The Ears Have It

                   At the end of a long week I returned home one evening, slid into bed exhausted, knowing my cat, “Precious,” would soon join me.  Precious is one of our “good sam” cats that was very easy to adopt due to her affectionate personality.  Like all good cats, Precious owns me, and our bedroom is her domain. Her favorite time of day is bedtime and on that evening, it was my favorite time of day as well.  I began to massage her head and chest, as usual, before we both drifted off to sleep.  As I approached her ear area, I noticed her wince a bit and then I felt it…Precious was developing an ear (aural) hematoma.

                        Aural hematomas can be likened to a large “blood blister” that consumes part of or the entire ear flap, also called the “pinna.”  To understand why aural hematomas occur, you must first understand the anatomy of the pinna, which consists of two layers of skin and cartilage, and numerous, small blood vessels.  If you have ever had a pet with even a minor laceration on its pinna, you know how extensive the blood supply and associated bleeding can be. With one good head shake, a pet with a pinnal wound can “paint” a room bright red.

                        Because of this abundant blood supply, any blow to the ear or violent head shake can lead to a rupture of the many ear blood vessels. Bleeding within the pinna causes the two layers of skin and cartilage to separate, and the space in between them fills with blood, resulting in an aural hematoma.

                        The majority of aural hematomas occur in floppy-eared dog breeds that by design are more prone to ear infections.  For these breeds, even an innocent, good ear shake after rising or stretching can cause an aural hematoma.  Veterinarians will closely examine pet ears with hematomas through an otoscope to rule out ear infection as the underlying source for ear shaking.

                        Ear infections are a common reason for visits to veterinary offices.  Signs of pet ear infections include odor, redness, build-up, pain on contact, head shaking, and ear scratching.  When I educate new pet owners, I remind them to touch puppy and kitten ears and examine them daily so the pet is comfortable with ear handling, and the pet owner will be aware of changes in the ear health if they arise. When ear infections are recognized and treated expediently, the pet doesn’t suffer needlessly AND aural hematoma formation will be less likely.

                        Ear infections can also be prevented by routine ear care which includes daily inspection, ear plucking, and ear cleaning with a drying ear cleanser as prescribed by your veterinarian.  Be sure to discuss with your veterinary professional the proper method to pluck and clean your pet’s ears to avoid unnecessary injury. 

                        I find most pet owners are not aggressive enough when it comes to ear cleaning.  I tell my clients “if you can see it, you must go after it” when I am referring to the removal of pet ear debris. The external ear canal has an “L” shape, requiring a person to make a turn within the canal in order to injure the pet’s eardrum.  Therefore, when cleaning your pet’s ears, if you put any cleaning implement in deeper than you can see, you probably are in too far.

                        If your pet is diagnosed with an ear infection or “otitis,” your veterinarian may take ear swabs for microscopic examination and culture in order to determine the best treatment for your pet.  Some pets will require oral as well as topical medications to treat their infection.  Temporary usage of an oral anti-inflammatory drug can be very helpful in providing pain control and accelerating the pet’s recovery.

                        When your pet has an aural hematoma, your veterinarian will first identify and treat the underlying cause, then she will make recommendations for treatment of the hematoma itself.  Minor hematomas can be treated with “benign neglect” which means you treat the underlying cause and wait for the hematoma to re-absorb on its own. Some hematomas are as large as the pinna and will require surgery for drainage and to prevent it from recurring.

                        My little Precious did require surgery for her aural hematoma as her swelling consumed her entire pinna and she was constantly batting at her ear.  While she did very well with her surgery and the hematoma did not return, she did develop a common sequela to pinnal injury, the dreaded “cauliflower ear.”  Cartilage doesn’t like to be traumatized, especially in cats, so it responds by shrinking and crumpling.  Fortunately for dogs, aural hematomas are infrequent in breeds with erect ears, and the cauliflower effect is often minimal for those with floppy ears.

                        Precious’ aural hematoma was most likely the result of her own clumsiness, probably when she was jumping on our bed.  (She had a spinal injury when she was young and her coordination skills are not always the best.) Nevertheless, she takes great pride in sporting her new cauliflower ear as she reminds the other four-legged family members in our household that she is indeed the queen.

Author:  Dr. Bonnie Jones