on its own or grow large and require surgery. About a week later I noticed it had grown more, a few milimeters a day. Now it is roughly the width of quarter and pillow like. Other then apply pressure direcly to the hematoma, there does not seem to be any discomfort (no excessive shaking, you can touch the rest of the ear). This being Labour Day weekend I began to grow increasingly apprehensive because I would not be able to get him into my doc until Tuesday and my uncle no longer practises so he can not assist, just offer advice. When I called our emergency service the vet that answered (not mine) was very rude and refused to give me a straight forward answer. I described the size and the speed it is growing (slowly according to the research I have seen) I asked if this was a matter that could endanger his life if not taken care of immediately, he informed me no, but when I repeated it back to him, he started to change what he was saying and made it clear that in order to take him away from his long weekend was going to cost a lot more then just the standard emergency rate. After feeling like I do not trust my dog in his hands, I declined service and left a message with my vet to call me first thing tuesday to set up for either surgery or drainage depending on her recomendation. My very roundabout question to you is, did I just critically endager my dog's life by not taking him to that emergency vet?

Doc

Hello, Sasha,

Aural hematomas are not life-threatening, just uncomfortable and unsightly.

If untreated, they eventually do heal, but the way in which they heal naturally is quite slow and long-term, and tends to cause pretty severe deformity of the ear flap (pinna).

The longer they are untreated, the bigger they tend to get. The bigger they are, the more troublesome they are to heal with a cosmetic result.

I have never heard of an aural hematoma bursting or otherwise causing severe problems, other than the discomfort of the swollen ear.

Thanks for reading and writing.

Maria

Just wanted to say thank you very much for sharing your expertise!!! You are very insightful and offer many opinions, which is rare to find among vets --> the main concern tends to be the numbers on the bill they hand you at the end of it all.... ( it is sad to say, I have pretty much zero respect for 98% of vets I have encountered and I have seen plenty )

Thank you again - I have read the entire thread of posts and decided I will be asking my vet for the prednisone treatment or simply leaving it to heal on its own. Dyce's ( my APBT) other ear is deformed from an attack as a puppy, I care very little for her aesthetics -- much more so for her stress level, and not having to cause her unnecessary pain and discomfort of a surgery. She seems fine and shows no signs of being in any pain. I think I am more distressed over the whole thing than she is.
She does have skin allergies and I have recently started giving her oral homeopathic allergy drops. Could this have had anything to do with the sudden hematoma?

Again, thank you very much!

Doc

The homeopathic drops are unlikely to have caused a problem.

Cheyne

Is it possible to have the ear repaired to look normal after it has shriveled up and healed itself? I recently took over care of a dog who had a hematoma in both ears, both of which healed. Any information or suggestion would be great. Thanks!

Melissa

My golden retriever had the surgery for a hematoma in her left ear about a month ago. Everything went smoothly, but there was still a pocket of what the doctor called "fluid" where the hematoma once was. After a month and a couple attempts to drain the pocket via a needle, it still continues to fill up! Our doctor told us the next step would be to lightly sedate her and suture the area flat. Does this seem like a reasonable solution? Will this ever go away!?

Thanks for your help and advice! :)

Doc

Hello, Melissa,

I think that your veterinarian's plan is certainly reasonable. This should give you a permanent solution (though nothing is ever 100%-- you know, never say never, etc.)

Suturing the pocket flat eliminates the pocket, and if it is only a small area, this would not be too tough on the dog. When one has to use this technique to secure an entire ear flap, it's a pretty major surgery.

The other thing to consider would be the possibility of the immune-mediated vasculitis, especially if you didn't see another underlying cause for the hematoma (like an ear infection).

Your dog may or may not be a candidate for the prednisone therapy. Your veterinarian (who is actually seeing your dog) is your best resource, but don't feel bad about asking questions.

It's okay to open a discussion. Do remember that most doctors groan (at least inwardly) when a client starts with "I was reading on the internet...".

Good luck.

bugleg

My dog developed a hematoma over the weekend--we went to the vet and he suggested surgery. Unfortunately, we are traveling soon and are worried about recovery in our absence. In addition, the dog has a history of ear wounds healing very very slowly, so I am reluctant to open the ear.

In the meantime, the vet prescribed prednisone to knock down the dogs allergies, so he doesn't shake his head and make things worse.

The prednisone tablets are marked 100 (mgs?) and the bottle says to take three tablets twice a day for three days, then three tablets once a day for three days, then three tablets every other day.

Is this a long enough course to help with the hematoma? Should I discuss spreading out the dosage so it runs longer? Thanks!!

Doc

Hello, Bugleg (an old family name, I presume),

It is unlikely that your dog is taking 300mg of prednisone. I think there must be some misunderstanding about the labeling.

Prednisone is a synthetic form of cortisone. It is not an innocuous drug. Don't alter the dosing on your own. That is not a safe thing to do.

If you want to see if your dog can benefit from the immunosuppressive dose, then you need to talk with your veterinarian about that. You'll have to tell him/her you read about it on the internet, and he/she will groan (maybe not out loud, but we ALL groan when we hear that).

If the prednisone dose is being given for allergic symptoms, then it probably is not enough to suppress the immune response that damages the blood vessel in the ears.

You really need to communicate with your veterinarian who actually sees your dog on this. I can only speak in general terms about medical problems. Each patient has different needs.

Good luck.

Rachelle

Dear Doc -

Zoe is a 10 year old Am Staf/Sheppard mix with a fairly large sized hematoma in her ear. She is on antibiotics and ear medicine to help treat her possible infection and her consistent scratching.

I have discussed with the vet the surgery option but can not afford it no matter how much I love my dog (I am not a bad owner just a poor school teacher).

The vet told me it will take time to heal -- my question is how much time? What can I do in the mean time to help her "feel" better. When I touch her ear, she does not flinch and she is eating and playing normally.

I am a worried Mommy and do not know what to do. If you tell me 6-8 weeks - then I know to be patient -

Please advise - and thank you so much for your blog it does certainly help.

Zoe's Mom!

Doc

Hello, Rachelle,

If Zoe has an ear infection, then it is certainly important to treat that. The hematoma will not get better any faster if she is constantly scratching, shaking, etc. because her ear canal hurts inside. So, good job on that.

If you are planning to let this resolve on its own, then it certainly will probably take six to eight weeks. What has to happen is that the clotted blood stops the bleeding. Then the body has to dissolve the blood clot, which will take quite a long time. In the process, the ear pinna (floppy part) will tend to crinkle up and look pretty weird. This will be a permanent situation. That won't be painful, just funky looking.

In the meantime, if your dog has constant scratching, you might ask your veterinarian if she might have allergic problems that need to be addressed.

As far as the swollen ear pinna is concerned, if it is not painful, then there is really nothing to do for it except be patient. If it were painful (due to pressure from the swelling), then pain medication would have to be addressed. Since aspirin inhibits platelet function, aspirin would NOT be a good choice. If you believe that Zoe's ear is painful, you should talk to your veterinarian about that. It sounds from your description as though the ear is not painful.

It is important to let you veterinarian recheck the ear when you finish your meds to be sure that the canal is now clean and healthy. If it isn't, then additional evaluation and treatment would be needed.

Good luck.

kate buttling

Dear Doc,
My companion of 13 years, Lucy, a black lab mix, has what appears to be an aural hematoma that suddenly has blown into this huge swelling, like her entire ear flap. I am ashamed I have not noticed the swelling, but I care for my daughters 3 kids and barely had time to spend with her. What can I do until I can find a vet for her and hopefully get the funds to help her?

Doc

Hello, Kate,

First of all, these can come up really fast, so don't blame yourself for being busy.
There really is no good home remedy for this condition. If the dog would allow a cold compress (a cloth soaked in ice water, NOT ice), it would be good to apply cold for 20 minutes three times daily.

These are often painful due to the pressure created by the swelling. Aspirin is not good, as it inhibits platelet function, which would make the bleeding worse. Over the counter NSAIDs, like Aleve and Ibuprofen are not really safe to give to dogs.

Most dogs can tolerate Tylenol for short periods, but this could be a problem if the dog has other medical problems, such as a pre-existing liver condition.

You really need to get her to a veterinarian.

Good luck.

Danny

Dear Doc, I'm so glad I found this site. I have a much better understanding of what my dog is going through now. I have a five year old American Pitbull Terrier, and a hematoma showed up in his ear a few hours after a bath. At first it was about an inch and half around, and he didn't seem to be in any pain. I knew what it was but not how to treat it, so I began researching online. I read that ear infections were the most common cause, and that aspiration, drainage tube, or the surgey requiring quilted stiches were the vet treatments. I also read that if the underlying cause was taken care of, the hematoma would go away on its own (I read anywhere from 2-4 weeks, I had no idea it could take longer). And like many who have written here, I am ashamed to admit that I cannot afford to take him to the vet, so I was hoping home remedy type stuff would do. I used tea tree oil drops to treat a bacterial ear infection (because there were no symptoms of yeast infection or mites) but later began to suspect it may have been a food allergy (as we've just moved about six weeks ago and i can't find his old food brand anywhere), I used a hot compress twice daily (as I read was recommended), and I gave him baby aspirin. You are the first to mention that the hot compress or the aspirin might make it worse, but that makes sense because here we are a week and two days after the hematoma began and it now encompasses his entire ear flap. It doesn't seem to be painful, as he allows me to touch it, but it is obviously bothersome as he lowers that side of his head and sneaks in a head shake when he can. I tried tying his ear in place so that he couldn't shake it, but that appeared to put more pressure on it. I am wondering how to get ahold of prednisone, or if that would even work at this stage... Is that something I can purchase or have prescribed without having to undergo surgery? Any advice will help! Thanks.

Doc

Hello, Danny,
Prednisone is a prescription medication. It has many effects in the body and it is a drug that should not be used without medical supervision.
If you were able to buy it over the counter (and you shouldn't be, legally) you really don't have the expertise to use it safely.
It can certainly be prescribed without surgery. It would have been more likely to be effective when the hematoma was not so large.
It might still work, but it would take longer term therapy.
I wish I could offer you some great home remedy, but I just don't know of any.

Chris

This is all very good information. I would like to know more about a compression bandage. I have read that after aspiration, some vets use a compression bandage but I hve never seen an example of the bandage.

Paulena

Hello Doctor,
This is the best site for information and truly a gift from you, thank you!
My GSD, 8 yrs, has had a hematoma for 2 mos, twice drained by his vet and refilled. The vet, God bless him, doesn't see the need for surgery, as the hematoma is in the tip of the ear, doesn't seem to bother my dog unless pressed, and advised I let it heal naturally. Ribbons of scar tissue are forming; his beautiful stand-up ear is flopped over and crinkling at the end. Would soft massage on the scar tissue help? Would a paper cone to hold the ear upright help drain it? Would prednisone at this point help? Many thanks for any advice you can give.

Doc

Hello, Paulena,

With scar tissue already forming, I fear that some deformity of the ear is inevitable. Massaging and stretching the ear can help keep adhesions from forming, and might minimize the deformity.

Taping the ear around a soft cone would basically be putting a splint on to keep it straight. Also, the tape would keep the layers of the ear pressed together, which sometimes works to prevent fluid from refilling the ear.

I really couldn't say whether Prednisone would be helpful at this point. It is something you would need to discuss with your veterinarian. It is not an innocuous drug, so you have to be prepared to monitor and deal with the side effects.

Good Luck.

fromtheheart-anna.blogspot.com

So funny to read years of comments /questions about this problem. Our vet didnt drain it completely. is this the reason it filled up so quickly?I was very frustrated that she said we could try draining it more once we got him home but with such small punctures she couldnt guarantee how long it would be before they sealed up.She gave us the quote for the quilting process and no other options. Max is a golden mix at 68lb. He had yeast, bacterial infection. She put him on antifungal-Ketoconozole 200mg and antiobiotic-cephalexin 1,000mg 2xday for a month, baytril eardrops,prednisone 30mg 2x day for three days then taper to 20 mg for 3 days then 20 mg every other day. Will this dose of prednisone help as you suggested or does it need to be given at higher doses? We are working on switching food and started fish oil caps. Any other reccomendations?

OnMy3rdGolden

Dear Doctor,

Lots of good information here, thanks for the site!

My 9 year old male golden retriever just had surgery for an aural hematoma. He does have allergies and is on a maintenance dose of Vanectyl-P, but also periodically gets ear infections, the scratching of which we believe led to the hematoma. I normally catch and treat his ear infections quickly, but this one snuck up on us. It is now being treated with the usual anti-fungal ear drops.

The hematoma first developed last Wednesday, and we knew immediately what it was because another golden we had previously got one when rough-housing with another dog. The first dog had the surgery (including the x-ray film stitched to the outside of the ear) and the hematoma never returned. There was some scarring and his ear was a bit stiff and crinkly afterwards. I do not remember the incision being left open in that surgery.

In this case, my veterinarian drained it with a needle last Thursday morning. We increased his dosage of the Vanectyl-P to increase his Prednisone level. The hematoma returned on Saturday night, but I was unable to get him back into the veterinarian until this morning. Having already tried the draining, we opted for the surgery. She said she would be making an S incision, leaving it open and doing the "quilt stitching" of the affected area. They weren't able to do the surgery until early afternoon, so he is remaining at the clinic overnight. She stated she'd be bandaging his ear up over the top of his head tonight, but removing the bandage tomorrow to allow drainage. Since the first dog's incision was closed, I'm wondering how much drainage to expect post surgery.

I am hoping to never have to deal with another aural hematoma, but am wondering if you've heard anything about the use of medical leeches for the treatment of aural hematomas. I read a little about it on line, and it looks like a really interesting option to me. I'd be interested in hearing your observations on it as a possible treatment.

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