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Ear: aural hematoma

icanis
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Introduction

  • An aural hematoma is blood lying between the cartilaginous structure and skin of the pinna or within fractured aural cartilage.
  • Cause: probably this is secondary to head shaking or scratching at the ear both secondary to ear irritation, injury or disease.
  • Signs: vary from small, fluctuant swellings on either surface of the pinna to extremely large tense structures distorting the whole ear. The concave surface is more often affected.
  • Diagnosis: history, signs.
  • Treatment: drainage, usually surgical, and by correction of underlying problems.
  • Prognosis: neglected cases can result in the formation of a 'cauliflower ear' - a distorted pinna shape due to fibrosis and contraction of the hematoma within the ear. However, this is usually only of cosmetic concern.

Pathogenesis

Etiology

  • Vascular disruption and consequent bleeding into the space between the auricular cartilage and skin.
  • There is evidence for an autoimmune process occurring at least in some cases but this is disputed.

Predisposing factors

General

Pathophysiology

  • The pathogenesis of the condition is not fully understood.
  • In many instances, violent head shaking as a result of ear disease, irritation or injury results in cartilaginous damage and vascular injury to branches of the great auricular artery.
  • Increased capillary fragility or bleeding tendencies may occasionally result in hematomas in animals without obvious ear disease.
  • There is evidence for an autoimmune process occurring at least in some cases but this is disputed.
  • The condition is caused in most cases by bleeding into a potential space (between the auricular cartilage and skin of the pinna) usually following traumatic injury to the cartilage and associated blood vessels.
  • A fluctuant fluid swelling develops. In severe cases, the swelling may be large, tense, firm and very painful.

Timecourse

  • Several days.
  • Minor hematomas may be present for several weeks before attention is sought.

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Joyce J A et al (1997) Immunopathogenesis of canine aural hematoma. JSAP 38 (4), 152-158 PubMed.
  • Swaim S F & Bradley D M (1996) Evaluation of closed-suction drainage for treating auricular hematomas. JAAHA 32 (1), 36-43 PubMed.
  • Joyce J A (1994) Treatment of canine aural haematoma using an indwelling drain and corticosteroids. JSAP 35 (7), 341-344 VetMedResource.
  • Ramatowski J (1994) Nonsurgical treatment of aural hematomas. JAVMA 204 (9), 1318 PubMed.
  • Kawahara J (1986) Canine and feline aural hematomas. Results of treatment with corticosteroids. JAAHA 22 (5), 641-647 VetMedResource.
  • Kawahara J (1986) Canine and feline aural haematoma - clinical, experimental and clinicopathologic observations. Am J Vet Res 47 (10), 2300-2308 PubMed.
  • Dubielzig R R et al (1984) Pathogenesis of canine aural hematomas. JAVMA 185 (8), 873-5 PubMed.

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