An aural hematoma is one of the most painful-looking conditions I know of. Aural means ear and hematoma means bloody swelling. The pinna is the floppy, outside part of the ear (as opposed to the ear canal, the tube going down and in to the ear-drum). The pinna is a 3-layer sandwich of skin, cartilage and skin. When a blood vessel in the pinna breaks, it oozes fluid between the layers, separating the skin on the underside of the pinna from the cartilage. The ear can look like it has a slight bulge, or it can look as though it has been inflated to the point of bursting. This swelling means that the area is under a lot of pressure, and that means pain.
Affected individuals are usually holding their head sideways, and they may or may not be shaking their head. They are pretty uncomfortable, if not downright painful.
When I was in veterinary school in the seventies, the conventional wisdom was that the dog (or cat) has an ear infection. This causes him to shake his head and scratch his ears until he finally breaks a blood vessel in the pinna, which then begins the inflation process. Treatment would obviously need to include treatment of the ear canal infection that started the process. Then the pinna would receive a major surgery. If you don’t drain these bloody swellings, it takes months for the body to stop the leak and absorb all the fluid. The ear pinna gets badly scarred and deformed and "wadded up" in the healing process, much like the cauliflower ear of the boxer whose head has been pummeled hard enough to break ears, noses, and cheekbones. Plus,the pet stays really uncomfortable for a long time.
Draining the swelling by simply puncturing it doesn’t work very well. The pocket refills quite rapidly. You needed to keep the pocket draining until the vessels inside healed up. In the old days (jeez, I was a kid in "the old days"), this involved cutting a sliver of skin out of the underside of the ear so that it wouldn’t heal up too fast. Then the ear pinna was sewn to a piece of some rigid material so that it wouldn’t wrinkle up and "cauliflower" as it healed. What a horrendous, messy piece of surgery that was, not to mention the mess during the healing process.
A huge advance was the development of a much less drastic technique that works ninety percent of the time and frequently doesn’t even require a tranquilizer. Using a large-bore hypodermic needle, a small (1/8 inch) incision is made in the pocket and the fluid drained out. Then a little plastic drainage tube is sutured in place and left for a couple of weeks. This allows the fluid to escape so that the ear can "stick back together". You have to keep them on antibiotics during this period, as bacteria can enter the pocket through the tube that the fluid is draining from, and it’s a great place for them to grow. It’s still pretty messy for a few days, but so much cheaper and easier on the dog, the owner, and the surgeon.
Here’s the basic tube, designed to be put up into a cow’s udder to allow nasties to drain when she has mastitis (breast infections). It’s got a little screw on cap, a little hole in the end, a little hole in the side, and two little spurs to keep it from falling out.
I cut the end a little shorter to enlarge that hole, cut the existing side-hole larger, and add another hole to the opposite side. Then the cap is removed, and the round flange trimmed to make a flat surface that will lie against the ear when the tube is inserted.
Even better, there has been new work that suggests some of these are NOT due to the trauma of head-shaking and scratching. I have often seen these hematomas in animals whose ear canals appeared perfectly clean and healthy, i.e. no ear infection. This was puzzling, but I attributed it to one good hard shake that played "crack the whip" with the ear. New evidence suggests that many of these hematomas are immune-mediated. This means that the body’s defense system has gone a little haywire and attacked its own blood vessels, causing the damage that blows up these ears. What this means in practical terms is that if you suppress the body’s defenses long enough for it stop this self-attack, the hematoma may heal without any surgery or drainage at all.
Many of these cases will respond to high doses of prednisone (a synthetic form of cortisone) with no other treatment. It is amazing to see one of these ballooned-up ears return to normal just by taking pills. The down-side would be the side-effects of the prednisone (excessive appetite, excessive urination, followed by excessive water-drinking, are the most obvious). Worse would be a patient who gets a bad infection while you are suppressing his body defenses. That’s not common, but it certainly can happen. It’s also important to taper the dosage off slowly. If you stop as soon as the ear swelling goes down, it’s very likely to recur rapidly.
One thing is for sure: small hematomas almost always get bigger. When you first notice that ear swelling, rapid treatment will result in a much faster and simpler healing process than if you wait until the entire pinna is involved.