Pinna Hematoma

[cpearl]

Our dog, Smoky, has a pinna hematoma.  It fills to the point that it looks as if it is about to burst.  The DMV prescribed Mometamax Otic drops for the infection that caused the problem but he was very concerned that Smoky is for too old for the surgery needed to stop the bleeding.  He said that hematomas would usually heel on their own anyway.  I decided to take the safest route and by pass the surgery. The DMV order his assistant to drain the flap. She used a 22g needle with a 20cc syringe.  After filling the syringe with blood, she attempted to stick the flap again only to have Smoky snap at her.  Smoky is medium large lab/chow mix.  So I didn't blame her at all when she decided not to proceed.  The flap, of course, refilled after a few days. I am a RN.  I felt that I could drain the ear myself and for go the chance that Smoky would misbehave again.  Besides I also felt that instead of sticking him several time with a needle, using 20g IV catherter that would be left in for the duration of the procedure would be a better choice.  I shaved and sterlized the site. The procedure went very well and Smoky behaved much better.  I drained about 160cc's.  However, the flap still continues to refill every few days. So my question is, should I continue with draining the flap every few days, maybe leave the cath in and do daily sterial dressings, or just leave it alone?  Or perhaps you have a better sugestion.  I would greatly appreciate your opinion.  Thank You,  CPK  

[cpearl]

I really appreciate all of your input and concern.  I am not sure what we are going to do about smoky's ear flap but I will certainly consider all of your wonderful caring advice.  I am afraid that leaving the blood in the flap to pressure off the vein would eventually cause his ear flap to burst. You would need to see it to believe how hugh his ear flap gets. Wow!  I have never drained the flap more than every  3-4 days, anyway. (which is 2x each week)  

One thing I don't have to worry about though; is Smoky scratching and head shaking.  He has never done that, not even before the anti-infective.  Only symptom he seened to suffer was the inside of his ear was very red. I also, don't know why the DVM did not give him a steroid or why he feels that a 12 year old dog that has never had any health issues (other than a broken toe 6 years ago) should not have surgery.  My guess is treating the ear is safer than the surgery.  I will call him about getting the Temeril-P.  It has never been a problem getting it for my other dog's allergy.  I really do like the head wrap idea, though. If we use it I will let you know how it does.  Thank you so much:  Dr.Cheng, ireneo, & peekawho

[peekawho]

We had that problem once after an injury to our dogs ear, and placed a sanitary napkin against the ear, and secured it with vet wrap around the head, sort of as a pressure dressing.  After about a week (changing it every day), it stopped refilling.

You will have to address the scratching and head shaking though, or pressure dressing will do no good.  

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

The most important thing is to get Smokey to stop flapping or scratching her ear!  Did your vet give Smokey an injection of steriods in the office, or an oral steroid such as prednisone, or an antihistamine/steroid combination such as Temeril-P to take at home?  If not, ask your vet, in a nice manner, if he thinks a steroid may help.  Unless Smokey has a bleeding disorder the hematoma will resolve once the head shaking, and scratching cease. As long as Smokey has discomfort or itching of her ear she will continue to shake her head and scratch,  and prevent a clot from forming in the pinna; an aural hematoma is caused by delicate capilliaries being broken in the ear from head shaking or scratching due to pain or itching of the ear.  Mometamax is sometimes enough to stop the itching and shaking of the ear, but steroids are usually a necessary part of a serious aural hematoma protocol,  because they stop the painful inflammation and the annoying itching of an ear infection quicker.  Draining the hematoma should occur only twice per week.  Once you have drained the hematoma a bandage should be placed.  You gently pack the ear with 2-3 guaze sponges, than place the ear pinna flat across the top of the head and secure with vet wrap around the head.  Elasticon bandage may have to be placed to prevent slippage.  This is best done at the vets office the first time so that you can be shown the proper procedure.  Occasionally, a culture and sensitivity of the infection can be performed prior to placing in ear meds so that the appropriate antibiotic can be given orally.  However,  many of these itchy and painful ear infections may just be a nasty yeast infection.  Additionally, you mentioned that Smokey was too old to undergo surgery if this is the case she may have other health issues that prevent her from taking steroid and perhaps that is why your vet did not prescribe them.  Trust your vet, because he has all Smokey's information, and may have good cause for treating the ear the way he did.  

[ireneo]

That's a fair amount of blood removed. Would it be safe to continue to drain that much every few days? Seems it would affect his crit after awhile. Wouldn't leaving the blood in there cause some pressure and slow down the filling time (like putting pressure on a wound)?
I do that with birds (totally different I know) when they have ruptured air sacs. Unless the pockets of air are interfering with eating or standing I won't aspirate them. The pressure keeps the subQ emphysema from getting worse and the air sacs heal more quickly.