Aural Haematoma

Introduction

An aural haematoma is a collection of blood within the cartilage plate of the concave surface of the ear from damage to branches of the great auricular artery.

Various causes have been proposed, including:

Otodectes cynotis

Otitis externa

Trauma

Allergies

Headshaking and ear scratching lead to damage of the pinnal cartilage.

The fluid within the lesion is more akin to seroma fluid than that found in true haematomas.

Clinical Signs

The initial lesion develops at the base of the concave aspect of the pinna, subsequently enlarging towards the apex.

It is an acute presentation and causes acute discomfort to the dog.

Aural haematomas are warm, tense and painful.

If the lesion is chronic, the seroma will slowly resorb and chronic scarring fibrosis will develop which distorts the pinna and results in a 'cauliflower ear' appearance.

Management

Diagnosis of the condition is straightforward.

Treatment aims include: addressing the underlying source of irritation, evacuating the haematoma and preventing recurrence.

Surgical correction usually has the best results, but acute presentation may respond well to drainage and pressure dressings.

Surgical incision, drainage and suture: this is the most consistently successful treatment technique, however it needs general anaesthesia.

1. the concave surface of the pinna is incised in a linear, ovoid or S shape along its long axis
2. the haematoma is evacuated, the fibrin is curetted out and the cavity is flushed with sterile saline
3. full-thickness sutures are placed parallel to the incision in rows, without excessive tension. This is to obliterate the cavity.
4. the incision is left open for drainage
5. the pinnae should be bandaged against the head
6. pain relief is necessary for the first 2 days
7. sutures are removed after 2-3 weeks

Recurrence is a complication, and points to an underlying pruritic condition that should be diagnosed and managed.

The sutures should never be placed horizontally as blockage of the vessels of the ear may lead to pinnal necrosis and sloughing.

Other options for treatment include:

Needle aspiration and pressure bandage

Incision and pressure bandage

Continuous drainage through a cannula, penrose or closed suction drain for 2-3 weeks.

Prognosis is good if the underlying cause can be identified and the haematoma is acute.

Chronic and allergic causes for the haematoma are harder to control and it may recur.

Aural Haematoma Learning Resources
Flashcards Test your knowledge using flashcard type questions	Small Animal Soft Tissue Surgery Q&A 17

References

Lipscomb, V. (2010) Surgery of the Ear RVC student notes

Harvey, R. (2001) Ear diseases of the dogs and cat Manson Publishing

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