Aural Hematoma repair question

I don't usually put these things in the form of a post, but the comments don't seem to be working as they should on the Aural Hematoma post, so I am re-posting this lady's question, along with my answer.

Hello Doc– I'm contacting you regarding my 7 year old golden retriever mix with very floppy ears. He is absolutely my fur baby and having him in pain of any sort breaks my heart. He recently suffered an awful aural hematoma.

After multiple attempts to eliminate other possibilities I believe he is allergic to grass which causes some redness and itching in his ears as well as his lower belly. I treat this with antibiotic cream, hypoallergenic hydro-cortisone spray with aloe vera, and Dynavite in his daily diet, which seems to help a lot. However, he continues to shake his head excessively and scratch quite a bit, resulting in this hematoma.

Unable to afford the very expensive surgery I consulted multiple online sites similar to yours(though I'd easily say yours is the best so far) on which multiple other pet parents encouraged the use of arnica gel as a homeopathic treatment for aural hematomas. I used this for about a week and a half with no result. Very stressed, I was advised by family of a local vet who would perform what was quickly appearing to be the necessary surgery for just $85. With some reservation I opted to seek out this veterinarian.

He did in fact perform the surgery for the price indicated, but his bedside manner was not great.  I was never even given the opportunity to speak with him. He simply performed the procedure and sent me home with a large drainage hole in my dogs ear, un-bandaged and bleeding freely, with nyastatin cream as the only additional treatment and instructions to return in two weeks to have the stitches taken out.

I have no way of knowing if he performed the procedure correctly or not. My pet does act as if he feels significantly better. He has returned to his normal exercise and eating levels, but is drinking a lot more water than he used to. His ear is slightly swollen and has been so since the day of the procedure. It is warm but not hot to the touch.

My biggest concern is he continues to shake his head vigorously. It is obvious to me that his ear is itching still and when I catch him he will let me scratch it lightly which helps keep him from shaking. After reading through several posts here I'm worried he may have an infection, and even more so that when we take the stitches out his hematoma will simply fill back up due to the continuous head-shaking.  I just don't know what to do. Please advise.

My advice can only be general, as I have not seen your dog.

Personally, I like to send home antibiotics when I have an open draining wound, like an aural hematoma surgery.  This doctor may have had different experiences with these surgeries, and has seen your dog, while I have not.

It is good that the dog is feeling better now.  That's a plus.

The discomfort may be post-surgical, and additional pain control medicine may be needed.  It is also possible that your dog does have an ear canal infection.  Did you ask the doctor about this?  Are you supposed to put the ointment down into the ear canal?

Ear canal infections need to be thoroughly cleaned of debris before treatment with medicines. Medicine cannot penetrate waxy gunk. This may require sedation or even general anesthesia.  The doctor may have done this prior to performing the surgery.

Often the ear canal is swollen and painful, and treatment with oral cortisone is needed to open things up, even before cleaning can be accomplished.  Reducing the inflammation also makes the dog feel better, but it is just the first step (though an IMPORTANT first step).

Dogs with chronic recurring ear infections usually have an underlying problem, most frequently allergy. Environmental allergies will usually require some type of systemic cortisone treatment.

Food allergies are more complicated to deal with. Here's an old post on them:

If you do not have confidence in your doctor, then find one that you do have confidence in. These can be complicated cases and can't really be treated "long distance".

17 thoughts on “Aural Hematoma repair question

  1. Geri Taran says:

    Hello Doc. I also have a 7 year old Golden with an aural hematoma. Just yesterday I took him to my regular vet who drained the ear (two large syringes of blood) but today it is filling up again. I tried to find online info on heparin without much success. As I am pretty adept I’m considering just sterilizing a large needle such as an upholstery needle, and piercing it myself, making sure that after it drains I clean it with H202 and watch it carefully.
    What do you think about that?

  2. Doc says:

    Hello, Geri,

    Heparin keeps blood from clotting. Placing it in the hematoma would most likely increase the bleeding. I cannot think of any good reason for you to need heparin.

    Poking holes in it repeatedly and squeezing it out is pretty useless. Even when carefully drained under sterile conditions, you would need some type of compression bandage to keep it from refilling. It is difficult to get enough pressure and not too much (which would cause injury).

    If you do this repeatedly, you are very likely to introduce contamination and have a rip-roaring infection in that sack of bloody fluid.

    Hydrogen peroxide is great for cleaning blood stains. It breaks up the protein bonds and really helps get the blood off.

    It is not much of a disinfectant.

    So, to answer your question, I think you are most likely to do harm with your proposal, rather than help your dog.

    Call your veterinarian and let them know that it is refilling already. See what they say when they receive your feedback.

  3. Sharon says:

    I’m sorry if this comment/question doesn’t directly relate to the post, but I have been researching online and was led to this post. I’m seeking advice for a rather complicated situation. My cat was a healthy, energetic 2-year-old Maine Coon mix rescue cat but after having her ears flushed she came home from the vet with vestibular disorder and total bilateral deafness. The vet that did this to her was not helpful or accountable, so after a terrible week of suffering, I took her to a vet neurologist who did an MRI and found ruptured ear drums and one tympanic bula completely clogged. She was put on an antibiotic and 5 mg daily of prednisone. After about a month she seemed to respond to sound a little (only loud sounds and she still couldn’t localize them – also, her ears have not moved in response to sound since the cleaning ten weeks ago.). When the vet recommended fading the prednisone, we went from 5mg daily to 5mg every other day, but after a week of this she didn’t seem well (lethargic on the “off” day) and she also seemed to revert back to total deafness, so the vet has recommended going not only back up to daily but to increase to twice daily and see if it helps the hearing return (perhaps it’s inflammation blocking the hearing). The other strange thing is I have not increased yet (still debating) and she seems lethargic and has reverted back to deafness. I don’t understand how her hearing can fluctuate from total deafness to partial deafness and then back again. I want to do everything I can to try to help her return to her previous state prior to this terrible incident. She is recovered from the vestibular syndrome but I feel the prednisone is making her lethargic and she seems to have trouble swallowing (she just makes gestures with her mouth like she has a lump in her throat). She does drink more, but nothing excessive, and urination and food intake seem relatively normal. I’m nervous to increase the dose and really want to start fading to get it out of her system but on the other hand it’s the final attempt at recovering her hearing. If we continue, including the fade-out time, it will probably total about three months on the medication. Is it dangerous to continue for another month? My gut tells me not to do it, but on the other hand, it is the last option to help her. What should I do?

  4. Doc says:

    Hello, Sharon,

    I have been told by a specialist in ear disease that ANYTHING is potentially toxic to the inner ear, even saline solution.

    Flushing that gets into the tympanic bulla always has the potential to damage hearing, though this rarely happens. We are always cautioned not to use certain medications if the eardrum is not intact. However, if the ear is full of gunk, you cannot see if the eardrum is intact or not. 90% of the time it is not, but you cannot successfully treat the ear if you leave it full of gunk. You are between the proverbial “rock and a hard place”.

    Most of the time, there is no hearing damage, but sometimes there is. Bad luck.

    Has the clogged tympanic bulla been addressed? Has it been flushed out or surgically drained? If it is still full of crap that isn’t going to help the hearing situation. It could also be full of a tumor instead of just inflammatory exudate (though this is less likely in a 2-years old cat).

    Taking the prednisone for a longer term is usually a manageable situation which the cat will tolerate okay.

    You ask what you should do. At this point, my advice would be to give the neurologist who has actually seen your cat as much feedback as possible, and follow his/her advice.

  5. Sharon says:

    Thank you so much for the feedback. We were treating the clogged bulla with antiobiotic, which she took for about six weeks. It’s hard to know if it’s cleared without doing another MRI and they are just so expensive. Her balance improved and she wasn’t shaking her head anymore, so I think it helped, but I have no evidence that it’s cleared. The neurologist wants to do 5mg of prednisone twice a day (instead of once a day as we’ve been doing). I actually started this yesterday and so far so good. I suppose we will try this for a couple weeks and see what happens, but your comment does make me worry that perhaps the hearing loss is permanent. The neurologist is pushing the prednisone, but I felt unsure. Thanks for providing another perspective and (cautious) assurance that the prednisone is relatively safe given the context of this situation.

  6. Caroline says:

    I have a staffie and his ear has just come up like a ballon. His ear doesn’t look infected and he doesn’t seem bothered about it, this might seem like a silly question but just before this happened I had prepared my hall for decorating and he discovered an electric cable and had chewed it . The electrition said he was very lucky that it didn’t kill him or give him a nasty shock poor boy. Could this have been the cause of it

  7. doc says:

    Hello, Caroline,
    What is usually seen with electric shock are burns in the mouth, and (with bad shocks) fluid in the lungs, which can be fatal.

    Those things usually happen within an hour or so of the shock, so you shouldn’t have to worry about it now.

    It doesn’t seem likely to me that the shock caused the hematoma.

  8. Annie says:

    Successfully treated my dog’s aural hematoma firstly with Arnica oil I bought on Amazon. I religiously put it on her ear daily and there was no shift. Then I read that if it is caused by internal trauma then you need the homeopathic remedy lachesis, if it is external then the remedy is arnica. My dog’s hematoma occurred through head shaking so the remedy for hematoma reduction is lachesis (homeopathic remedy). I gave her a low dose of 30c for about 5 days twice daily and I noticed a reduction in her swelling. I continued with arnica oil. I could not touch her ear in the beginning when it had ballooned but gradually it went down. The whole process has taken 6 weeks and required patience and perseverance. Glad I waited as she had surgery on her other ear and she cried so much afterwards that I did not want her to go through that again. The cost was about £300 in the UK. She has a few bumps where the hematoma was but she seems happy. I will continue with arnica oil and see if I can get rid of the two small bumps that remain. I particularly wanted to continue with the Arnica as it stops lumps in the blood. I am a qualified homeopath in the UK. My Staffordshire Bull Terrier is 10 1/2 has severe arthritis of the knees so I did not want to put her through surgery for her ear as she may need a double knee replacement on both knees. I treat her with supplements and homeopathy and she has remained mobile and her surgeon says he will not operate at the moment as he cannot make her any more mobile than she is now. I have successfully treated my dog’s hematoma with homeopathy. Lachesis was very deep acting and the indicated remedy for her condition.

  9. Doc says:

    Hello, Annie,
    Thank you for sharing your story. I must confess that I have little experience with homeopathic remedies, and have not found any controlled studies that make me confident in them. I am glad that you have had a good outcome.

  10. Daniel Whitton says:

    Please pardon any misunderstanding I may have with surgery. I cannot come to the conclusion that performing and leaving an open wound on my animal is in any way a humane or ethical treatment for repairing an aural hematoma. If past medical science is any indication of how to treat this, then pressure stops bleeding, and splinting holds the tissues until time animal grows the tissues back together. I find these both occurring while using an auralsplint and would recommend your clients seek this holistic treatment instead of surgery.

    • Doc says:

      Hello, Daniel,
      I personally don’t feel that leaving a big open wound is any way to treat these if it can be avoided. Most of the ones I see now are treated with prednisone to stop the immune-mediated vasculitis that causes them. A long time ago you had sent me samples of your invention, but I had difficulty making it work. I rarely cut one now. I put a drain in one 3 weeks ago, and that was the first in years. That one had become infected. I had never seen pus in one before, and I suspect that the owner had tried to aspirate it and contaminated it.

  11. Andrea says:

    Hi. We have a very healthy, active mixed breed rescue, age 11 years, who got a trauma induced aural hematoma playing with the dog next door. We didn’t know what it was, and thought it might be a bee sting, so we rushed her to the ER vet. There, we were told it was an aural hematoma and they gave her methadone and tried to drain it but it was apparently too painful. The vet then suggested that we medically treat it- with 10mg a day of Prednisone for seven days, then taper her off with another seven days at 5mg. Additionally, we were to use Gabapentin as needed, every 12 hours. I personally hate steroids and avoid them as much as possible. So far, she has had three 10mg pills and I don’t think it has done anything to reduce the inflammation. However, we stopped the pain pills yesterday because she isn’t shaking her head and doesn’t seem to be in any pain. She even lets me touch it. Since I have been told and have read that scarring and deformity could happen anyway, I am disinclined to keep going with the steroids. Have you ever seen a case where the affliction is minimally treated or untreated have good results? It just seems a shame to keep her on steroids when it’s giving her diarrhea and making her restless.

    • Doc says:

      Hello, Andrea,
      I understand about the side-effects of the steroids. To see results with prednisone, I usually have to use 1/2 to 1 mg per pound of body weight for 7 to 14 days to get the hematoma to regress. I then drop by 25% at 2-week intervals. If there has been no reduction by 10 to 14 days of high dose prednisone, it isn’t going to work, and a surgical drain is indicated.

      If you just let the swelling stay big and organize and reabsorb on its own, that will take weeks, and the ear tends to really wrinkle up. This is not apparently painful, but is unsightly. While there is swelling, there is pressure, and pressure is uncomfortable.

      • Andrea says:

        Thanks for the response. We went to another vet on the 5th day of Prednisone. She said it is a mild hematoma, not painful anymore and confirmed that there is no infection. She urged us to do the 7 day course and then taper to half over the following week, which we are doing now. Our dog is 11 years old and I just hate the idea of surgeries and anesthesia for her. She is very susceptible to drugs and their side effects. Hoping to get in with a holistic vet next week. To top it off, we are to go on vacation next week, the dog, too. ☹️

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