Why does my dog’s ear look like a wonton?

We asked Dr. Yung about this type of ear infection, also called “pillow ear” or “hematomato.”

What is an Aural Hematoma?

A hematoma is swelling created by a broken blood vessel after bleeding has occurred inside a tissue. Hematomas in the earflaps are called aural hematomas (which sounds like “oral” but has nothing to do with the mouth!)

How does it happen?

Pets that paw at their ears or shake their heads vigorously, especially those with large ears, can cause a hematoma.  The head shaking breaks a blood vessel within the earflap and the earflap then swells with blood.  The swelling can be so large that the opening of the ear canal is blocked off.  The earflap will feel fluid-filled, like a water balloon, hence the nicknames.

The pawing and shaking is most often due to an underlying ear infection.  It can also be due to irritants around the face and ears, or foreign material in the ear, like grass awns.

Who gets them?

Dogs mostly, but it can occur in cats as well.

What treatment is available?

There are two therapies for aural hematomas – medical or surgical.  Medical therapy consists of draining the fluid from the ear, then injecting a cortisone injection into the ear.  The pet may then be sent home with a tapering dose of corticosteroids as well as treatment for the ear infection if that is the underlying cause.

It is advantageous in most cases to use medical therapy first because there is no need for general anesthesia, there is minimal discomfort, and the cost is less than surgical correction.  Surgical treatment is used in those situations in which the problem is not successfully corrected with medical therapy.

Some hematomas are too large or involved to attempt medical treatment initially.  Or there may be a contraindication for corticosteroids in a particular pet.  There are as many surgical techniques for resolving aural hematomas as there are ears in the world (which means that no one surgical technique is 100% successful), but the general goal of surgical therapy is to remove the fluid from the earflap and then employ a method of flattening down the ear with sutures and other material so that the fluid does not build back up.

Regardless, treatment won’t be successful unless the underlying problem is identified and corrected.

What is the prognosis?

Very good! Most cases respond well to medical therapy, but there can be more complicated cases that require surgery or surgeries.  It is difficult to predict how a particular patient will respond and heal.

Aural hematomas do eventually heal no matter how complicated but can cause some scarring of the ear flap – like the “cauliflower ear” human boxers get.  Aural hematomas can, of course, reoccur if the underlying cause reoccurs.

While aural hematomas aren’t necessarily emergencies, they should be seen and treated as soon as possible.  These patients come in with their head cocked to the side, feeling very uncomfortable.