EAR HEMATOMAS & RADIOSURGERY

Silver Sands Veterinary
17 Seemans Lane
Milford, CT 06460
203-877-3221
Fax 203-877-8301
E-Mail DonDeForge100@gmail.com
Director-Donald H DeForge, VMD
26Feb2020

                                         

THE AURAL HEMATOMA

An aural [ear] hematoma is a fluid-filled swelling created by  broken blood vessels after bleeding has occurred between the skin and cartilage of the ear. These most often occur from self-inflicted trauma!

 Aural Hematomas within the ear flaps occur when head shaking or scratching at the ears ruptures blood vessels within the ear flap. 

The ear flap may partially or completely fill with blood. The ear flap will feel fluctuant and fluid-filled, like a water balloon.   
The fluid accumulation between the skin of the outer pinna of the ear and the ear cartilage may become so large that the opening of the ear canal is occluded. 

Early Treatment is Imperative:

Aural Hematomas should be surgically repaired:

• When the Hematoma is so large that the ear canal is occluded the repair cannot be postponed.  Since the Aural Hematoma is commonly associated with ear infections and allergy, the diagnosis of the pathology [i.e examination of the outer ear canal] is inhibited by the Hematoma itself.
• The Hematoma, needs immediate repair if it is in a location where it will create scarring in such a way that the ear canal will be permanently narrowed. A permanently narrowed ear canal can predispose the patient to a lifetime of ear infections. 
• The Hematoma should be immediately repaired if the owner states their pet is unacceptably uncomfortable!
• The Hematoma must be repaired to maximize the ability of the ear flap to stand up straight after Hematoma resolution and to prevent excessive scarring in the ear flap! 

Radiosurgery is the best tool for Repair of Aural Hematomas

ASPIRATION – This is a temporary procedure that involves  using a syringe to remove the fluid contents from the Hematoma. The problem is that a space is left behind when the fluid is removed and this space readily refills with more fluid leading to only temporary results. If the clot in the hematoma is already well organized and on its way to scarring, there may not be much fluid left to aspirate and the technique may not work at all.  If aspiration fails, Aural Hematoma Radiosurgery is needed to permanently correct the Hematoma.

Radiosurgery creates eliptical drainage sites and conforms to the anatomy of the ear pinna.

For Radiosurgery to be successful the cause of the Aural Hematoma must be diagnosed.  If the Aural Hematoma is associated with allergy, without treating the allergy allows the problem to become chronic.

Ear culture and cytology is to be considered in any patient with chronic otitis.

If present, ear mites must be treated at the time of the Aural Hematoma Surgery.

Tumors of the outer ear must be biopsied to rule out malignancy!

The Aural Hematoma and Ear Infections:
The new long acting otic infusions that remove yeast and bacteria while reducing pain and inflammation are excellent.  The pet owner does not have to treat the ears at home, during ear Hematoma surgery recovery, with these long acting infusions.  

Dr. DeForge recommends treating with these otic infusions monthly for 3 months after an Aural Hematoma has been treated with Radiosurgery.

Allergy Blood Testing for Inhalants and Food Allergy is also offered and recommended by Dr. DeForge.

Dr. DeForge always gives the option of scheduling a referral appointment with an Animal Dermatologist.

A new immunotherapy for Inhalant Allergens-[i.e. Atopic Dermatitis]-named Cytopoint is always recommended by Dr. DeForge in the truly atopic patient.

CYTOPOINT is a safe, effective, long-lasting treatment to help control itch due to allergic or atopic dermatitis. It is an injection that is given by Dr. DeForge  that targets itch at its source.

CYTOPOINT works like your dog’s own immune system. It is specifically designed to target and neutralize one of the main proteins that send itch signals to your dog’s brain that triggers scratching, licking, and chewing. CYTOPOINT blocks signals that trigger allergic itch, so the constant scratching can stop, and red irritated skin can heal. In fact, in a study, CYTOPOINT helped damaged skin begin to heal within 7 days. Dogs with atopic dermatitis commonly suffer from ear problems, anal  problems, and skin problems.

The First Night Home:

1. Keep indoors
2. Leash walk only for urination and defecation
3. Cool compress the inside of the ear every other hour for 5 minutes till bedtime the first day/night home
4. The ear will ooze a blood tinged fluid for 72 hours
5. Cool compressing is accomplished with an-ice bag or a bag of frozen peas in an outer wrap freezer bag.  Do not put direct ice on the surgery site.
6. After cool compressing apply Aquaphor healing ointment to the Radiosurgery drainage sites on the inside of the ear.  Not doing this will allow a scab to form and stop drainage.
7. The ear is very swollen from the Hematoma being present for an extended time.  The swelling will reduce in 5-7 days
8. After day one, WARM compress the inside of the ear flap 4-6 times daily [clean wash cloth soaked in tepid water] for about five minutes each time for one week.  This allows drainage and stops the Hematoma from reoccurring
9. Failure to do this will allow the Hematoma to reoccur
10. Apply Aquaphor to the healing drainage sites every time after warm compressing
11. Re-checks are important with Dr. DeForge weekly for 4 weeks
12. Continue the Gabapentin as prescribed by Dr. DeForge to reduce pain
13. No topical ear medicines are needed.  The otic infusion controls infection and inflammation.
14. No antibiotics are needed because of the anti-bacterial function of the ear infusion
15. Call daily with progress reports until you first re-check 7 days after your Aural Hematoma Surgery

The Aural Hematoma is a complex medical problem.

Flea Control is necessary with a prescription flea and tick topical prevention product or a prescription flea and tick oral prevention product to reduce the possibility of atopic dermatitis combined with flea allergy dermatitis.

Food allergy if present must be addressed.

Rechecks are essential to a positive outcome while avoiding unnecessary additional ear surgery.