An aural (ear) hematoma is a collection of blood, serum, or a blood clot within the pinna (ear flap). When present, the pinna will be very thick. The swelling may involve the entire pinna or it may involve only one area. When something irritates the ear canal, the dog responds by scratching or shaking the head. Excessive shaking causes blood vessels to break, resulting in bleeding. An understanding of the ear's anatomy makes the sequence of events more logical. The ear flap is composed of a layer of skin on each side of a layer of cartilage. The cartilage gives the ear flap its shape. Blood vessels go from side-to-side by passing through the cartilage. Violent shaking causes the vessels to break as the skin slides across the cartilage. 

How is it treated? 

There are four steps in treatment. 

1. The blood is removed from the pinna. This is accomplished by making a small incision in each end of the hematoma. A rubber drain tube is passed through the hematoma and sutured to the ear. This assures drainage of any more blood or serum that accumulates in the area. The tube will be left in for 14 to 21 days. 

2. The space where the blood accumulated is obliterated. Since the skin over the hematoma has been pushed away from the cartilage, it must be reattached to it to prevent another hematoma from occurring. This is accomplished by a series of sutures that are passed through the ear flap. The need for this will be determined by the size and duration of the Hematoma. 

3. Most cases will only require step 1, 2 and 4 but some others will require the following: The pinna is stabilized to prevent further damage. The presence of the drain tube may cause some dogs to shake their head even more. Shaking at this time may cause further damage to the pinna. Therefore, the pinna is laid on top of the dog's head and bandaged in place. Although the bandage may be somewhat cumbersome, it will prevent further damage to the pinna and allow proper healing to progress. 

4. The cause of the problem is diagnosed and treated. Another important aspect of treatment is dealing with the cause of the shaking. If an infection is present, medication is dispensed to treat it. However, some dogs have no infection but have foreign material (a tick, piece of grass, etc.) lodged in the ear canal. If so, the foreign material is removed. It is also possible that a foreign body initiated the shaking but was later dislodged. If that occurs, and no infection is present, further treatment of the ear canal may not needed. 

Will I need to bring my dog back for further treatment? 

The specific time for a return visit will be determined by just exactly what is done. If the ear was bandaged over the head this may be removed in 5 days. If the skin was sutured to the ear cartilage the drain tube may be removed in 5 to 7 days. If only a drain tube is used this may stay in as long as 14 to 21 days. There will be two holes in the skin where the drain tube entered. They will close within a few days. If discharge occurs from the holes before they close, it should be cleaned off with hydrogen peroxide or warm water. If an infection was present, it will be necessary to recheck the ear canal to be sure that the infection is gone. Otherwise, another hematoma may occur.