Jpn J Vet Anesth Surg, 36(4): 93-96 2005

Treatments and Prognosis of 59 Cases of Canine Aural Hematoma

Kazuhiro MIKAWA1), Teruo ITOH1), Kenichi ISHIKAWA1), Kiyotaka KUSHIMA1), and Hiroki
SIHI1),
１）Division of Animal Medical Research, Hassen-kai, 2-27Onozaki, Saito-shi, Miyazaki 881-0012

SUMMARY: Treatments and prognosis of 59 aural hematomas in 49 dogs were evaluated

retrospectively. Of 2 cases untreated, 1 case, which could be followed periodically, developed marked
deformation of pinna. All 23 cases treated by needle aspiration showed immediate recurrences of
hematoma. No case reached healing by repeated needle aspirations alone, but 9 cases receiving
repeated aspiration followed by local injection of corticosteroids reached healing within 4 weeks. Nine
of these 23 cases received surgery because of recurrence. In 43 cases treated by surgical incisions and
mattress sutures, no recurrence was noted before the suture removal. Recurrence after healing was
observed in 2 of 9 cases (22.2%) receiving the corticosteroid injection, 4 of 14 cases (26.6%) treated
by longitudinal incision, and none of 28 cases treated by multiple incisions using a biopsy punch.
These results suggest the suppressive effects of corticosteroids against the hematoma reformation after
aspiration, and the comparatively better prognosis after surgery using the biopsy punch.
Key words: aural hematoma, dog, conservative management, surgery.

Introduction
Aural hematoma (AH) is a disease in which blood accumulates in the auricular cartilage. Its
treatment aims are removal of hematomas, prevention of recurrence, management of intercurrent
diseases, and maintenance of pinna2, 3, 7).
Various treatments are used for AH, including needle
aspiration3, 7), drainages using silicone drain placement4), the nipple duct11) and closed aspiration
tube10), surgical incision and suture3), and systemic or local corticosteroid therapy6). However, the
evaluation of each treatment varies: postoperative implant management and pinna deformity are
problematic5, 6, 10, 11), whereas delayed healing by corticosteroids has also been pointed out3, 7). Recently,
new surgical techniques using punch skin biopsies5) and carbon dioxide lasers2) have also been
reported. Thus, there are many options in the treatment of aural hematomas, so the treatments used by
clinicians and their outcomes may differ. In this study, we investigated the treatment and prognosis of
59 cases of dog ear hematoma diagnosed at several institutions.

Materials and Methods

The cases examined were 59 AHs in 49 dogs diagnosed in 5 facilities in Miyazaki Prefecture
between January 1998 and March 2005, and information on treatment and prognosis was collected
from the medical records. The physical examination findings at the time of examination were recorded
for the dogs who visited the hospital after the start of the survey. Signalments of all cases are
summarized in Table 1, and their details have been reported elsewhere8). The incidence was higher in
medium to large dogs after middle age, and golden retrievers accounted for 44.9% of all affected dogs.
Of the 59 affected ears, 45 had concomitant otitis externa. The duration of illness between the time an
owner noticed AH and the first visit was described in 36 cases, including 33 within 1 week and 3 from
1 to 2 weeks, but not including chronic cases of AH consolidation or ear deformity. The follow-up
period after treatment was 2 years or longer in 26 cases, 1-2 years in 13 cases, 6 months to 1 year in
17 cases, and unknown prognosis in 3 cases.

Results
In cases with otitis externa, treatment for it based on the results of cerumen examination was
performed together with AH treatment. AHs were treated conservatively in 23 cases or surgically in
43 cases (including 9 cases initially treated conservatively). Two case were untreated, and one of them
was followed up and showed auricular deformity. There were 14 cases treated with needle aspiration
alone as conservative therapy and 9 cases who received 0.4% dexamethasone (4 to 8 mg) or 1%
prednisolone (0.5 mg) infusion after aspiration, the treatment and prognosis of them are summarized
in Table 2. With aspiration-alone, all 14 cases experienced re-accumulation, none of which did not
resolved by repeat therapy (including 2 cases received 8 treatments), and 9 cases changed to surgical
treatment. In the remaining 5 cases, auricular deformity occurred in 3 cases and the progress was
unknown in 2 cases. On the other hand, in 9 cases injected with corticosteroids after aspiration, AH
resolved by repetition of the therapy after re-accumulation, but 2 cases had residual mild deformities.
Fig. 1 shows the decrease in the retention fluid in 5 cases in which suction and dexamethasone injection
were performed every week and the amount of suction was recorded. Four cases showed a decrease in
fluid retention by week 2 and a complete resolution by week 4, and the remaining one showed an
increase in fluid retention until week 3 and resolution by week 4 with the same dose of dexamethasone
infusion.
As a surgical treatment, the conventional treatment by longitudinal incision and mattress suture3)
was carried out in 15 cases, and the treatment using skin biopsy punch reported in 19985) was carried
out in 28 cases. In the latter method, multiple drainage holes on the concave side was made by using
a 4 to 6 mm diameter depending on the size of the affected ear, and then mattress sutures that penetrate
the pinna was placed between the holes (Fig. 2). Of the 28 cases who underwent this procedure, 19
(67.9%) received antibiotics plus prednisolone (0.125 - 0.25 mg/kg, bid, po) for 3 - 8 days after surgery.
In addition to managing otitis externa, compression bandages and Elizabethan collars were used in all
surgical patients to reduce physical irritation to the ears after surgery.
 The treatment period and prognosis of these surgically treated cases and corticosteroid injected
cases were summarized in Table 3. In contrast to conservative therapy with the corticosteroid injection,
no recurrence was observed in the surgical cases during treatment up to suture removal. The mean
duration of treatment was the longest in the corticosteroid injection group (18.3 days) and the shortest
in the longitudinal incision group (11.8 days). Re-retention within 5 days after suture removal was
seen in 2 cases (7.1%) with punch drainage method, and since the policy of delaying suture removal
was changed in subsequent cases, the overall average treatment days were extended as a result. These
2 cases were cured by drainage and re-suturing. After 2 weeks of treatment, recurrences of AH were
observed in 2 of 9 cases (22.2%, 1 and 2 months later.) treated with corticosteroid injection and in 4
of 15 cases (26.6%, 2 weeks, 1 month, 18 months, and 36 months later) with longitudinal incision, and
these recurrences after healing were not seen in 28 cases who underwent the punch drainage.
Postoperative deformity could not be evaluated in the cases of longitudinal incision because there is
no description about it in most cases. In the case of punch drainage surgery, the deformity was observed
in one ear where the sutures could not be removed without visit for several months, but in the other
dogs, the deformity was not observed.

Discussion
It is known that untreated AH cause marked auricular deformation1, 2, 3, 7). Because AHs within
the auricular cartilage are not rapidly absorbed but replaced by large amounts of granulation tissue and
contracture progresses, early drainage is essential for maintaining appearance and early healing 1,3,7).
However, re-accumulation was seen in all cases with needle aspiration drainage alone, indicating that
repeated aspiration is often difficult to prevent recurrence. On the other hand, a decrease in the
retention fluid was observed in the corticosteroid-injection cases, suggesting that this drug suppresses
the production of retention fluid. Kuwahara reported that daily treatment with dexamethasone (0.5
mg/kg po and local injection of 0.2-0.4 mg) cures in 3-5 days6), and Romatowski reported that more
than 95% cures in 2 weeks with oral low-dose prednisolone (0.125 mg/kg, bid) and local injection of
triamcinolone acetonide (1 mg) 9). These results were better than those in the present study, probably
because of the combination of systemic therapy, the type of injection, or the short treatment interval.
Surgery using the biopsy punch was comparatively convenient, and it seemed to be the useful
therapy, because it cured smoothly without causing the deformation in most cases. Kuroki et al., who
devised this method, observed recurrence before suture removal in 2 out of 11 dogs to which this
method was applied 5), but this was not observed in 28 dogs in this study. One of the reasons for this
may be that oral corticosteroids were effective. However, since the duration of treatment was longer
in the cases of this study, there is a possibility that the delayed healing due to the corticosteroids,
possibly contributing to the recurrence immediately after the suture removal in 2 cases. Therefore, the
benefit of corticosteroids used with surgery requires further evaluation. In terms of prognosis after
cure, it was suggested that the punch drainage method is more effective in long-term suppressing
recurrence than conventional longitudinal-incision surgery or the corticosteroid therapy. In the punch
drainage method, adhesion between the skin and cartilage occurs in multiple punch holes, which may
have contributed to the suppression of recurrence. Similar adhesion effects have been suggested in
surgery using carbon dioxide laser to create multiple drainage perforations2). Since predisposing
factors are suggested in the development of AH8), the value of surgery leading to firmer adhesions in
each method is needed to investigate further.
A review of the developmental patterns and pathogenesis of the same 59 cases of this study
suggests that multiple risk factors are involved in the development of AH, and that 2 factors are
associated with the progression or recurrence of AH: perichondral edema and inflammation, and slow
healing within the cartilagine8). Therefore, 1) the control of inflammation and edema (inhibition of
fluid production), 2) the continuous drainage considering the delay of adhesion, and 3) the promotion
of adhesion actively, were considered as treatment strategies. The results of this study suggest that
simple aspiration without these effects does not lead to cure, and that corticosteroid injection reduces
fluid retention and actively suppresses inflammation and edema. However, corticosteroids may inhibit
adhesion of lesions 3, 7). On the other hand, although iatrogenic inflammation, possibly increasing fluid
production, is added by surgery, reliable and continuous drainage is possible, and perforations or
sutures have a high adhesion promoting effect. Because the mechanism of therapeutic effect is greatly
different between corticosteroid and surgical therapies, the efficacy and validity of each treatment
should be evaluated by classifying cases according to disease duration, size of AH, or underlying
diseases. In addition, this study was unable to sufficiently evaluate the aural deformation due to the
lack of records, so it is necessary to carry out further comparative studies.

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Table 1 Signalments of 59 aural hematomas in 49 dogs
 Table 2 Prognosis of dog aural hematoma after aspiration treatment

Fig. 1 Changes of rate of accumulated fluid after dexamethasone injection

Table 3 Treatment duration and recurrent cases