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November 28, 2006

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Doc

Hello, Anna-from-the-heart,

It sounds like your Golden Retriever, Max, must have an infection in his ear canal, also known as "Otitis Externa". The treatment you have described sounds completely appropriate for a mixed bacterial and yeast infection with a lot of inflammation.

That dose of prednisone should really help with inflammation in the ear canal. I doubt that it will have any effect on the hematoma, though. It usually takes much larger doses.

Again, I haven't seen your dog or his ear, and I really can't prescribe for you. You might ask your veterinarian about the higher doses of prednisone once the ear infection is controlled.

Good luck.

Doc

Hello,"On my 3rd Golden",

It is usually recommended to leave an open incision when the ear is "quilted" together. This allows fluid to escape so that the layers of the ear can adhere to one another. An "S-shaped" (also called sigmoid) incision is commonly used. Some people use a straight incision with a thin sliver of skin removed so that it doesn't heal together to quickly, causing fluid to accumulate. Parallel incisions have also been used.

By the time your veterinarian leaves your dog un-bandaged, the drainage will probably be pretty minimal.

In re medical leeches, it would be interesting to try. I am skeptical that they would be very helpful, however.

Leeches are the state of the art when dealing with severed fingers that have been re-attached. When the microsurgery is done to re-connect the blood vessels, only the largest arteries and veins can be repaired. Since arteries have more pressure, they typically allow more blood into the appendage than the damaged veins and lymphatics can remove. The re-attached finger becomes so swollen with stagnant blood that it often gets infected and does not do well because of the poor circulation.

The leech produces a natural anti-coagulant. This keeps the pooled blood from clotting, allowing the leech to feed at leisure. The leeches remove the blood slowly and continually. Of course, you have to keep using fresh, hungry leeches. This allows the finger to heal without being full of stagnant clotted blood. It's amazing to realized that with all our modern techniques and medicines, the lowly leech is the best solution.

In the case of an aural hematoma, you've got a lot of fluid in a big pocket. Draining it with a needle empties it completely, but without some compressing pressure (and often even with it), the hematoma will usually refill within 12 hours. The problem is that a blood vessel is leaking.

I think that if you used leeches, this big pocket would still refill. There is no compression on the vessel to stop the flow of blood. There is also nothing to stop immune mediated damage to the vessel (the reason we use the prednisone).

Someone would have to keep the dog from shaking or scratching off the leeches. The leech spit apparently has some local anesthetic properties. You usually don't feel their attachment, but I'd be surprised if the dog didn't notice they were there and go to work on them. Even if the dog cooperated, someone would have to keep adding new leeches as the old ones filled up.

I can't say it wouldn't work, but it would certainly be a logistical challenge to keep applying fresh leeches and getting the dog to tolerate it over a period of several days.

Thanks for reading and writing. Good luck.

OnMy3rdGolden

Thanks for the reply.

Doggie is home and doing well. There was a fair bit of drainage the first 24 hours, so she actually ended up keeping him at the clinic until the end of the day after the surgery, figuring I would far prefer the mess to be in the crate he was in there than all over my walls and carpets at home. After the first night she had him bandaged with the ear flipped back over his head, but bandaged in such a way that the incision is exposed to allow further drainage. He's also got an e-collar on to keep him from fussing at the wound and bandage. He's also had an injection of antibiotic that she says should be good for 14 days, to prevent infection at the incision site. The incision ended up being a straight one instead of the S.

Now that he's home he's still bandaged and e-collared in the same manner and there's been very little discharge from the incision site, even when I massage the area to help the drainage. The hematoma was fairly high on the ear flap, so keeping it folded back also helps keep the incision open and applies pressure to the area. He's the worlds most compliant dog and doesn't appear to be in much pain, even when I have the bandage off to massage the hematoma site to encourage drainage out through the open incision. He hasn't been trying to get the e-collar of the bandage off, but did try to go after the ear before I put the collar back on after re-bandaging, so I guess he's in the collar until this has run it's course.

Leticia L.

My dog has just been diagnosed with an aural hematoma... and I am the paranoid parent. I just wanted to say that after googleing to learn more, your site brought me a sigh of relief. I, like many owners am unable to afford the surgery (cost of $560.00) suggested by my vet; yet I hate to see my baby in discomfort.

Do you know of any non-profit organizations that assist with the cost of pet required surgeries? I live in California (city of Merced) and any information on financial resources would be greatly appreciated.

Doc

Hello, Leticia,

I am sorry that I do not have any information on this subject.

Good luck.

Terrie

I just discovered an aural hematoma on my 7 year old lab mix yesterday. This guy is a rescue that was seriously abused as a small puppy and as a result is on prozac daily and Xanax for extreme situations. He has always had a habit of shaking his head and pawing at his ears. We have had his ears check extensively under sedation (he doesn't do well during exams) and the doctor said he was fine. We made a joke out of it that his crazy little brain was itchy, I had no clue something like this could happen. My question is, do we put him through the stress and anxiety of treatment for the hematoma or just let it heal on it's own. This guy deserves the best of everything after all he has been through so the cost of surgery is not an issue, the psychological impacts however worry me. Any advice?

Doc

Hello, Terrie,

It is always difficult to make any kind of long-distance diagnosis and recommendation. There are so many things that I cannot see and do not know about your dog. However....

One of my concerns here is the dog's long-standing head-shaking and pawing at the ears. This has not really been handled. It may or may not be the cause of the hematoma, but it is bothering the dog.

Using psychotropic drugs can change you mood, but not your situation. It is not uncommon for allergic animals to itch inside their ears. This can happen with no other apparent allergic signs. Food allergy patients have been documented who itched ONLY inside their ears, and sometimes only in ONE ear. Psych drugs are not going to help itching very much.

Not even considering the hematoma, I would be concerned about the dog's ear situation. Despite the fact that the ear canals appear clean and normal, you could have an un-handled allergic condition. You could also have a middle-ear problem. to rule that out, you would need to take X-rays of the tympanic bullae. This requires anesthesia so that an X-ray can be taken "looking" straight down through the open mouth.

Allergic problems could be tested for by giving the dog anti-inflammatory doses of some type of corticosteroid (prednisone, for instance). A cortisone-containing ear drop may also give relief of allergic ear-itch when you see no yucky stuff in the ear. If the dog has food allergy, it requires a long-term dietary elimination trial (4 to 16 weeks), eating a special diet which the dog has never eaten before. It has to be new ingredients, not just a different brand of food.

Since there is no evidence of ear infection (providing that the X-rays of the middle ear are normal), this dog might be a candidate for the immuno-suppressive doses of prednisone, rather than surgery. If it doesn't work, you can still do surgery.

Again, while the hematoma would eventually resolve on its own (though this may take weeks to months, and will not be very cosmetically appealing), in the meantime, the dog is uncomfortable. In addition, you really need to get a better handling on the head-shaking, ear-pawing thing.

I think it is unlikely to be a prozac deficiency.

Good luck.

cristina

Dear Doc,

Our 9- or 10-year old Labrador has aural hematoma for weeks now. I remember him having a much milder version of this condition before therefore I chose not to do anything about it as it resolved by itself then. Yet his ear is now around 2 inches thick. We are worried now. The last time he had anesthesia for stitches, he was out for a day. (And although he is a Lab, he is not so friendly or warm especially with new people so seeing vets can be stressful as well. We suspect that he had a bad childhood of some sort since we got him when he was more than a year old). So my questions are:

1. Will it still resolve by itself?
2. Is there anything we could do besides surgery?
3. Will he tolerate anesthesia at his age?
4. What local anesthetic could I ask for the vet if ever we choose to have it drained?

Thank you so much in advance.

Doc

Hello, Christina,

Without seeing the dog and examining him, I can't even be sure that a hematoma is the correct diagnosis. There is no substitute for an examination by your veterinarian. I can only speak in general terms.

1. Eventually a hematoma will resolve. The ear may be deformed and wrinkled in the process, but the ear doesn't explode. It just looks weird. In the meantime, if there is pressure, then that is uncomfortable. Also, the ear canal needs to be examined to be sure that there are no other problems that you can't see from the outside. nothing hurts like an ear-ache.

2. If his ear canals and eardrums are normal, and he really has a hematoma, it is possible that the dog might respond to the high dose prednisone therapy I mentioned in the original post. Again, you need to discuss this with your veterinarian.

3. Modern anesthesia allows us to do some major procedures on some mighty old dogs. Pre-operative risk factor assessment will tell you more: blood tests for liver and kidney function, chest X-rays to assess heart and lungs, and perhaps an ECG for the heat as well. With that information in hand, if there is any doubt, your veterinarian can consult with an anesthesia specialist to help with the case management.

4. It is hard to numb the whole ear by injecting the hematoma. The medication gets diluted. A skilled anesthetist could perhaps numb the whole area by injecting nerves that supply it. Injecting local anesthesia can be a little difficult sometimes: even when buffered with sodium bicarbonate, it still burns a little.

I find that when hematomas are under a lot of pressure, a calm dog actually experiences relief when you drain it, and he doesn't act up much. A nervous dog would probably need at least a tranquilizer. There are some tranquilizers which have antagonists ("reversing agents") so that your pet doesn't stay sedated so long.

Your dog needs a checkup. His ears may be more painful than you know.

Good luck.

Bonnie

Hi, my dog has an aural hematoma. We found him as a stray about two months back. He's such a sweet dog, but we can't afford to get him the surgery, as we already have to get him worm tests, treat his mange, and get him healthy. I don't want him to be in pain, so is there a cheaper prescription medicine that would make having that thing easier on him? He's such a good sweet dog, and I feel like such a crappy person because I can't get him the surgery. Also if there is a cheaper way to fix his hematoma I love to know. Please help, I don't want him to suffer.

Doc

Hello, Bonnie,

If the hematoma is long-standing (two months or more), use of prednisone (the medicine described in the post) probably won't help much. At that point, the hematoma is probably not painful any more, though.

If it is a recent development, it is important to see whether or not he has a problem in his ear canal. If there is an ear infection causing him to shake his head (and rupture a blood vessel, producing the hematoma), then that IS painful and needs to be treated. The ear canal would need to be examined,and a swab examined to see what's causing the infection. the canal would then need to be cleaned and appropriate medicine used. An ear canal infection probably hurts worse than the hematoma.

If the canal is clean, and the hematoma is recent, your dog might be a candidate for the prednisone treatment. It doesn't work for every dog, but does work in a surprising number of cases.

I really cannot prescribe for your pet "long distance". You need to work with your veterinarian. Don't be afraid to ask him/her questions, or to ask what alternatives are available.

Good luck.

Paulena

Dr. Mobley is absolutely right about the usefulness of an anti-inflammatory. After 3 mos. of periodic draining of my dog's ear (by aspiration) and trying everything to keep it from scarring, the scarring set in anyway and I finally returned for the 4th time to my vet for another consultation about surgery. This time I got his partner (both in veterinary practice ~ 25 years) and his partner recommended an injection of an anti-inflammatory (not prednisone, something else), which worked wonders to internally drain the earlobe in 3 days. The hematoma has not come back (more than 1 month later). My German Shepherd's beautiful perky ear is bent over and bumpy, but it is only cosmetic and the ear itself is unaffected. A long ordeal which could have been shortened and the scarring avoided had I insisted on an anti-inflammatory at the outset.

Doc

Hello, Paulena,

I am glad that you are having good results now.

In defense of the first veterinarian, it is often difficult to predict what the best treatment will be for a particular case.

It's easy to "Monday-morning-quarterback" these things. Not so easy to always be right the first time.

Good Luck.

Bomber

Dear Doc,

I have an american bulldog who had a hematoma in his right ear. He recently underwent surgery (9 days ago). My question is, Should the pinna look like it should be healing yet? It doesn't look like there is any growth or change in the incision. He somehow managed to get to the sutures despite having a giant cone on his head. We are doing all the post care advised by out vet including a hydrogen peroxide solution spray, an antibiotic for the infection which caused him to shake and a cleaner to keep the ear free of dirt and germs. there is no redness or puffyness, I am just concerned because it doesnt look as though the incicsion is healing

Doc

Hello, Bomber,

If the surgeon made a larger opening by actually removing a sliver of skin (rather than just slitting it open), then it will take more time for that gap to fill in. This is often done so that the opening will not close too fast, sealing up before the rest of the ear layers have grown back together. This would allow fluid to re-accumulate, and prevent the ear layers from growing back together.

You should share your concerns with the doctor who is treating your dog. I am sure that he/she will want to know how the healing is progressing, especially if things aren't going according to plan.

Good luck.

Malcolm Stove

Hello, I have a 9 year old Staffordshire with this problem. This is about the 4th time, on alternate ears. It usually heals up after treatment, 1st time the left ear which has some inner scarring but the 2nd time it was treated, this time with Prednisone. It's the 2nd time on the right ear now, there was no scarring after being drained but it did heal up. This condition has been happening over the years. I could not see the vet this time but I got more prednisone which he's been on for 5 days now. It does not seem to have stopped the swelling and I'm not sure whether to take him back and have it drained. I do not want to do this as I have to put him to sleep as he will not let the vet touch it. this is day 5

Doc

Malcolm,
Other than trying the prednisone for a few more days, I don't see too many more options than drainage.

Your veterinarian is the best person to advise you here.

I am concerned about the recurrences. It makes me wonder if he has other immune-related problems or allergic problems that are predisposing him to this.

You might discuss this with your veterinarian, and consider referral to a dermatology specialist.

Good luck.

grace

Hello,

Gus is a 11 year old weimeraner that just underwent surgery for his 5 or 6 hematoma (I've lost track its been so many). The vets sent him home in an ecollar and the ear bandaged with a soft core that kept it in place, and 50mg of tramadol to be given 3 times a day. I removed the bandaging as advised the next day but he is definitely flapping and shaking his ears a fair amount and the ecollar bumps into the wound a bit from the side to side movement when he trots around. I am wondering if keeping some sort of bandage on might be a option to help the healing process or if there is some reason not to have the ear bandaged up. Also shouldn't he be on some sort of antibiotic? I'm just very concerned about it healing properly without recurrence or infection.

Thanks for all your help! There is obviously a demand for advice and discussion regarding aural hematomas! It's good to know we are not the only ones that continually struggle from this.

Grace and Gus

Doc

Hello, Gracie,

I am sorry you are having such difficulty. Without knowing what procedure was performed and knowing your dog, it is difficult for me to give you specific advice. Your veterinarian who is treating the dog is your best resource.

That being said, if there is a large open wound (as with some techniques) I personally do like to keep them on antibiotics. If they are not used, then careful monitoring of the open incision is necessary. You do need to watch for drainage, swelling or discoloration.

With a guy who is shaking that head a lot, it is sometimes helpful to bandage the ear flap across the top of the head (with some padding on both sides of the flap). This is a little difficult to do if you haven't had any practice and you don't have something to make the tape extra sticky so that it will stick to the ear flap.

Please discuss your concerns with your veterinarian.

Good luck.

stacy

Dear Doc,

I hope you can help, I have read everything & it has provided me with a lot of information. First I must tell you that my boxer mix was adopted from a shelter as a puppy 10 years ago. She has never had an aural hematoma, so when one appeared suddenly we rushed her to the vet. They confirmed that it was a hematoma, & gave her Betagen Otic 15 MI, 3-4 drops each ear 2 x's daily (I think for bacteria they found), they also gave her Metacam oral liquid, 1.4cc once every day for five days. They said they ONLY do surgery for aural hematomas, & that there was no other acceptable option. They said we needed to bring her back after the 5 days of meds for surgery. We drained our small savings to take her 4 days ago. The ear is not getting any smaller. She shows some discomfort when you touch it. Because of her age & an overnight stay, etc. they said it would cost almost $500 for surgery. We drained our savings for the first visit, & would have to spend our rent money to get the surgery.If she could die from this I would have already spent my rent money on her (she is much loved). Thankfully she can not die from this condition.
Finally to get to my questions...Would it help to find another vet who would drain the ear by aspiration? Or would it most likely refill & be a waste of money? She is so adorable I would hate for her to have "boxers ear" but I also do not want to endanger our housing. Considering everything I have told you would you recommend for the the ear to be left alone to heal with the care we have already provided.Or find another Dr. who will drain it (by aspiration). As I just don't know how we can afford such an expensive surgery. I feel like a bad pet Mom, I want to do the right thing for my dog & my children. Sad,stressed,& I can't sleep, please help. Thanks for your time!

AJM

Hi, My 7 year old black lab recently had surgery on her ear hematomas. Her left ear had a huge one and the right one was beginning to develop so we were able to catch that one before it ballooned up like the other one. We've had her home for about a week and the first half she had her head bandaged and wore a cone. Then the vet took her bandages off after about a week. She still has her stiches in as well. My question is: her left ear (the larger of the hematomas) looks to be swelling again but not like when she had the hematoma. Is it natural for her ear to be swollen looking after the surgery?

Doc

Hello, AJM,

That kind of swelling is not exactly desirable. It could just be some scar tissue thickening. On the other hand, you may have some infection present.

You really should let her veterinarian take a look at the ear to be sure everything is okay.

Good luck.

stacy

Dear Doc,
I have been checking in every day, & was sad to see you answered the person after me, but did not respond to my questions.

Doc

Stacy,
I posted a reply, but I'll be darned if I can see where it disappeared to. I usually email directly, also, but you did not supply your email address.

Anyhow, I don't think that aspiration is likely to be successful. Even when I wrap the newly drained ear around a soft core to try and keep it from refilling, it usually refills anyway. Repeated aspiration may introduce infection, also.

From your description, it sounds like putting in the small drainage tube (as illustrated in the post) might be an option. This procedure is usually done on an out-patient basis, often requiring very little or no sedation (depending on the individual dog's temperament and pain tolerance). It should be much less expensive than the major type of surgeries.

If you just leave it alone, there will certainly be some discomfort while the ear is swollen, due to the pressure. As it heals, the discomfort disappears, but the ear pinna does crinkle up, like the old "cauliflower" ear of the professional boxer.

Sorry about the delay. I hope this is helpful to you.

kernow

Have just picked up my darling girl boxer, age 11 from the vets. She developed a large hematoma. I noticed it Friday and took her straight down and had it drained, it refilled by Saturday evening and she was so uncomfortable sunday that I rang and booked her in for the "quilting" surgery today. This was a big decision as she had a large surgery for lump in her cheek, tooth and epulis removal only in November and because of her age was hoping not to put her through further procedures.
She has had a good recovery from the surgery and is sleeping comfortably as i write.
My question is on the timescale for healing, the vet has said stiches out after 3 weeks, have you ever known them to be able to come out sooner. In 3 weeks we will be on holiday and I have to check if kennels can take them with Brandy in a collar and possible stiches or find a kindly neighbour to dogsit, thankfully it is only a week away but i am so worried what stage she will be at, i will question my own vet when i see him for re-exam next week, just trying to get a feel of recovery in your experience

I know it is probably a bit pointless because every case is different but thanks for any reply.

Have not yet told her that she can no longer play head shake games with her toys :(

Doc

Hello, Kernow,

As you have surmised, yours is a difficult question to answer. If sutures are removed too soon, the layers separate. If left in too long, they begin to fester. They are foreign objects, after all, and once healing has occurred, the body starts trying to get rid of them.

I would think the kennel would be okay with the E-collar and sutures. This first week is when the discomfort would be the worst, and I suspect that your veterinarian has prescribed pain medication.

Patience is not one of my virtues, so it's hard for me to prescribe it to others. Unfortunately, that is what is needed. Your veterinarian will be able to give you a much better answer when looking at your dog.

Good luck.

Stacy

To Uber Patient Doc,
I have a three month old puppy. My boyfriend and I have had her about a month now. When we first got her she had ear infection in her right ear and the ear was pretty inflamed and on top of that she had this bite right at the base of her ear that got infected as well. She is the biggest puppy out of the litter we got her from (at the shelter) and she was definitely picked on the most. She also had a rough environment apparently she comes from a home of over 40 dogs. So her living space was definitely dog eat dog when it come to food I assume. Anyways, she is a Lab/Husky mix. Body of husky and the brains of a lab. It's been a week and a day or two that she has had an aural hematoma. Took her to the vet as soon as we noticed it. Tried witch hazel (which we found for a homeopathic remedy) and it did nothing. I think it started growing too big for it to do anything. It's starting to grow faster and I can tell it's starting to really bother her. She's a trooper and lets us both feel it and doesn't whine or pull away but she's not as playful or at least as willing to play and she sleeps on the same side so the hematoma ear is laying on top to relieve the weight. So now I get to my question or I should say questions. (I do understand the necessity to see the dog, but general advice is appreciated. This is my first dog I have personally owned.) The vet mentioned that since she has no present ear infection that she can tell at all that the cause of the hematoma is obviously a concern as well as relieving it. It seems that some form of surgery is going to have to happen. My concern is the putting her under part. Is she too young and what could be any health risks? (Oh and the vet we see works Mon-Thur which is why I'm prompting you.) And than is the tube thing a legit option for her? We want something inexpensive as the cheaper the better. But I just heard of this procedure in my findings. It sounds highly effective and I'm willing to clean up the mess. And she listens pretty good about being still so she doesn't shake. And to the last part. The vet did mention that an idea for the cause under her conditions that it might be cause of some form of autoimmune something a rather. And so I ask a third opinion on this. I'm just super worried for my little girl. And if she does have any autoimmune thing life might be a little rough for her when it comes to rougher playtime. But I want my little girl to be better so I'm seeking my third opinion. (We did take her to another vet and he seemed to think the same just minus the autoimmune, but I really don't like the idea of the cauliflower ear.) I AM calling the vet tomorrow. Thanks for any advice you have for me in advance!
Sincerely,
One SUPER Worried Dog Owner/Mom

Rick Harman

First, thank you so very much for this stupendous resource.

My 13.5 yr old cattle dog mix (she's half hound; ears floppy, not erect) developed a small aural hematoma (quarter-sized; her first to date) over the period of a week. She's always been a vigorous head-shaker. I realized what it was and when it started getting hard to the touch, I lanced it with a sterile needle and squeezed out the blood to relieve the pressure. As expected, it began to slowly fill again in about 24 hrs; I researched the options in great detail. I decided on a specific course of action (drain; local steroid injection; tight wrap) before calling my vet. The vet refused to consider anything but surgery and I made an appointment with a different vet who would do as I wished.

This went fine except for one thing: I believe they botched the bandaging.

After draining and injecting the steroid (methylprednisolone), they wrapped the ear around a rigid cylinder (a hypodermic syringe body); but then they taped the ear to the cylinder with nonelastic adhesive tape (I had suggested an elastic wrap to provide uniform pressure to keep the evacuated blister cavity collapsed, but they didn't do that). A few hours later I could tell the blister was filling with fluid again (the adhesive bandage was beginning to bulge slightly and the bulge was spongy to the touch). If this is the standard bandage for this procedure, it is no surprise that these drain/inject/wrap solutions often fail. How could it possibly work reliably if the evacuated blister cavity is not completely collapsed during the recovery? Any runner understands this.

Rather than struggling with the vet over how to do their job, I am going to just re-bandage it the way I think it should be done: with a self-adhesive ace-type wrap, under tension, compressing the ear against the cylinder. This elastic wrap will be applied directly over the fur, with an adhesive tape wrap over that to keep everything in place.

I guess I'm just looking for an independent confirmation that I have analyzed this thing correctly and am doing the right thing. Sadly, I don't feel I have a local vet resource that will listen and respond to my concerns.

Sorry this is so long...

Rick

Sudha

Hi doc,
My 10 years old bull mastiff/labrador had aural hematoma. We took him to the vet on Friday and the surgery was done. He has stitches done. He has a collar on now to prevent him from scratching his ears. The thing is he's refusing to eat. He seems to be very weak. He only drinks water. He hasnt barked since we came home. It has been close to 48 hour. Is this normal? Could he develop a fever or any infection our of this?

Doc

Hello, Sudha,

Sorry to be so late on this. We have been changing over our practice management computer software in the last week and it has been killing me.

You've probably already handled this by now. Infections can certainly develop, because you have an open wound. The big thing right after surgery is probably just post-operative pain. You should ask your veterinarian for some additional pain control, I suspect. Also in the first 24 hours, some dogs (particularly older patients) may have some lingering effects of the anesthetic.

I hope things are going well now.

sudha

hi doc,
thank you for your kind reply. we took him to the vet and thankfully, he did not develop any infection. he's doing so much better now. everything is back to normal.
thank you again for your time.

Carla

Dear Doctor:
You have repeated almost word for word what my veterinarian has told me about my Black Lab's ear hemotoma. It feels good to know that he knows what he's doing. My question is: Do you know or recommend Doc Ackerman's holistic allergy remedies? We are hesitant to put him back on Pred.
Thanks,
Carla in PA

Doc

Hello, Carla,

Of course, you assume that maybe I myself know what I'm doing.

I looked at the herbal product you asked about, but I really have no expertise in that area. I've forwarded your question to a veterinarian trained in traditional Chinese veterinary medicine and the use of herbs.

I'll let you know what she says.

Thanks for reading and writing.

Doc

Hello, Carla,

Here is what the herbalist(traditional DVM, Missouri Vet School, later training in traditional Chinese veterinary medicine, herbal, etc.)says:

"I never advise getting oral herbs online no matter how good they look. They are unregulated. These people need to find a practitioner who has investigated and trusts a line of products and knows what herbal formula specifically to use for a specific patient's condition. Herbs are not something for people with no training to be monkeying around with. I wouldn't recommend that any more than I would have someone search for antibiotics online to treat a bladder infection."

So, good luck with that.

Mandy Perez

Hi Doc,

My Great Dane is 7 months old and was very sick with worms, bacteria in his stomach, and and ear infection when we got him. Now after about $1000.00 everything is finally clearing up. But when I started using the ear wash and ear medication to clear up the infection he started shaking his head alot, which I think caused an aural hematoma. I havent had the money to take him to the vet and today he shook his head and blood went everywhere. I tried wiping his ear to get the blood off and some hard flesh came off with it. I was wondering if this will heal itself or should I take him to the vet? I really cant afford more vet bills. Should I put a triple antibiotic cream on it?

Doc

Hello, Mandy,

Triple antibiotic ointment on the sore place certainly will not hurt. I doubt that you can actually get it inside the ear canal effectively, though. It is a little hard for me to visualize what is happening here.

Infections in the ear canal do usually require removal of the debris in order for the medicine to be effective. Some ear washes contain acetic acid. This inhibits the growth of bacteria and yeast, but also will really burn if the ear is sore. Just flushing the ear with plain water or hydrogen peroxide would probably be better and less painful.

Continued shaking of the ear usually makes the hematoma worse. Ideally, we would put a padded bandage to wrap the ear over the top of the head, leaving the opening of the canal open for treatment.

Will this heal itself? If it does, there will probably be pretty severe scarring and wrinkling of the ear flap. If you have an open, infected wound, it could be a really long time healing.

I would definitely recommend a return trip to the veterinarian. Sorry I can't fix it "over the phone".

Good luck.

Rex

Dear Doc,

I am from Manila, Philippines.
My 4year old black male lab had surgery for aural hematoma Dec 2009. I remember the vet telling me that he did a procedure where later on, the fluid would be drained by itself without having to go back to the vet.

Well last week, I started noticing a familiar smell from my dog. My suspicion was confirmed. There is a smelly liquid that is coming from the ear that had been operated on months before. I inspected the ear and there is no swelling, no redness at all... but it seems as if the ear was draining some fluid. I am cleaning his ear to make sure there were no wounds and I could not find any.

Why does the ear drain like that? I unfortunately moved away and the vet who did surgery is now about 3hours away. I still have to look for the vets in this area where we are now and I am afraid that it is going to be expensive.

Would you mind giving me some ideas what is happening? My lab does not seem to be in pain. As a matter of fact, I was teaching him tricks last night. Everything seems normal. His appetite, playfulness etc except for that fluid down the ear. This morning I put some ice packs near the ear and he probably remember how we treated him after his surgery. I would put icepacks covered with towels on his ear and he would sleep like a baby.

Please help.

Doc

Hello, Rex,

I cannot visualize exactly what's going on here.

Is the ear pinna (the floppy part) swollen?

If so, how much of the pinna is involved, percentage-wise?

If there is swelling, is it closer to the tip or to the base?

Apparently you cannot see the opening where the fluid is coming from. Does the pinna stay moist?

Just the inside or both sides?

Is it possible the fluid is coming from inside the ear canal?

If you massage the ear canal below the ear opening, does it feel squishy?

Can you hear fluid moving?

If you blot the fluid with a white tissue, what color is it?

If the ear pinna is not swollen, I would be inclined to think that there is an infection in the ear canal. This requires treatment, but probably no surgery and no major expense.

Good luck.

Damian

Hmmm this is good to know my dog got an aural hematoma 2 days ago and we took her to the vet first thing the next morning. My dog is a Boston terrier and has allergies the vet gave have her a steroid shot, ear drops, and antibiotics. Then told us what we already know that it was a aural hematoma, but said since it is a small one (just a bit bigger than a quarter) that he wants to leave it and let it drain on it's own. It hasn't gotten bigger and she shows no discomfort from it not even a bit of scratching so i wasn't to worried. I just wanted to know how long i can expect for it to take to be reabsorbed and get and estimate on how bad the scaring will be. Now i know that it will be a few weeks so i will stop feeling it ever day to see if it's gotten smaller lol. Still a bit worried about the scarring but i think she will still look as adorable with one ear straight up and one bent down as she would with both standing up.

Doc

Hello, Damian,

So, who knew the prince of darkness would have a little dog?

It sounds like you guys have a plan, but I would continue to check the dog's ear daily. While you don't want to go nuts looking for microscopic shrinkage, you do want to be aware of it if the hematoma starts to enlarge. That would mean you need to re-evaluate your treatment plan.

Good luck.

Damian

lol a little dog not be appropriate for the prince of darkness. Have you never met a Chihuahua those dogs are vicious if you aren't their owner or maybe they just don't like me. I almost lost a finger to a 6 week old pup that's head was only about as big a babies fist.:D I will be sure to keep a watch on it, and take her back in if it starts getting bigger. Thanks for the advice.

Erinn

Hi Doctor,

One of my ferrets seems to have developed what I think looks like an aural hematoma (I'm a veterinary technician so I've seen plenty of them in the past.)

Being the weekend, the ferrets' vet is out of office, and I plan to phone on Monday to get him looked at, but I'm curious what your thoughts are. Having much smaller ear pinnae than dogs or cats, can ferrets benefit from the drainage surgeries used to treat hematomas? Or is my option pretty much aspirating it and hoping it heals up?

Thanks for your opinion.

Doc


Hello, Erinn,

I've never seen such a thing in a ferret, but I don't see many ferrets.

I have emailed your question to people who are more in the line of being ferret experts and I will relay their answer to you.

Doc

Erinn,

Here's what the ferret doc has to say:

"Ferrets will often aggressively bite at each others ears (especially intact males or ferrets with adrenal gland diseases), and I have seen these become pretty swollen. I have never seen a primary aural hematoma. I would want to rule out traumatic bruising before recommending treating a hematoma."

Looks like you're going to need somebody there with "boots on the ground" for this one.

Good luck.

TroubledCat

I've been reading a lot of these comments, my parents have a 7 yr old cat they adore that appears to have a large hematoma in his left ear.

They really don't have the money for any type of surgery, and have asked me to do a little research. Does anyone have a range of how much this would cost them if we can get it together? We have no idea what to expect.

It's been getting worse and has increased in size over the past few weeks. The cat doesn't seem to be in pain and doesn't mind if you touch around the area. I understand they can go away on their own, but if there is an underlying infection which could be caused by a number of things are there any signs we could look for to know it's more than just fluid filled?

I appreciate any advice on this topic!

Doc

Hello, Troubled Cat,

Signs of ear infection usually include excessive wax or other material in the opening of the ear canal, odor from the ear canal, one ear looking more dirty than the other, and sensitivity if the ear canal is handled.

If the cat responds to prednisolone treatment, that is dirt cheap.

Surgery costs will vary considerably with the type of surgery performed. With an exam/consultation, anesthesia, hospitalization, medicine for pain and infection, and minimal surgery, it would be hard to get out for less than $150, even in the rural boondocks where things tend to be cheaper (like where I am).

The hematoma will eventually resolve, though the pressure is uncomfortable in the meantime, and the ear will probably crinkle up quite a bit in the healing process.

You really need to get the cat to a veterinarian to at least examine the ear canals. If you have an untreated ear infection, that is painful, and you will have other problems down the line.

Good luck.

jennifer Baxter

Dear Doctor,
My lab had a very large Hematoma his whole hear filled up and felt like a tomato.( it only took like an hour. At 4pm he was fine at 5pm huge ear!) I took him to the family vet who put a valve in that was similar to what you describe.( $600) For the next week his ear kept refilling, maybe only a quarter of what it did originally.Every night i would gently drain it and it would be a clear liquid maybe a little pink. On our week check up we take him in and the doctor is shocked to see that he is still building up fluid. He says that we are going to need another surgery to make it stop. One where they filet open his ear and put something on the inside and something on the outside?? I didn't really understand why they couldn't have let it continue to drain. he did have the second surgery yesterday and when my husband went to pick him up Cole shook his head and part of whatever they stitched on fell off. They had to keep him another night to fix it. Shouldn't they bandage him? and how are we going to stop him from shaking his head? and how much pain is he in now that they have sliced open his ear. I'm really angry at my vet right now over this and feel like i should go to some one else.
Thank you for any information that you can give me

Doc

Hello, Jennifer,

Sorry to be so late in replying. I have been out of town for a few days, no internet.

It's a little difficult for me to give you specific advice. Your doctor is seeing the dog and I am not.

That being said, I do think that it would be fine to call the doctor and tell him about the head-shaking, and ask them how you might bandage the ear across the top of his head with some padding.

Also, you could tell them that the pain medicine he has doesn't seem to be adequate, and ask them to prescribe an additional medicine or stronger dose.

Good luck.

Janelle

Dear Doctor,

My 12 year old lab/hound mix has a large hematoma in her ear. We took her to our normal vet today and they prescribed an anti-imflamatory and an antibiotic. They want us to bring her in to have a drain put in tomorrow. The cost of this procedure is going to be $450 (not including the office visit and meds today). This seemed really high to me in the research I have been doing since I got home. Can you give me any advise as to if this pricing seems in line?

Doc

Hello, Janelle,

I really cannot advise you about cost in this matter. I don't know what type of procedure is planned, what type of anesthesia and monitoring is planned, what type of pre-anesthetic risk factor testing is planned, how much bandaging and/or aftercare is included, etc.

You could ask the doctor for an itemized estimate. You may be better off to stick with someone you know and who knows your dog, rather than trying to price-shop the cheapest deal. It's often difficult to compare "apples to apples" when shopping it over the phone.

Good luck.

Adria Hernandez

Hello,

I have a lab names Pita. Pita had surgery for a ear hematoma about six months ago. Today I noticed another small hematoma in the same ear. I took her to the vet and she has an ear infection as well. The vet aspirated the ear and gave her medicine for the infection. Our hope is to have surgery again. The last hematoma was very large and covered most of the ear. She also had today a cortisone shot because of allergies. Is a cortisone injection the same as giving her prednisone? If not can I ask for some prednisone or will that interfere with the cortisone? In your experience would it be ok to let this hematoma heal on its own. She has had many surgeries. She had a leg amputated due to a arterial venous plexus. So I am trying to avoid any other surgery for those poor dog.

Doc

Hello, Adria,

We often give a single injection of some form of cortisone when dogs have an ear infection. It reduces the swelling and helps ease the dog's discomfort when we have to clean and medicate the ear.

Prednisone is a synthetic form of cortisone. The form injected by your veterinarian is probably a different form, but your veterinarian can speak with you about what would be appropriate in continuing cortisone-type therapy for the ear.

If the hematoma is small, the discomfort would be small, also, I believe. If she seems to be doing well with her ear infection healing up, there should not be a problem with seeing how the hematoma does on its own, without further intervention.

You really need to share your concerns with your regular veterinarian.

Good luck.

Angie K

Hi, I have a 9 year old Pitbull mix,Chaos, who has had a hematoma on the left side, healed within a couple of months with steroid injection in to the "bubble" and oral steroids. Now he has had one develop on the right ear. Given his age and last time we put him to sleep for a procedure he did not do well at all. Like a lot of your post I don't have a lot of money for the surgery either.

To date he has had this one for about 2 1/2 months. We have done oral steroids and injection in the "bubble" again. The injection and keeping pressure on the area worked well for about 2 weeks reducing the size. It has "bubbled" back up and we have just drained fluid out one other time.

Was wanting your opinion, since Chaos is not a good surgical canididate and I have heard horror stories of recovering from the procedure itself we want to do the same as we did on the other side and "leave it alone". Should I take him in for more aspirations or just let it do it's thing. His "bubble" is kinda tight but we have been trying to keep compression on it.

The deformity, as he has one on the other ear is not an issue, can barely tell it is there. Since it has already been 2 1/2 months will it be much longer before this thing absorbes?

Sorry to ramble on, just stressful more for us than him I think. He seems to be more annoyed by us messing with his ear but loving the extra attention. lol Any idea on time frame would be great.

Doc

Hello, Angie,

If I had a patient like this, I might be tempted to put the little teat-cannula drain in. That often works pretty well, and can often be done with minimal or no sedation (depending on how calm the dog is).

If he is not painful, and not bothering it, and acts okay, and you can live with the deformity, then I don't see a problem with just letting nature take its course. I don't have a good answer for you on the time-frame, but I would think at least a couple of months after you quit draining it.

Good luck.

Angie K

Thanks so much for your help. We went back to the vet last night, drained it again and did another Dexamethasone injection. Fingers crossed.

He is getting aggrivated with the dressing, as long as we watch him it stays on but every am he has wiggled his way out. We are trying this time to keep as much pressure on it as possible.

We are gonna give this one more try after that, I think I am just going to leave my poor baby alone and let it do his thing. Thanks so much for your input.

Angie

Angie Kinley

Hi, I have one more question to get your input on. As you can see above what we did at the last visit drained the ear, another shot of Dexamethasone and have been keeping compression on the ear.

To date it has been about 1 1/2 weeks since we had it last drained. kept is wrapped up round the clock for the first 3 or so days after the last drainage/injection. He have now cut back to keeping it wrapped atleast over night and may be a few hours during the day to prevent it from "bubbling" back up.

Now we have noticed a raw place that has a little drainage on the gause we use to wrap the ear, he does shake it off occasionally so I wasnt sure if this was raw from the dressing or something else. We have been keeping the area clean of course but wanted an opinion if we should stop wrapping it and just let it heal on its own, or if the wrapping and putting compression is still a good thing.

Thanks again in advance for your help.

Angie

Doc

Hello, Angie,

I am afraid that I am just too far removed from what's going on here to give you meaningful advice. You really just need to consult with your veterinarian.

Sorry that I cannot be of more help to you.

Samary

I have a miniature schnauzer, he is 4 years old and he has aural hematoma, the vet prescribed prednisone, but my question is for how long I have to wait until I can expect his pinna to look better? It has been 5 days now and the swollen area is still the same size. The prescription was for 2 for the first 5 days once a day and 1 for the next 5 days once a day and then one ever other day. Thanks for all the information!!

Thanks in advance.

Doc

Hello, Samary,

I have found that it can take 7 to 10 days for the swelling to begin shrinking, but that it usually shrinks rapidly after that. I have usually kept them on the higher dose of prednisone until the swelling shrinks quite a bit.

On the other hand, Schnauzers seemed predisposed to developing pancreatitis, and some folks believe that prednisone can also contribute to that.

Your regular veterinarian is in the best position to advise you on this. You should contact him/her and let them know what is going on.

There are patients where this does not work, but it works well for a lot of them.

Good luck.

Tayler

Doc,
My 7 year old Havachon, Gucci, is having surgery tomorrow morning to remove a rather large hematoma on her right ear. I read through all of the comments and your answers are so helpful, but I was hoping you could tell me a little bit more about the recovery process. Will she be in a lot of pain? What can I do to make her as comfortable as possible during recovery? Will I clean the wound, or will it be bandaged until the stitches come out? She has an extremely calm disposition and doesn't scratch her ears, so will the e-collar be necessary? And finally, is this surgery risky and how common are hematoma recurrences? Thank you so much for your help!
Best,
Gucci's mom

Doc

Hello, Tayler,

Will she be in a lot of pain?
If she is having the really major surgery, then I am sure your veterinarian will be sending home pain medication.

What can I do to make her as comfortable as possible during recovery?
Follow your veterinarian's instructions. Ask about pain medication, cold compresses, warm compresses, and so forth.

Will I clean the wound, or will it be bandaged until the stitches come out?
Many veterinarians bandage the ear across the top of the head to prevent shaking of the ear and scratching of the ear. The bandage would have absorbent material to wick drainage away from the ear.
Again, you need to be sure that you take your list of questions with you for your veterinarian.

She has an extremely calm disposition and doesn't scratch her ears, so will the e-collar be necessary?
This really depends on her reaction afterward. Frequently I will send home the E-collar, but suggest that the owner try leaving it off when the dog can be closely supervised. For the first few days, you will probably want to leave it on when you cannot supervise the dog.

And finally, is this surgery risky and how common are hematoma recurrences?
All surgery requiring general anesthesia involves an element of risk. If anesthetics were good for you, you wouldn't lose consciousness.
The surgery itself does not approach any vital organs, nor would we expect any significant blood loss, so I do not consider it a particularly risky surgery.

If you are having the major type of "quilting" procedure, recurrence would be extremely unlikely. If the hematoma is due to the immune-mediated vasculitis (where the body's defenses goof up and damage its own blood vessels), then you might later see a problem with the other ear.

These are all good questions, and you really should ask your veterinarian, since he/she is actually seeing the dog and has the best knowledge of what is going on there.

Thanks for reading and writing.

Tayler

Dr. Mobley,
Thanks again for your response. I have encountered a very strange situation this morning... My vet called to inform me that it is not an aural hematoma, so the surgery will not be necessary. She displayed the symptoms, but they actually discovered a rubber band around her ear. I got her groomed this past Tuesday, and for some reason I cannot fathom, the groomer placed the rubber band for the bow around the base of her ear. It caused the ear to lose circulation, and she almost had to have it amputated (I did not see the rubber band on her ear because the hair is quite long in that area). I've been researching this for hours trying to find out if it has happened before, but I haven't found anything. Have you ever encountered this in your practice? I'm not really sure how to handle it. Thank you so much for your time!
-Tayler Lewis

Doc

This is indeed unusual. I suspect the rubber band may have been placed elsewhere and slipped into this unusual position, though I'm not sure how.

I have seen several dogs who chewed up a newspaper and got a rubber band around their lower jaw. Sometimes the rubber band has cut clear down to the bone, just by gradual contracting pressure.

I would let the groomer know what the veterinarian found, and let them know that she is still being treated.

Take the high ground, rather than being accusatory. Give the groomer the opportunity to express his/her view of the matter. You may find that they are eager to do their best to make things right. Give them a chance.

Good luck.

Angie

Hi my dog has had the hematoma surgery. He had a lot of trauma to his ear b/c the swelling went down the side of his neck. He is about 1 month out from surgery.

He does have a very thick area at the base of his head where his ear is. The vet says this is scar tissue from the trauma he had since it got so big so fast. Monday he looked at it looked in his ear and said all looks well, just a little red at the top of the ear canal. We are cleaning and using tri-otic.

This am I noticed he was sleeping on that ear and my husband says that the canal has swollen some. We have put cold compresses on it today to help with the swelling. I guess my question is does this sound normal to you?

He doesn't see to be in too much pain, I mean he did sleep on it. Only time he wimpers is if you put pressure on the area, still eats, sleeps, drinks, just doesn't play too much and sleeps a lot. The vet did tell me this was scar tissue and would be painful for a while but not to worry. Now it is the weekend, they are closed, and he has this swelling. We have been dealing with this ear for quite sometime so I do get "anxious" about every little thing.

Sorry to ramble just wanted to give you some details on his actions, etc. Like I said other than a little swelling at the ear canal he seems to be fine. Just wanted to make sure that the cold compresses will help and we are not aggrivating the situation.

Thanks in advance for your reply.

Doc

Hello, Angie,

That does sound like a lot of swelling, and a long time after the event to still be having problems.

Cold shrinks blood vessels, so a cold compress (not ice, too cold, injures skin) helps to stop swelling when something has just been injured (or had surgery). If something has been swollen for days, then heat opens the blood vessels, bringing more circulation to the area.

I doubt that the cold compresses have done anything to harm the situation. Twenty minutes two or three times daily for a couple of days is probably as much as could help. More is probably time wasted.

Sorry to be so late in replying. I have been gone to a meeting.

Stay in touch with your veterinarian on this.

Good luck.

Angie

Thanks for the response. I got him some prednisone over the weekend and got him in at the vet on Monday. Said it looked like an allergic reaction to something. Ear is good and the prednisone has actually helped with the thick part behind his ear that I was told was "scarring/cartlidge". I am just so glad his ear is improving. Thanks for the response back. I do appreciate all your info on this site!!

Nicole Byron

Hi Doctor,

My 7 year old dog, Rosie, had an aural hematoma drained today at the vet. She has never had an ear infection, she does not currently have an ear infection or any other health issues. She has never had an aural hematoma before. She also got the steroid injection, and we have begun to give her prednisone. The vet did not instruct us to keep pressure on her ear at all, and said to call back in a couple of days so we can assess the situation and decide whether we should proceed to insert a drain. My question is that her ear still appears to be swollen and I am unsure if it is actually full again already (it has only been 6 hours since the draining) or if it just appears puffy because of the open area. How can I tell? I need to be able to give the vet an accurate assessment on Monday. Also, will we be able to tell if the prednisone is working in only two days? The prescription we have will cover Rosie for 12 days. Is there a reason why the drainage tube treatment would not have been advisable initially? I want to do whatever will help my dog to be free of this as quickly and painlessly as possible and reading these posts it sounds as though what she went through today is likely to be unsuccessful. The vet did say that Rosie's did not appear to be a severe case and Rosie did not appear to be in pain unless we were actually touching her ear. Rosie's behavior on the prednisone has been different, she has been sleeping all day.


Thank you,

Nicole

Doc

Hello, Nicole,

Dogs on prednisone can certainly experience alterations in mood. This may be responsible for the napping.

When the prednisone works, placing a drain is unnecessary. You would make a hole in the ear to no good purpose. It could also serve as an entry point for infection. I reserve the drains and more severe surgery for cases where the prednisone does not work.

Very few cases will show dramatic improvement in 48 hours. I wouldn't wait forever, but you will have to be more patient than that.

My best advice to you is to stay in frequent communication with your veterinarian. Unless he/she hears from you, he/she will have to assume that everything is going great.

My experience in successful prednisone treatments is that after the hematoma resolves, I have to taper the dog off slowly (over weeks) or it comes back. I suspect your veterinarian is planning to refill your prescription, but may have to change your dose in the process.

Good luck, and stay in touch with your veterinarian.

Paige

I have a female Old English Bulldog who is 11 years old. She has developed an aural hematoma on her right ear. She showed no signs of any issue with the ear, no head shaking, scratching or pawing at the ear before I noticed the ear bubble. I checked both ears and she did have some mild wax and hair that had been shed in both ears, but no sign of any infection or mites (she's solid white so her ears are very easy to spot anything that shouldn't be present). I used an ear wash to clean both ears twice a day and that is when she started shaking her head - not before. I've been aspirating the hematoma with a needle and syring once a day and getting about 1 - 1 1/2 cc of fluid out of it each day. I've also been giving her an injection of 8/10 of a cc penicillin I.M. (3,000 units per pound of body weight)as she weighs 80 lbs. She doesn't appear to be in pain and she lets me aspirate it once a day, but it fill up again and needs drained again in 24 hours. I have no income, lost my job and had to give up my home and move in with a friend in another state, or I would be on the street and homeless with my dog right now. I have no $ for a vet visit, let alone surgery. I hesitate to use steroids on her as she has a history of Demodex when she was a puppy that was brought on my steroid use when she arrived from the breeder with pneumonia. I can't understand why she has this hematoma when there is no sign of infection, mites or any issue with the ear leading up to this. 3 years ago this month, she was diagnosed with hemangiosarcoma and had surgery to remove her spleen and a small area of metastasis on her omentum where the tumor was lying against it. The tumor and spleen were removed before any rupture of the tumor had occurred, however the vet gave her a poor prognosis. He said I could expect her to survive 3-6 months after surgery. It's now been 3 years and she's still going strong, still playful and has had no health issues since her splenectomy. Have you encountered or heard of dogs with hemangiosarcoma being prone to aural hematomas? Could it be caused by trauma from a tumor growing somewhere in the head or ear? I'm really at a loss as to what to do. I'm doing all that I can with the tools I have to work with, but with no income and no way to pay for veterinary care, I'm just at a loss and frustrated. Is there anything more I can do to help her?

Doc

Hello, Paige,

Repeatedly aspirating the hematoma runs the risk of introducing infection into this cavity filled with bloody fluid - a great place for germs to grow.

Dogs who develop hematomas and have no trauma at all are frequently the ones who have the vasculitis - inflamed blood vessels that are leaking fluid. We don't understand why this happens. It is often steroid-responsive.

I understand your reluctance to use steroids with the history of demodex.

Hemangiosarcoma is usually really bad about metastasizing to other organs. You have really dodged a bullet on that one. When I did the splenectomy on my own Golden Retriever, he died of metastatic disease in less than one month. I doubt this is related to the hematoma on the ear pinna.

You could try wrapping the ear around a spongy core to put pressure on the cavity and try to keep fluid from re-accumulating after drainage. This sometimes works. You have to be careful to overlap your tape by half its width to avoid tight and loose spots. Very important not to wrap TOO tight, as you can cut off circulation to the ear - very bad.

If you just let the hematoma take its course with no treatment, they eventually resolve, causing the ear to "cauliflower" - they wrinkle up and deform the ear flap. This can take months.

I'm sorry that I don't have magic answers for you. I hope your situation improves.

Best wishes.

K. Lagory

My daughters cat developed a hematoma in one ear, the dr placed a tube in the ear to drain it. When we picked him up, the nurse only said to keep the tube clear but gave us no idea on how to keep it clear or any other care of the site. Should we wipe it off with peroxide? I told my daughter where i read on here to milk it but she didnt like the idea....lol. Told her to bring the cat to me, i paid for his vet care i wasnt gonna risk anything that might help heal him... he is like my grandcat...

Doc

Hello, K.,

We send home a sterile hypodermic needle to open the end of the tube if it clogs up. You could flame a sewing needle and do the same thing.

Blotting gently with a cotton ball soaked with hydrogen peroxide should be okay.

Don't use much pressure when you squeeze out the fluid. If it takes much pressure, the tube is not open.

I recommend you call the office tomorrow and ask for more explicit instructions. My instructions are good for my tube, but I haven't seen your cat or your drain tube. Call your veterinarian.

Good luck.

Stephanie

I have a 10 year old mixed breed female dog. She presented with a hematoma on 2/3/2011 and had the quilting procedure done the following day. 2 weeks later she had her sutures removed and it has been down hill ever since. After the stitches came out I had her home from no more that 15 mins when her ear filled and then exploded. She has been on Rimadyl for 7 days 3X now and has had around 15 laser treatments in this 6 week period. After surgery she has always maintained a small pocket of mostly serum in the tip of the ear, Is that normal? The vet worked very had to get the incision to close but now it seems as that may have been a bad idea. It closed on 3/11/2011 and the next day her ear "blew up" to twice the size of the original hematoma. The vet drained it with a needle which seems to have aggravated it more as it was a temporary solution. On 3/15/2011 the Vet decided to use rubber tubing to "thread" through her ear to allow drainage, Only to find out once the tubing was in place that about 50% of the swelling was inflammation of ear flap. Do you have any idea's for treatment?

Doc

Stephanie,

I would ask for referral to a dermatology specialist or surgical specialist. This sounds like your veterinarian has been working very conscientiously, but the results are just not what you need.

I would not attempt to advise you on the specific treatment of this case from a "long-distance perspective".

I wish I could be of more help.

Stacy

Hi. My roommate's cat has what looks like an ear hematoma. He's out of town and the earliest that I could get the cat to the vet is Friday. I know the ear is uncomfortable for the cat, so I'm a little worried leaving it go for a couple of days. How soon should this be treated? Is it an emergency?

Doc

Hello, Stacy,

This is not an emergency. It will be uncomfortable, but not intolerable.

The sooner the better on treatment, but it's not critical.

Thanks for reading and writing.

Mariah

Hello doctor my 10 yr lab has an ear hematoma that was drained a couple of the times. The second time her doctor gave her an antibiotic but the hematoma is still there even seems fuller. She does not have an ear infection, I check her ears on a daily basis, i can touch her ear (hematoma) and does not seem to hurt, she has had the hematoma for about 15 days... i think it wont get any fuller and are totally afraid of surgery, how long does it take to disappear on its own?

Doc

Hello, Mariah,

Over a period of several weeks, the hematoma will clot, organize, and finally shrink. This will deform the ear flap considerably. Have you ever heard of human fighters who have "cauliflower ears"?

It shouldn't be painful, but it won't be pretty.

Mariah

Thanks for your quick answer. I took her to another clinic to get a second opinion. The doctor says that she does need surgery and mentioned that the recovery period can be between 2 to 4 weeks, and that is not dangerous to sedate her, he will do blood work before.
What i want to know is what can i do to make her recovery less painful and quicker. are there any post-op risks? do you recommend leave her at the clinic?
will she need a special diet? can i take her out for walks? can she be near my other dogs?

Doc

Hello, Mariah,

You should really ask your veterinarian these questions, as he/she will be following up the procedure and is actually seeing your dog.

I feel sure he will be prescribing post-op pain medications, so be sure to follow the directions. Also, if you feel that pain control is not adequate, be sure to let the doctor know. If he/she does not hear from you, they assume everything is going okay.

Once she is fully recovered from anesthesia, her regular diet should be okay.

Talk to the doctor about acceptable activity levels after surgery. I would think that walking on a leash would be fine, but ask your veterinarian.

If the other dogs do not lick or bite or otherwise get rough around her head, ear or just in general, I don't see a problem. You do NOT want a lot of rough-housing, and especially no further trauma to the ear.

As far as post-op risks, we are always worried about infection, additional trauma, and so forth. Keep your veterinarian posted as to the dog's progress. If something doesn't look like it is doing well, CALL THEM. They need to know what is happening, and they are not psychic.

Good luck.

Marzmeetsvenus

Dear Doc, I have a 7 year old German Shepherd/Wolf Hybrid who appears to have an aural hematoma. He's had issues with his ears since he was a puppy. He frequently gets yeast infections, and even when he doesn't have a yeast infection he'll scratch his ears & shake his head.

Like others on here, I just don't have the $ to afford surgery. And from what I've read it's no guarantee that he won't just get another one later. Of course I don't want him to be in pain, he cries when we touch his ear.

What I wanted to know is more about this Prednisone treatment. Will the prednisone only work if the cause is "immune-mediated?" In my dog's case I know the cause is likely from trauma, so for him should we not even consider asking about the prednisone therapy?

I noticed he does have another yeast infection, so we're going to take him to the vet to at least get that part taken care of. I doubt we'll be able to do any surgery. I'm wondering where all these people who are aspirating their own dogs ears are getting these syringes?

Oh, also I was going to ask what you mean by taping their ears to their head? I was wondering if this was something we should do to him? As soon as we put him outside he starts shaking his head & scratching. We might get him an e-collar, but that won't prevent him from flopping his ears around.

I really don't want for my dog to have to suffer, but I don't know what else to do. First I read to put on a hot compress, then I saw your page and was like uh oh. So now I'm putting ice packs wrapped in towels, but he won't let me do much. I wish I could find pictures of what the deformed "cauliflower, boxer ears" look like. So I know what we're dealing with here in the aftermath, but all I can find are pictures of humans with ears like that ;)

Doc

Yes, the prednisone is only helpful for the immune-mediated problem, not for trauma-induced hematomas.

After the ear has been drained or had surgery performed, we sometimes lay the ear over the top of the head, inner surface UP, and bandage it in place. This wouldn't be practical while the hematoma is full of fluid.

If no surgery is performed, ask your veterinarian about pain medication to make your dog more comfortable ( in addition to treating the era infection, of course).

The "cauliflower ear" or cicatrized ear pinna looks like you wadded up the ear and stuffed it in your pocket. It opens up a little, but still looks pretty wrinkled up.

I could have taken a picture of one today, but he is black and it wouldn't show up that well anyway.

Best wishes.

Melinda

Thanks Doc, That's what I figured about the prednisone. We have an appointment with a vet for him tomorrow. I know we don't want him to have the more drastic surgery. We're hoping this vet can put in one of those drain tubes, it's a local vet in a very rural area.

We really want to cure what is causing him to get these recurring yeast infections. I read that changing his diet to a grain free dog food would help. I looked up these grain free foods at pet stores, and they are very pricey. But, then yesterday we were at Costco, and found one that is very reasonable, $29 for a 30 lb bag.

Do you think a grain free diet will help with the yeast infections? I mean it makes sense. Plus I read that acidophilus would be good to give to him as well, or plain yogurt w/out sugar. I would think that the acidophilus couldn't hurt?

Doc

Hello, Melinda,

I don't think the acidophilus will hurt at all. Grain-free may or may not help. A lot of dogs with recurring ear infections do have an allergy as the underlying problem. Food allergy is one of the more frustrating to deal with. Some dogs with food allergy don't itch anywhere else BUT inside their ears.

The thing is, the dog can be allergic to any component of the food, and probably the protein sources are more often the culprit (rather than the carbs, i.e. grain).

Dietary elimination trials require feeding a diet composed of something the dog has no previous exposure to. We use things like foods made with duck and potato, or venison and green pea, or kangaroo and oats. There are also the hydrolyzed antigen diets like Purina HA or Hill's Z/D.

When you do a dietary elimination trial, you have to be really strict and not let the dog have any of his old type food, or treats, or even flavored heartworm preventive. These trials can take as long as three to four months before every last vestige of the old food has been "washed out" of the intestinal tract.

Talk to your veterinarian about this.

Good luck.

Laura

Hi Doctor!

My seven year old english lab was just treated for an aural hematoma with the plug method you outlined here. Since I had to work, my wonderful husband took him to the vet first thing this morning and picked him up when they closed at noon (and might have forgotten to ask a few crucial questions). Being an overprotective pet-parent, I want to be sure we're doing everything right. The doctor told him to drain the ear "ten times a day" by "popping the pimple." Am I just supposed to squeeze any fluid out several times a day? Is there an open/close setting on this tube (it looks just like your picture!)? Not a whole lot seems to be coming out and I want to be sure we're part of this 90% success rate. Any tips on how to keep bacteria from sneaking up that tube (aside from the anti-biotics)? Also, what should I expect for when the tube comes out as far as recovery from there?? Thanks so much for all the great info! Glad we stumbled upon your site!

Doc

Hello, Laura,
The tube that I use is always open. If it takes a lot of effort to get it to drain, then it is possibly clogged. I send home a sterile hypodermic needle to open it. You could flame a sewing needle and use that. Talk to you veterinarian about this first, though.

If the ear is not filling, then the fluid is draining on its own. If the ear is filling, then you do need to help the fluid drain out by gentle squeezing. A sudden "Pop!" is not a good idea.

Even if you keep the ear flap clean, bacteria will still try to enter the wound. Be alert for any change in the drainage or filling of the ear, or thickening of the ear, or discoloration of the ear.

Once the tube is removed, I find that most patients have a little scarring and crinkling of the ear, but it's not bad.

Rebecca Stroud


Dr. Mobley -

Your info/advice on aural hematomas has been so very helpful to us.

Although my own vet is well aware of the situation - as a "nervous nellie" dog-mother - I still insist on "searching the internet" (and I'm glad I did).

Our 15-yr-old Maggie, a border collie mix, presented with a hematoma two weeks ago. For what it's worth, we are going to allow it to resolve by itself. Yes, it did seem to "grow" a bit in the last few days. But, for the most part, Maggie is not terribly bothered by it and we don't give a hoot what her ear will eventually look like as long as she's in no distress.

As you can well imagine with an active BC who spent years flying in the air chasing/catching balls, Maggie has many arthritis issues and our hope is just to keep her as comfortable as possible for as long as possible. She also has multiple lipomas so a "cauliflower ear" will just add more "beauty to my beast" as she is the dog from hell when it comes to vet visits.

Anyway, just thought I'd let you know how much you're appreciated. And, btw: Maggie's ears are upright and now the one is starting to "crinkle" some. So I find it rather nostalgic that her ear is looking exactly like it did when we brought her home from the shelter 15 years ago...:-)

julie sellenberg

I would advise anyone who is using rimadyl to stop immidiatly it will kill your animal if it hasnt had blood work for its liver
I think thats what killed my dog.

Doc

Most dogs can take Rimadyl safely long-term. However, they should be monitored at least twice yearly for liver and kidney damage. It actually isn't that common, but it certainly can occur. This is true with any of the NSAIDs (non-steroidal anti-inflammatory drugs), including Deramaxx, Previcox, Metacam, etc.

Human NSAIDs like Ibuprofen and Naproxen (Aleve) can also cause severe bleeding ulcers even with very short-term use, so they should really be avoided in dogs.

Todd Foy

Hey Doc,

My great Dane's right ear appears to be swollen. It's is thicker than the other one. Is this an ear hematoma. There isn't really a visible swollen area or an appearance of a bubble... What do you think? Should I ice it and keep it compressed or is this serious enough to get drained?

Doc

Hello, Todd,
If you want to email photos to [email protected], then feel free. Photos are not always adequate, but your description is a little vague, and I really don't feel I can give you any advice, other than to see a veterinarian (the best advice, anyway).
You can get mild swelling with insect stings, other inflammatory conditions, trauma, etc.
Even if I look at a picture, this could easily be something that requires some "hands on".
A cold compress is unlikely to hurt anything. Don't use ice, as it's too cold. A rag soaked in ice water is okay.
Best advice: examination by your veterinarian.

Traci

I have read all the posts and I think I have a pretty good handle of what the options are. I have but 1 more question I know that the #1 concern with aspirating is introducing infection if the injection site is cleaned prior to aspirating and the area is cleaned regularly between aspirations should that keep the possibility of infection down or should antibiotics given just to be sure.

Traci

Also forgot to mention that the dogs ears are clean and no signs of mites or infection.

Doc

If you just aspirate, they usually refill rapidly. I have had poor success with aspiration, even when I wrapped the ear around an absorbent core pretty tightly. Introducing an infection is certainly a concern, but mostly I just find the results disappointing.

stacy martone

Hi There, We noticed an aural hematoma on labs ear about 9 days ago... i feel my story is a pretty successful one or luck, not sure which but I wanted to share this with you, just in case you were hesistant on surgery options to correct it as we were. We saw the vet on the 2nd day of the hematoma, it felt firm,like an air pocket in the flap of his ear. The vet wanted to do sx to drain it but couldnt guareentee that it wouldnt refill again, only to pay another $500 each time to do this. To aspirate it would only be about $150 but she was against it, cause it would most likely refill and I read on sites about the option of prednisone but she wouldnt try this for us with our dog. So we were stuck.. we really didnt have the money to try the sx and have it fail. So I did warm compresses on the ear everday for 8 days /2x a day and held the warm wet washcloth on my dogs ear flap for as long as he would let me (15mins) and I also gave him one dose of Claritin 30mg a day, (every other day) in a peanut butter cracker so he wouldnt notice the medicine inside it. The vet said we could do the claritin everyday, but i personally dont like the idea of giving my dog medicine. The swelling in the flap at first went down a little bit and then around day 5/6 it significantly went down to almost nothing, its softer and smaller. I have to say that its working and I had success without the invasive surgery and healing process my dog would have gone through. Hope this helps and of course always ask a vet for dosage on meds. My dog is 85 pounds and 7 years old. good luck

Doc

Hello, Stacy,
Thanks for sharing your experience. If the hematoma had begun to organize (fully clotted, bleeding stopped) then I can see how the warm compresses would help it resolve.
I would be a little concerned about applying heat to a fresh one. Heat makes blood vessels open up, cold makes them close down. In the initial stages of a bleeding or leaking process, you don't want to apply heat.
I'm not sure how the claritin would affect things. Dogs generally don't respond much to it when it is given for itching and so forth.
I'm glad you had a good experience, and thanks for sharing.

Tink's Mama

Hi,

I have a 2-yr-old Shepard mix named Tink. Last Tuesday she very quickly developed a puffy ear which we identified as a hematoma and made an appointment with our vet. They couldn't see her until today, the following Monday. They anticipated doing surgery so we didn't feed her last night, and today the vet said she had a yeast infection that needed to be cleared up first so the surgery would need to be rescheduled. So I have $50 medication and a surgery they said would be about $300. Unfortunately between time off work and the overall cost I just cannot afford this as I had a very sick kitty last month. Are the injections effective once the ear is quite puffy? I don't want Tink to be in pain, but I honestly don't have $300 right now. I want to be a good petparent, I just wasn't prepared for two big pet catastrophes so close to one another. I guess
I'm just wondering if there is a cut-off point in puffiness/time elapsed for the effectiveness of some of the lower-cost treatments?

Thanks so much!

Doc

Over a period of time (days to weeks), the blood vessel leak stops, and the blood inside the swelling clots and becomes solid. At this point, you are unlikely to reduce the swelling without surgery.
Eventually, the hematoma will organize, and the fluid part will reabsorb. The ear flap will get somewhat crinkled up during the healing process at that point (the "cauliflower ear" of the professional boxer).

While the contents are still liquid, placing a small drainage tube, or using prednisone may be effective.

You do need to clear up the ear infection as your veterinarian advised. If the dog is shaking and scratching its ears because of the infection, none of the treatments for the hematoma will help very much.

Good luck.

Feli

If my dog is prone to these hematomas and if the surgeries wont work...would cropping be an option?

Doc

Hello, Feli,

Quite frankly, I had never considered that. However, if a dog had recurring problems, it might be an approach to consider. He certainly wouldn't have much ear to flop around after that.

We treat most of these with prednisone now, but still there are dogs that require surgery.

Thanks for reading and writing.

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