Aural or auricular hematoma (AH) is a hemorrhage fluid-filled swelling affecting the concave surface of the pinna in both dogs and cats. This condition most commonly results of shear forces created by violent head shaking or ear scratching secondary to otitis externa, ectoparasitism, ottorrhoea, foreign bodies, hypersensitivity and allergic dermatitis which leads to rupture of the pinna blood vessel resulting in hematoma formation [1]. A bloody fluid accumulates under the skin of the inner pinna after vascular trauma and separation from the underlying cartilage. The exact location of the source of the hemorrhage is not known but is thought to come from branches of the great auricular arteries and veins within, under or between the cartilage layers. These vessels penetrate the scapha to supply the concave surface of the ear [2,3] Various management protocols employed for AH disorder based on the severity and the effectiveness of the procedures. AH fluid aspiration, AH fluid aspiration and dexamethasone infusion and surgical incisions are among the management protocols [4]. Surgical intervention is the most commonly used treatment for this case as it effectively prevents recurrence of the hematomas and maintain the natural and aesthetic appearance of the ear pinna [5,6]. Delay intervention may lead to hematoma maturation and fibrin formation. Furthermore, the chronicity drives to fibrosis and deform the ear (cauliflower contraction) [8]. Therefore, this case report describes surgical drainage followed by loose interrupted vertical mattress suture intervention protocol for AH in the dog.

A one-year-old dog was presented to Addis Ababa University, College of Veterinary Medicine, Teaching hospital, Bishoftu, with a history of the swollen left ear for one week (Figure 1). On physical examination, the rectal body temperature of the dog was 38.7OC with a 32 breaths/min respiratory rate and 88 beats/min heart rate.

Figure 1: A dog with an aural hematoma on the left ear (the arrow).

Soft fluctuating swelling was noticed at the medial side (concave surface) of the left ear pinnae. Upon aspiration, hemorrhagic fluid was observed. Flea’s infestations were abundant in the body of the dog. Based on the findings, the case was diagnosed as aural hematoma and decided for surgical intervention.

The incisional technique was used during the procedure under general anesthesia. The dog was placed in the right lateral recumbency with the affected ear on the top and aseptically prepared; tramadol 2mg/kg and xylazine 1mg/kg was administered as pre-anesthetic and anesthetized with ketamine 5mg/kg and diazepam 0.5mg/kg intravenously. The longitudinal incision over the length of the hematoma on the pinna’s concave surface was made (Figure 2). The incision was made from hematoma’s distal edge to its proximal edge, running parallel to the margins of the pinna. Following the incision, the blood was drained using gauze with mosquito forceps. The cavity was flushed with sterile saline solution (Figure 3) and povodine iodine. Then loose interrupted vertical mattresses with non-absorbable sutures were placed through the skin on the concave surface of the pinna (Figure 4). A postoperative bandage was placed (Figure 5). Finally, broad-spectrum antibiotic penstrip (Chongqing Fantong Animal Pharmaceutical Co. Ltd, China) 1ml/25kg/day, IM was prescribed for a week. After a month, the dog recovered completely (Figure 6); the fleas were also successfully treated and no relapse of the hematoma was seen.

Figure 2: Longitudinal incision on the concave side of pinna and drainage of hemorrhage.

Figure 3: Flushing of the cavity with saline solution.

Figure 4: Interrupted suture made parallel to the major vessels.

Figure 5: The incised ear bandaged.

Figure 6: A month after treatment the affected ear was healed without recurrence (the arrow).

The dog with swelling of the left ear reported in the current case was diagnosed as aural hematoma based on the clinical findings and removal of hemorrhagic fluid during the incision. A report by Hassan and Beteg. Concludes that most cases of aural hematoma are associated with traumatic injury and irritation to the ear which leads to head shaking or pawing. In the current instance, flea infestations were observed on the body of the dog and established that the fleas were responsible for the disorder as they can able to cause irritation [8]. Presently, surgical intervention technique was done with the aim of removing the hematoma, establish drainage, and prevent recurrence and to retain the pinna’s normal appearance by minimizing scar formation. Accordingly, the operation was successful, no recurrence observed and the healing was with a minimal scar which is in agreement with Beteg, Manjunatha [9].

The intervention of aural hematoma with surgical operation has advantages over other means of treatments as it guarantees to heal without recurrence and minimal scar and hence less defect.

We are grateful to Addis Ababa University College of Veterinary medicine, Veterinary Teaching Hospital staff, Mr. Dereje Gudeta in particular and the owner of the animal for their enthusiasm.

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