cat ear hematoma

I have a cat with an ear hematoma from a mite infection and I took him to the vet for surgery.  Now another cat has a hematoma and I really can't afford a second vet bill if it isn't necessary.  Is the surgery primarily for cosmetic reasons?  I'm concerned also with putting another cat through surgery as the first didn't do so well.  I don't want to put him through the stress and trauma if he doesn't need to.  I don't care what his ear looks like as long as he is happy and healthy.  His ear is also not quite as swollen as the first cat's.  Both are now being treated for mites.  Does he really need to have the surgery?

[Aleda M Cheng, D.V.M., C.V.A]

It doesn't really have to be treated, however if you don't it will probably fibrose down and turn into a cauliflower ear.  Cauliflower ears don't really function as ears anymore, i.e.: will no longer amplify sound, will be difficult to clean and to prevent mite infestation because it will be hard and wrinkled, and it will be less resistant to trauma (it can be more easily torn, and may not heal as well when torn).

Even with surgery some ears result in cauliflower ears.  The most important thing is to stop the itching using oral prednisolone, topical ear mite medication and topical ear medication for the secondary invaders (bacteria and yeast otitis).