Hematoma of the Earflap (Aural Hematoma)
An aural (ear) hematoma is a collection of blood, serum, or a blood clot within the pinna (earflap). When present, the pinna will be very thick. The swelling may involve the entire pinna or it may involve only one area.
When something irritates the ear canal, the cat responds by scratching or shaking the head. Excessive shaking causes blood vessels to break, resulting in bleeding. An understanding of the ear's anatomy makes the sequence of event more logical.
The earflap is composed of a layer of skin on each side of a layer of cartilage. The cartilage gives the earflap its shape. Blood vessels go from side-to-side by passing through the cartilage. Violent shaking causes the vessels to break as the skin slides across the cartilage.
Treatment
There are two ways to treat aural hematomas. The first is to aspirate the blood from the earflap with a needle, inject a cortisone-like drug into the earflap, and bandage the earflap to the top of the head. This is successful about 50% of the time. Because it is less involved and less expensive, some perfer to try this approach first. If it is not successful, the surgical approach is needed.
There are four steps in the surgical form of treatment.
The blood is removed from the pinna. This is accomplished by making a small incision in each end of the hematoma. A rubber drain tube is passed through the hematoma and sutured to the ear. This assures drainage of any more blood or serum that accumulates in the area.
The space where the blood accumulated is obliterated. Since the skin over the hematoma has been pushed away from the cartilage, it must be reattached to it to prevent another hematoma from occurring. This is accomplished by a series of sutures that are passed through the earflap.
The pinna is stabilized to prevent further damage. The presence of the drain tube will cause the cat to shake its head even more. Shaking at this time may cause further damage to the pinna. Therefore, the pinna is laid on top of the cat's head and bandaged in place. Although the bandage may be somewhat cumbersome, it will prevent further damage to the pinna and allow proper healing to progress.
The cause of the problem is diagnosed and treated. Another important aspect of treatment is dealing with the cause of the shaking. If an infection is present, medication is dispensed to treat it. However, some cats have no infection but have foreign material (a tick, piece of grass, etc.) lodged in the ear canal. If so, the foreign material is removed. It is also possible that a foreign body initiated the shaking but was later dislodged. If that occurs, and no infection is present, further treatment of the ear canal is not needed.
Follow-up Care
The drain tube and bandage are generally removed in about 3-5 days. At that time, the hematoma is usually healed. There will be two holes in the skin where the drain tube entered. They will close within a few days. If discharge occurs from the holes before they close, it should be cleaned off with hydrogen peroxide.
If an infection was present, it will be necessary to recheck the ear canal to be sure that the infection is gone. Otherwise, another hematoma may occur.
