Give Us an Earful: How Do YOU Treat Aural Hematomas?
Originally Published: Clinician’s Brief, March 8, 2012
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Give Us An Earful: How Do YOU Treat Aural Hematomas?
“What are you going to do this time?” my technician whispered as we looked into the waiting room. The 4 y.o. MN Bernese Mountain Dog looked back happily, then violently shook his head. The hair on the outside of his right ear was starting to re-grow, as was the fluid-filled pouch on the underside. His owner spotted me peeking around the doorframe as I tried to assess the situation, as well as the attitude of the client who was making his fifth visit in the last 8 weeks. He gave me a pained grin that said, “I like you a lot, but you really need to fix this.”
To be honest, I was (and still am) quite fond of this particular dog. However, frustration over this unresolved aural hematoma was threatening to seep into my bedside manner. During this case, I read widely on treatment options, and discussed everything from medical management to ear amputation with the owner. I tried multiple courses of steroids, ran blood work, evaluated clotting times, drained, opened, sedated, anesthetized, quilted, and asked for advice from almost every veterinarian I knew (and some that I didn’t).
Ultimately, it was a combination of steroids, quilting, and drains (and possibly prayer) that seemed to do the trick. I used an 6-week tapering course of prednisone with 1cm full-thickness sutures and a ¼-inch fenestrated latex drain, which I removed after 3 weeks. Having gone through this emotionally scarring ordeal, three things now happen whenever I see an aural hematoma. First, I develop a mild eye twitch that my technicians are starting to pick up on. Second, I preemptively warn the owner how frustrating treatment of this condition can be. And finally, I kick myself for not writing down all the great advice I was given on effective treatment of this condition the first time.
So today, for the sake of all the veterinarians that are battling (and will battle) this potentially humbling condition, I ask for your help. Please share your best advice for treating aural hematomas in the comment section below. Your words of wisdom may save a young (or not so young) veterinarian a lot of frustration!