Introduction
An aural hematoma is the accumulation of serosanguineous fluid or blood within the pinna characterized by purplish rounded fluid-filled swelling of the external ear. It is the most common physical injury of the pinna and is apparent on the pinna’s concave surface. When pets vigorously shake their heads or scratch their ears, trauma to the ears causes the blood vessels and capillaries in the pinna to rupture (Henderson et al., 2003). As a result, blood pools in the space between the skin and cartilage creating a hematoma. This condition is usually unilateral, but it can be bilateral. Hematomas should be drained as soon as possible. If they are left untreated, fibrin formation can occur, leading to fibrosis, contraction and thickening, potentially leaving the ear with a deformed cauliflower like appearance (Medleau and Hnilica, 2006).
Several etiologies have been postulated for aural haematoma including excessive head shaking due to ear irritation from otitis externa, otic foreign bodies, flies etc. Ear infections, ear mite infestations, foreign bodies within the ear canal, and allergies are common underlying causes of aural haematoma formation (slatter, 1993).
There are various methods of treatment for the arual haemotoma. Simple aspiration is the most conservative treatment and relieves acute pain, but recurrence is common. Surgical drainage is best method and it includes Silastic drain placement, Teat cannula placement, closed near future, suction catheter system, suture technique, incisional drainage, Carbon dioxide (CO2) and laser procedure. But all the techniques have their own limitation.
The present case report describes the surgical treatment of aural haematoma in dogs presented to the teaching veterinary hospital, Madras Veterinary College.
Case Description
This case report is based on the clinical examination during the study period. Observations were performed on a number of 4 dogs with different ages presented for diagnosis and treatment at the Clinics of Madras Veterinary College (Table 1). For each dog, owners’ complaint was fluid filled swelling at right ear with shaking of head. The swelling of the ear was examined physically and no pain was observed on palpation. The dogs were active and alert, feeding habit was satisfactory. The temperature, heart and respiratory rate were recorded and found in the normal range. All of the four dogs displaying these clinical signs were diagnosed as aural haematoma and it was decided to remove the haematoma by surgical treatment.
Table 1.An overview of the dogs diagnosed for surgical correction of aural haematoma
Patient No. Breed Body weight (kg)
Sex Temp. ( °F) Age (year)
1 Spitz 12 Male 103 8
2 Spitz 15 Male 102 7
3 Spitz 12 Male 102 8
4 Spitz 14 Male 102 6
Anaesthesia and restraining
The animals were controlled by lateral recumbency and pre-anaesthesized by diazepam (0.5 mg/kg body weight ) and anaesthesized by ketamine HCl ( 10 mg /kg body weight ) keeping the affected ear upwards . The animal was stabilized by 5% dextrose saline. Following restraining, the intended area of incision site was shaved and soaked with tincture iodine and alcohol. The external orifice of ear was closed by cotton plug. Then a triangular incision was given on right ear flap and hematomal content was drained out. The cavity was thoroughly irrigated with povidone iodine. Then pressure bandage was applied over the ear.
Post-operative Care
After surgery, medication was provided to the dogs. DNS 5% saline was administered during the operation to maintain the electrolyte balance. A course of antibiotic (intramox – amoxicillin + cloxacillin) was given intramuscularly for 5 days to prevent bacterial infection and analgesic (tramadol 1 cc) was administered intravenously. The owner was advised to keep the animal in clean house and not allowed to rub its head. On the 5th day the pressure bandage was removed and the animal showed uneventful recovery.
Aural haematoma is a frequent disorder in dogs, cats and pigs. Several methods have been described in the literature for the management of aural haematoma. Among various methods of correction of aural hematoma, pressure bandage was preferred because it is used to help control hemorrhage. But it must be used with caution and for a short period of time. Pressure can help to control wound edema and they are more effective in controlling passive edema than inflammatory edema. Pressure bandage also helps to prevent formation of excess granulation tissue, to obliterate dead space and to immobilize and injured part (Kagan, 1983).
A properly applied pressure bandage tends to keep some dynamic pressure on the wound as the patient moves. Even when pressure bandage is used, excess pressure can impair arteries, venous and lymphatic flow and can lead to tissue slough as well as impinging on nerves. The animal should observe for swelling, hypothermia, cyanosis, dryness, loss of sensation or odor in the area distal to the pressure bandage. If the animals lick or chew a pressure bandage, the bandage should remove and the area should be examined (Reid and Kommareddi, 1980)
Unless a pressure bandage is used to apply tension continuously, it is difficult to maintain pressure on a wound surface by using cotton or linen dressing. When cotton and similar material are applied as a pressure bandage, they generally become compressed in a short time and thus no longer act as a pressure bandage. However, if cotton and linen do not compress sufficiently to relieve the constricting effect of tightly applied adhesive tape, the result may be circulatory embarrassment of the wound and bandaged suture (Bojrab et al., 1998).
Bandaging the ear helps prevent pets from damaging the surgical site either by shaking their heads or trying to scratch the site. It is important to avoid incorporating the normal ear in bandage and it is best to avoid the hematoma site and ear cannel opening exposed.
In conclusion, correction of aural haematoma by pressure bandage with its better drainage and less cost materials could be a better approach to the management of aural haematoma.
Figure 1 : aural hematoma.
Figure 2 : incision of the skin.
Figure 3 : drainage of hematoma fluid.
igure 4;Washing with providone iodine.
Figure 5: Bandaging with pressure bandage.
Figure 6 : After bandage of the dog.
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ACKNOWLEDGMENTS
The author is ever grateful and indebted to the immeasurable grace and profound kindness of Almighty “GOD” the soul authority and supreme ruler of universe, who enabled him to complete the work successfully.
The author feels proud in expressing his deepest sense of gratitude, sincere appreciations, indebtedness to respected teacher and supervisor Himel Barua Associate Professor, Department of Microbiology and Veterinary Public Health, Chittagong Veterinary and Animal Sciences University for his ingenuous and scholastic supervision, constant inspiration, providing valuable suggestions, necessary corrections to report writing and for affectionate help in completion of this report.
The author would like to express his deepest sense of respect and affection to the honorable Vice Chancellor Prof. Dr. Gautom Buddha Das and Dean Prof. M. A. Halim, Faculty of Veterinary Medicine, Chittagong Veterinary and Animal Sciences University.
The author express his sincere gratefulness and thanks to Prof. Dr. AKM Saifuddin, Director, External Affairs (CVASU) for his valuable suggestions for completion of this report.
The author is also greatfl to all of her teachers of CVASU and her parents for their impressive support, suggestions, cordial help and inspiration regarding my study from its inception to the last.
The author
November 2017
BRIEF BIOGRAPHY
I am Sharmin Akhter Mii, daughter of Md.Mokbul Hossain and Shalina Akhter . I have completed my Secondary School Certificate (SSC) examination from PDB High school (2008),Kaptai, Chittagong and then Higher Secondary Certificate (HSC) examination from Muktagacha College (2010), Chittagong. Then I got admitted in Doctor of Veterinary Medicine (DVM) course under CVASU. During my internship programme I got a short term research on aural hematoma in dogs at Madras Veterinary College, Chennai, India.
