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104 Aural Hematoma

Aural Hematoma Client Education
Sheet
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effective in preventing recurrence than
BASIC INFORMATION
DIAGNOSIS
fine-needle aspiration (FNA). May be less
Definition Diagnostic Overview effective if significant scar tissue has
A collection of blood, typically fluctuant/ Diagnosis is based on highly characteristic already formed.
fluid-filled, within the split cartilage plate of physical examination findings and history of ○ Through-and-through indwelling Penrose
the ear or on the concave surface of the ear otitis externa. drains. A proximal and distal incision over
pinna the hematoma is made and flushed with
Differential Diagnosis sterile saline. The Penrose drain is placed
Epidemiology • Abscess through the hematoma site and secured
SPECIES, AGE, SEX • Seroma with non-absorbable sutures. Removal in
Dogs and cats; it is the seventh most commonly • Soft-tissue neoplasia 2-3 weeks.
treated surgical condition in small animal ○ CO 2 laser drainage has been successfully
practice. Initial Database reported.
• CBC, serum biochemistry profile, and • Medical treatment
GENETICS, BREED PREDISPOSITION urinalysis: generally unremarkable ○ FNA of the hematoma: invariably inef-
Dogs with pendulous pinnae may be at • Otic examination under anesthesia (p. 1144) fective long term. Should be performed
increased risk of rupturing capillaries during ○ Samples of exudate are collected for daily until adhesions form.
self-trauma. microscopic examination (bacteria, yeast, ○ Oral or injectable corticosteroids (dexa-
parasites) and culture/susceptibility testing methasone 0.2 to 0.5 mg/kg IV q 24h)
RISK FACTORS ○ Thorough examination for foreign bodies combined with draining improves success
• Otitis externa (e.g., grass awn [p. 398]) and integrity of rates with nonsurgical treatments.
• Pinna trauma tympana ○ Intralesional steroid may also be effective
(dexamethasone 0.2 mg intralesional q
CONTAGION AND ZOONOSIS Advanced or Confirmatory Testing 24h × 5 days)
Parasitic infestation (Otodectes spp) • Workup to determine cause of generalized • Pinna is ideally bandaged to head to prevent
dermatologic problem further trauma and allow tissue adhesion to
GEOGRAPHY AND SEASONALITY ○ Thyroid profile (pp. 525 and 1386) occur (2-3 weeks). However, ear canals must
• Geographic distribution of parasitic causes ○ Atopy testing (p. 91) be accessible to provide treatment of underly-
of otitis externa ○ Food allergy investigation (pp. 345 and ing cause.
• Associated with seasonal incidence of otitis 347) • If bandage is not tolerated, e-collar must be
externa: warmer weather (humidity, swim- ○ Examination for parasite infestations (fleas) worn to prevent scratching.
ming), atopic disease (p. 1091)
• CT scan (preferred) or skull radiographs of Chronic Treatment
Clinical Presentation bulla to detect and diagnose concurrent otitis • Control/treatment of underlying dermatologic
HISTORY, CHIEF COMPLAINT media problem is imperative to limit recurrence.
• Head shaking or scratching ears • Affected patients should have regular otic
• Acute or chronic otitis externa TREATMENT examinations with cleaning if necessary.
• Generalized dermatologic problems • General anesthesia (or heavy sedation) is
Treatment Overview usually necessary.
PHYSICAL EXAM FINDINGS Successful resolution of the aural hematoma ○ To allow thorough examination and
• Characteristic soft, fluid-filled, or fluctuant depends on 1) complete evacuation and ongoing cleaning
swelling on concave surface of pinna drainage with stabilization of the pinna until ○ To provide analgesia
○ Swelling may become firm and cauliflower- adhesion formation and 2) control/elimination ○ To minimize iatrogenic damage to the ear
like as fibrosis develops. of the inciting cause. canal
○ Usually not painful
• Otitis externa Acute General Treatment Possible Complications
○ Evidence of parasitic infestation/bacterial • Surgical treatment is most successful. • Recurrence of the hematoma due to
or yeast infection ○ Incisional method, using longitudinal, inadequate/ineffective treatment and failure
○ Evidence of other causes (excessively hairy S-shaped, or elliptical incision. The inci- to identify or control underlying cause
ear canals, structural anomaly) sion is made through the inner concave • Associated with treatment
• Generalized dermatologic problem skin layer and is extended through the ○ Incisional technique
cartilage, if necessary, to reach the hema- ■ Insufficient incision size may lead to
Etiology and Pathophysiology toma. The hematoma is completely premature closure, hematoma recurrence.
• Aural hematomas are most often caused evacuated. To prevent deformations and ■ Incorrect orientation of incision and
by self-trauma (head shaking or scratch- cauliflower ear, full-thickness mattress inadvertent ligation of an auricular
ing) to the pinna secondary to otitis sutures are placed through the pinna artery may cause regional necrosis.
externa. parallel to the incision over Penrose drains ○ Closed suction drain: premature removal
• Shearing forces fracture the cartilage and or intravenous (IV) tubing to avoid pres- by patient
cause rupture of epithelial and intrachondral sure necrosis. Healing of the incision ○ Passive drainage: premature removal of
blood vessels with subsequent hemorrhage occurs by second intention. Penrose drains
and hematoma formation into the resulting ○ Temporary insertion of a closed suction ○ FNA technique: failure to remove all fluid
dead space. drainage system can be effective, allowing prevents tissue adhesion
controlled scar formation. This is more ○ Corticosteroids: side effects of these drugs.

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