Aural Haematoma

An aural haematoma is a pool of blood that collects between the skin and cartilage of the ear flap, essentially a large blood blister. They are caused by ruptured blood vessels in the ear, most commonly from vigorous head shaking, scratching, or trauma during play. Aside from obvious head trauma, an aural haematoma is almost always a sign that the ear is itchy or uncomfortable underneath.

• A soft, fluid-filled swelling of the ear flap
• The affected ear hanging lower than usual, particularly noticeable in dogs with erect ears
• Head shaking, head tilting, or pawing at the ear
• An unpleasant smell from the ear
• Redness, discharge, or visible irritation in the ear canal

The haematoma itself is caused by burst blood vessels, but the trigger is almost always something underneath. Common causes of itchy or sore ears include:

• Otitis externa (ear canal infection, bacterial or yeast)
• Ear mites
• Fleas and biting flies
• Allergies (atopic dermatitis, food allergy, contact allergy)
• Foreign bodies in the ear canal, such as grass seeds
• Trauma from rough play or fighting

The haematoma itself is obvious on examination. Identifying the underlying cause is just as important and usually involves a full ear examination with an otoscope, an ear swab and cytology to check for infection or mites, and an assessment of the skin to look for signs of allergy. Treating the haematoma without finding and addressing the cause almost always leads to recurrence.

Surgical correction (preferred)

The best outcome is achieved with surgery. We use a punch biopsy technique to drain blood from the ear, then place sutures in a diamond pattern across the ear flap. The sutures hold the skin against the cartilage so they bond back together properly, reducing the chance of recurrence and preventing scarring. Sutures stay in place for around two weeks. Your pet will be sent home with antibiotics, pain relief, and an Elizabethan collar that must be worn for the entire two weeks to prevent scratching.

Medical management

In some cases, the haematoma can be drained and managed with bandages alone. This avoids surgery, but the haematoma usually recurs and the cosmetic outcome is generally less satisfactory.

Treating the underlying cause

This is the part that prevents another haematoma. Depending on what we find, this may involve ear cleaning, prescription ear drops, oral medications, parasite control, or longer-term allergy management. We will tailor a plan to your pet.

Without treatment

Left alone, the haematoma will eventually scar down and the ear will contract into a crinkled, cauliflower-like shape. The ear remains permanently deformed, and the underlying cause continues to cause discomfort. We can use steroids while it is healing to try to reduce some of the scar tissue but these also have potential side effects.