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Years of selective, designer breeding have led to significant changes in the dogs’ ear shapes and sizes. But altering their natural anatomical features, we have accidentally increased the risk of ear problems. Ear problems are among the most common reasons for visiting the vet’s office.

Dogs are prone to a plethora of ear problems, but ear flap issues seem to be quite frequent. The most frequently reported ear flap issue is the ear flap hematoma. Ear hematomas usually occur in dogs with long and floppy ears. On the flip side, dogs with erect ears are less likely to experience such an issue.

Dog Ear Flap Hematomas 

Earflap hematoma can be defined as an accumulation of blood between the ear’s tissue layers (more precisely, between the cartilage and skin). It can develop on one ear (called unilateral) or both ears (called bilateral). Unilateral ear flap hematomas are much more common than bilateral ear flap hematomas.

Based on how much space the accumulated blood takes, ear flap hematomas can be classified as diffuse or localized.

The anatomy of the ear plays an essential role in the hematoma’s development. Namely, the ear flap is built of three layers of tissue – two skin layers and a central cartilage layer between the skin flaps. The cartilage is what gives the ear its shape while the skin layers have a protective purpose.

 The three ear flap layers are well vascularized (rich in blood vessels). The blood vessels are well dispersed, and some of them pass through the cartilage.

The two skin layers are mobile, and when gliding on the cartilage’s surface can easily tear some of the blood vessels on its surface. If the blood vessels tear, they will keep on bleeding until they fill up the entire space with blood.

When the previously empty space becomes filled with blood, the accumulation puts pressure on the torn blood vessels, which eventually stops the bleeding.

Causes of Ear Flap Hematomas in Dogs 

Earflap hematomas develop after prolonged and repetitive episodes of excessive ear scratching and vigorous head shaking. The most common reasons for ear scratching and head shaking are ear mites, ear canal infections and allergies.

Earflap hematomas can also develop as a consequence of severe ear trauma that involves injuring some of the blood vessels inside the ear.

Last but not least, blood clotting issues can cause ear flap hematomas. Warfarin (popular and frequently used rodenticide) poisoning disables blood clotting and can potentially cause ear flap hematoma.

A predisposition to ear flap hematomas can also include various dog breeds. New studies suggest that ear flap hematomas are more common among certain dog breeds, including the Golden Retriever and the Labrador Retriever. According to veterinary reports, ear flap hematomas occur more frequently among older dog breeds.

Signs of Dog Ear Flap Hematomas 

Earflap hematomas are easy to spot – the ear will look more like a puffy pillow than a regular ear. If touched, the swelling will be fluctuating, hot and jelly-like. Once the blood clots, the consistency will change to either firm or dough-like.

Earflap hematomas are painful, and affected dogs may show signs of pain such as decreased appetite, lethargy and even increased body temperature.

How are ear flap hematomas diagnosed? An experienced vet will be able to diagnose this condition just by looking at the dog’s ear. However, the vet will perform a complete and thorough physical examination to determine the underlying cause.

Dog Ear Flap Hematoma Treatment 

The treatment of choice for ear flap hematomas is surgery. The procedure is performed under general anestesia and the recovery period is short and straightforward.

In the past, ear hematomas were treated by draining the accumulated blood through a wide needle or by aspirating the accumulated blood with a syringe. However, this treatment results only in temporary alleviation. It does not solve the problem. Consequently, more often than not, the ear flap will re-fill with blood again shortly after the drainage.

Lately, some experimental treatments involve injecting certain drugs under the ear flap’s skin, directly into the accumulated blood. However, this approach does not guarantee full blood reabsorption, and it does not prevent future accumulations.

If a dog's ear hematoma is left untreated, it could lead to an unsightly crinkled "cauliflower ear."

If a dog's ear hematoma is left untreated, it could lead to an unsightly crinkled "cauliflower ear."

What Happens if a Dog's Ear Hematoma is Not Treated?

Can ear hematomas heal without treatment? Theoretically speaking, yes, most cases of ear hematomas can resolve on their own. Ear hematomas are considered a minor medical issue, and if left without treatment, over time, the accumulated blood is likely to reabsorb, and the pain will go away.

However, without proper veterinary care, the ear will likely endure permanent disfiguration. Plus, since ear hematomas are painful, leaving a dog without treatment is inhumane.

Last but not least, in cases where the ear hematoma does not heal on its own, the accumulation may become some big, that the ear canal gets wholly occluded. This will trap the content of the ear and may trigger a severe ear infection. The consequences of leaving dog ear hematomas untreated are therefore various. 

There is a popular misconception that ear flap hematomas can explode if left untreated. This is nothing but a myth. The consequences of leaving ear hematomas untreated are in most causes purely cosmetic. Cosmetic issues are a problem only for show dogs.

So, if having your dog’s ear hematoma surgically treated is too expensive or if your dog is too old and you do not want to take the risk, probably you will have to deal with a so-called cauliflower ear.

The term "cauliflower ear" is used to describe the permanent disfiguration of the ear that develops if the hematoma is left untreated. The disfiguration is caused by the scar tissue formation that follows the abnormal changes in the ear’s tissue layers.

As previously stated, the cauliflower ear can be considered a medical issue instead of cosmetic only if the disfiguration affects the ear canal to the point it becomes completely occluded. In such a situation, surgical reconstructive surgery is necessary to restore normal appearance and function.

About the Author

Dr. Ivana Crnec is a graduate of the University Sv. Kliment Ohridski’s Faculty of Veterinary Medicine in Bitola, Republic of Macedonia. 

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