What are aural haematomas of dogs and cats?

What is an aural haematoma and what are its causes?

An aural hematoma is a blister of blood that forms inside the ear flap, ‘aural’ meaning ‘of the ear’ and ‘haematoma’ indicating a build-up of blood in tissue (outside of blood vessels). Bruises are haematomas as well, though of a less spectacular kind.

The ear flap is quite a simple structure, being made up of a sheet of cartilage that gives it its shape, lined with elastic skin on both sides, under which runs a network of fine muscles, blood vessels and nerves. When one of these blood vessels bursts, because the elasticity of the skin doesn't offer much pressure, it can leak a certain volume of blood before the space fills up and the increased pressure finally stops the bleeding, allowing the blood to clot. Hence the impressive sizes ear haematomas can reach.

Because they were frequently seen together, it was previously assumed that the most likely cause of the bursting ear blood vessels was direct trauma, like the head-shaking and scratching at the itchy ears because your cat or dog has an ear infection, ear mites or an allergic flare-up. But recent research suggests that, in dogs, there’s a link between the way a dog's ear cartilage folds and the weakness of the ear blood vessels, which makes their rupture more likely when ears are repeatedly traumatised.

How to recognise an aural haematoma?

Because ears are easy to see and touch, all it takes to spot an aural haematoma is to look:

• there’s a bubble that disturbs the even surface of the ear flap (on either side), of variable size, sometimes soft, but mostly feeling firm, with little give,

• the cat or dog may be scratching at their ears, or rubbing them with their paws, or on furniture and floors,

• they may have a head tilt, often with the ear with the haematoma towards the ground,

• some may show pain, whilst others may not,

• the ear canal entrance might be mucky, red and/or smelly.

When to see your vet?

It is strongly recommended to take your pet to the vet when you discover an ear haematoma, even if it is very small and there’s no other problem with the ear. The blood that gathers up in the ear flap makes it feel ‘heavy’, causing the pet to shake their head even more, extending the bleeding and making the blister grow until it eventually fills the entire ear.

If you’re not sure your dog or cat has an aural haematoma or not, book an appointment with us using the button below this article and, within 30 minutes, one of our friendly vets will help you determine that and advise you how to proceed further.

What can your vet do? Treatment of aural haematomas

Aural haematomas can be challenging to treat because the pets themselves often perpetuate their existence with their head-shaking, ear-scratching behaviour. There are three ways to deal with them.

The first option is to use anti-inflammatories to reduce the bleeding and ear discomfort while leaving the ear alone. This might be a solution only for very small haematomas and it is the least invasive approach. But there’s always the risk that your pet continues to shake their head and they end up with a larger blister. For large haematomas, this is not a good solution at all as the clot forms and gets absorbed very slowly, causing the pet a lot of discomfort during this time. The breakdown of such a large blood clot leaves the ear with a shrunken, unaesthetic appearance. But the main problem with these ‘cauliflower’ ears is that they are chronically painful (remember the nerve network under their skin).

The second option for the vet is to drain the fluid using a needle and syringe, then bandage the ear tight against the head for several days, to provide the necessary pressure and prevent the blister from filling up with blood again. The success of this approach depends a lot on your dog or cat’s temperament and how tolerant they are of the bandage.

The third option involves surgery under general anaesthesia. First, the fluid is completely drained. Then small sutures are placed across the ear flap to keep the skin layers sticking tight to the central cartilage layer and a series of small incisions made in the skin, both in order to prevent another large blister forming. This usually is the best approach for big haematomas as it ensures the fastest healing and preserves the ear shape.

What can you do to help your pet?

Once a haematoma has formed, the best thing would be to speak to a vet.

While you’re waiting for the appointment, you can apply a cold compress made of an ice pack wrapped in a towel on the swollen ear to slow the bleeding and make it more comfortable.

Please do not pierce it at home, however tempting it may be. It will not get rid of the bleeding (there will be even less pressure to help it stop) or resolve the problem and you are likely to end up with a house full of blood, flying off your pet’s ear with each headshake, for days on end. The head and neck area is a tricky one to bandage properly, therefore it has to be done by a skilled vet (nurse) or it could slip off or harm your pet.

Aural haematomas can easily recur, so it is important to make a plan with your vet to treat any causes of ear itchiness or pain, such as your dog or cat's ear infections and allergies.

Regularly check your pet’s ears and use parasite prevention that covers ear mites.

If you're not entirely sure what's going on with your pet's ears, book a call with us using the button to the right and, within 30 min, a vet will help you with answers.