Ear Hematoma in Dogs: Signs, Causes, and Treatment

How an ear hematoma forms

The ear flap is a thin sheet of cartilage covered by skin on both sides, with small blood vessels running through it. When a dog shakes its head hard or scratches the same ear again and again, one of these vessels can break, and the cartilage itself may crack. Blood collects between the layers of the ear flap and forms a fluid-filled pocket.

Vets do not fully understand every step of this process. Repeated shaking and scratching play a part in nearly every case. A knock to the ear, a scratch, or a bite from another animal can also start one.

Common causes

The usual trigger is an ear that itches or hurts. When a vet looks for the reason, these are the most common findings.

• An outer ear infection caused by bacteria, yeast, or both
• Allergies to things in the environment or to food, which often inflame the ears
• Ear mites or other parasites
• Something stuck in the ear canal, such as a grass seed
• Long-standing ear disease that keeps coming back

Some illnesses make small blood vessels more fragile. Hormone conditions such as Cushing's disease are one example, and they can make a hematoma more likely. Less often, an immune condition or a bleeding disorder plays a part. A dog with a clotting problem can develop a hematoma even without shaking or scratching. Any dog can get an ear hematoma, but dogs with ongoing ear problems are the ones vets see most often. Cats can get them as well.

Signs to watch for

The swelling can be small or it can fill the whole ear flap. A large one can partly block the opening of the ear canal. Usually only one ear is affected, but both can be. Owners often notice some of these signs.

• A soft, squishy swelling on the inside of the ear flap that feels filled with liquid
• An ear flap that feels warm and looks thicker than the other one
• An ear that hangs lower or looks heavier than usual
• Head shaking, scratching at the ear, or rubbing the head along the floor
• Flinching, pulling away, or crying out when the ear is touched
• Signs of ear infection, such as a bad smell, redness, or discharge from the ear canal

When it is an emergency

An ear hematoma on its own is usually not an emergency. It is painful, though, and it is recommended to have your vet look at it soon rather than wait for it to go down. Left alone, the blood is slowly reabsorbed, but the inflammation leaves scar tissue behind. The ear often heals thick and misshapen, and in some dogs the scarring narrows the ear canal.

Draining the swelling at home with a needle or blade is not recommended. It can let in infection, and without proper treatment the pocket tends to fill again.

Contact your vet or an emergency clinic the same day if your dog has a head tilt, loses balance, has trouble standing or walking, or has eyes that flick from side to side. These can be signs that an infection has reached the middle or inner ear. The same goes for a bite wound on the ear, bleeding that does not stop, or unexplained bruises or bleeding elsewhere on the body, which can point to a clotting problem.

How vets diagnose and treat it

A vet can usually recognize an ear hematoma by looking at and gently feeling the ear flap. They may draw a small sample of the fluid with a fine needle to confirm what the swelling contains. The bigger task is finding out why your dog was shaking or scratching. The vet will look into the ear canal with a lighted instrument called an otoscope. They often take a swab of the ear debris to check under a microscope for yeast, bacteria, or mites. Depending on the findings, they may suggest allergy testing or blood tests for hormone conditions.

Surgery is the most common treatment. Under general anesthesia, the vet opens the swelling, removes the blood and clots, and places stitches through the ear flap. The stitches close the empty space so it cannot fill up again. They usually stay in for two to three weeks while the layers heal together. Some vets make a series of small holes instead of one longer cut.

Other options avoid a full surgery. A vet may drain the fluid with a needle, sometimes placing anti-inflammatory medicine into the pocket afterward. The pocket often refills, so this may need to be repeated. Another approach is to leave a small drain in the ear flap for several days so fluid can keep escaping. Some dogs also receive anti-inflammatory medicine by mouth while the ear problem is treated. These less invasive methods are more likely to let the swelling come back and to leave the ear wrinkled.

Many of the less invasive methods do not need general anesthesia. That can make them a better choice for a dog that is not a good candidate for it. A vet may also suggest letting the hematoma heal on its own while treating the cause. This can take weeks and is uncomfortable for the dog. The ear usually ends up thick and crinkled, a shape often called cauliflower ear.

Whatever method is chosen, treating the cause is part of the plan. That may mean ear medicine for an infection, parasite treatment for mites, or a longer plan to manage allergies. If the itching continues, a new hematoma can form in the same ear or the other one.

Recovery at home

Many dogs go home with a bandage that holds the ear still against the head, often for several days to a couple of weeks. Your vet will usually also recommend a cone so your dog cannot scratch the ear or pull the bandage off. Keep the bandage clean and dry, give every ear medicine as directed, and go to each recheck visit, including the one for stitch removal.

Call your vet if the bandage slips, gets wet, or smells bad, if the swelling comes back, or if your dog seems in more pain than before. When the hematoma is treated well and the underlying problem is under control, it rarely returns. Some scarring or wrinkling of the ear flap can still happen with any treatment.

Prevention and other pets

The best prevention is to deal with ear problems early. Check your dog's ears regularly for redness, smell, or discharge, and see your vet when head shaking or scratching starts. Keep up any ear treatment until your vet confirms the infection has cleared, even if the ear looks better sooner. Clean the ears only if your vet recommends it, with a product they suggest, and avoid cotton swabs, which can push debris deeper. Try to keep water out of the ears at bath time, and ask your vet about a drying product if your dog swims. Dogs with allergies often need a long-term plan to keep their ears comfortable.

An ear hematoma is not contagious. It cannot pass to other pets or to people. Ear mites are a different matter. They spread easily between dogs and cats through close contact, so if mites are the cause, vets usually recommend treating every pet in the home.

Rescued and newly adopted dogs

Dogs that lived on the street or in crowded conditions may arrive with ear mites or ear infections that were never treated. At Paw Squadron, the first stops after every rescue are the vet and a bath, with a checkup, deworming, and treatment against fleas and other parasites. Before adoption, every animal gets a checkup, treatment, vaccinations, and a microchip.

If your adopted dog has a thick, crinkled ear flap, it may have had a hematoma in the past. Mention it at your first vet visit and ask the vet to check the ear canal, especially if your dog still shakes its head or scratches at that ear. In a new dog, head shaking is worth an early vet visit, before a small ear problem turns into a swollen ear flap.

You can find more guides on ear and skin care in PawPedia. If you have questions about a dog you adopted from us, our FAQ is a good place to start.