Aural Hematoma in Cats


Overview of Feline Aural Hematoma 

Aural hematoma, commonly called a pillow ear,  is an accumulation of blood within the cartilage layers of the ear. They usually appear as fluid-filled swellings on the concave (underneath) surface of the pinna, which is the pointed or floppy portion of the ear. The exact cause is poorly understood but any condition that leads to head shaking or ear scratching such as bacterial ear infection or ear mites may be responsible.

Aural hematomas can be painful to the touch and may aggravate an underlying ear disease. Left untreated, the swelling may eventually resolve on its own, leaving the ear deformed, a so-called “cauliflower ear.”

What to Watch For

  • Head shaking
  • Swelling of the pinna
  • Secondary ear infection (red inflamed ear with discharge)
  • Diagnosis of Aural Hematoma in Cats

  • On physical examination, a warm, fluid-filled swelling is noted on the inner surface of the ear. Eventually, the hematoma may become firm and thickened, resulting in a deformed “cauliflower” appearance.
  • Concurrent ear disease like infection or foreign material is common, but not always present.
  • Radiographs of the skull may be indicated if your veterinarian suspects external or middle ear disease is present.
  • Evaluation of the ear may show bacteria, yeast, ear mites, or foreign material to be present. Abnormalities in laboratory tests (blood work) are uncommon.
  • Treatment of Aural Hematoma in Cats

  • The underlying ear disease must be treated appropriately.
  • Needle aspiration of the hematoma usually resolves the problem only temporarily. Recurrence is common with this technique.
  • Surgical treatment is usually indicated.
  • Home Care and Prevention

  • Take your pet to a veterinarian to have the hematoma evaluated and to determine whether there is any underlying ear disease.
  • Delaying treatment will rarely result in a satisfactory or cosmetic outcome and fails to address the reason why the hematoma occurred in the first place.
  • Check your pet’s ears frequently, at least once a week, for evidence of inflammation such as redness, swelling or pain.
  • See your veterinarian as soon as head shaking, ear scratching or ear rubbing begins.
  • In-depth Information on Feline Aural Hematoma 

    Very few other medical problems resemble an aural hematoma. The fluid-filled swelling of the pinna is characteristic. Occasionally, an abscess or a tumor of the pinna might have a somewhat similar appearance.

    Ear Abscess

    An abscess may occur secondary to a penetrating foreign body or a bite wound. An infection could become established between the cartilage plates leading to the formation of a pocket of pus. Differentiation from a hematoma is simple, using needle aspiration. The abscess produces yellow or green pus; the hematoma yields blood.

    Ear Tumor

    A tumor of the pinna requires needle aspiration to obtain cells for examination on a slide, under a microscope. Differentiation between a bloody or fluid-filled tumor from a hematoma may be possible with this technique. Failing this, a biopsy specimen may be obtained. Tumors of the pinna are normally firm, fleshy or ulcerative (bleeding) and, therefore, quite different from an aural hematoma.

    In-Depth Veterinary Care for Feline Aural Hematoma 

    Veterinary care should include diagnostic tests and subsequent treatment recommendations.

    Diagnosis In-depth

  • Your veterinarian will evaluate the ear closely and will palpate (feel) the swelling.
  • Your veterinarian will also examine the external ear canal. Visual inspection of the ear canal may be followed by otoscopic examination. Some cats may tolerate this procedure quite well, but others may resist and squirm, necessitating sedation or even general anesthesia. For this reason, a detailed examination of the ear canal may be done at the time of surgical treatment of the hematoma.

    Visualization of the horizontal and vertical ear canal, together with the tympanic membrane or ear drum, is essential as part of the work-up for an underlying cause of the aural hematoma. Cultures may be obtained at this time to see what bacteria or fungi are growing in the ear and to what medications it is sensitive. Cotton-tipped swabs can obtain samples from the ear canal, be smeared onto a slide and evaluated under a microscope for parasites such as ear mites and yeast.

  • Skull radiographs, in cases where underlying external or middle ear disease is suspected, are also obtained under general anesthesia. Radiographs are only necessary if the canal is narrowed and occluded, preventing visual evaluation of the ear drum. When available, computed tomography (CT scan) or magnetic resonance imaging (MRI) can be more helpful than radiography to evaluate involvement of the middle ear.
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