Aural haematoma-what do you do???

Re: Aural haematoma-what do you do???

Anthony Todd — Thu, 24 May 2012 13:41:29 GMT

[quote user="Mark Hedberg"]

For what it's worth, I always used a chessboard pattern of suture; just don't tie them ischemic tight. Less distortion that way. Always hated the xray film, not thick enough for what you want it for and it was just places for bacteria to get stuck under...

[/quote]

Totally agree; the film just breaks up gives no support and certainly no shape preservation [neither do buttons]. Checkerboard, parallel to the long axis of the pinna is vital, around 8-10mm apart in all directions, knots on the outside and easy to remove after 6 weeks if you use a plastic container splint.

Re: Aural haematoma-what do you do???

Anthony Todd — Thu, 24 May 2012 13:40:44 GMT

[quote user="Mark Hedberg"]

[/quote]

Totally agree; the film just breaks up gives no support and certainly no shape preservation [neither do buttons]. Checkerboard, parallel to the long axis of the pinna is vital, around 8-10mm apart in all directions, I reckon, knots on the outside and easy to remove after 6 weeks if you use a plastic container splint.

Re: Aural haematoma-what do you do???

Mark Hedberg — Thu, 24 May 2012 08:49:22 GMT

Re: Aural haematoma-what do you do???

Anthony Todd — Wed, 23 May 2012 22:52:12 GMT

[quote user="mariette asselbergs"]and the result was very good.[/quote]

3 months full frontal picture please, someone, please......

At least your method couldn't be worse, at 3 months, than buttons. [as far as pinna distortion goes, that is]

Re: Aural haematoma-what do you do???

mariette asselbergs — Wed, 23 May 2012 14:05:07 GMT

After following this discussion I tried the drain and steroid method (I had always stitched buttons), and the result was very good. Owner very pleased, minimal discomfort, quick procedure, minimal cost.

THANKS!

Mariette

Re: Aural haematoma-what do you do???

Anthony Todd — Sat, 19 May 2012 15:11:51 GMT

[quote user="patrick murphy"]

do you dress it, or let it dribble?

[/quote]

If you're asking me, drain at the time using minimal trauma, that is the smallest hole ventrally that will allow the clot to be expressed then the mattress sutures and the "splint prevent refilling.

I used to insert an 18-20 x1" needle and suck out as much as possible, breaking up the clot with the needle.

Why make a hole in the medial pinna any bigger than you need to drain the clot and serum? A bigger hole or 6mm punch must cause distortion when it heals with the associated contraction.

Antibiotic cover for 5 days and steroids by injection for the same time. Stitches out at 6 weeks. Stitches must be parallel to the long axis of the pinna or you get disastrous distal necrosis......

Re: Aural haematoma-what do you do???

patrick murphy — Sat, 19 May 2012 14:00:38 GMT

do you dress it, or let it dribble?

Re: Aural haematoma-what do you do???

Anthony Todd — Fri, 18 May 2012 11:00:48 GMT

[quote user="Niall Taylor"]

We've done 2 using this technique but both dogs had floppy ears (both have done well btw). What is the particular concern re prick eared animals (or am I missing something here)?

Niall

[/quote]

Means you can actually compare both ears side by side so "good cosmetic results" can be judged comparatively, and my tailored splint method will bear comparison with the other "normal" ear most times and perfectly.

As I said, you have to match the contour of the ear exactly with the 2L, 5L [or what ever matches] container or milk or detergent plastic container exactly.

Re: Aural haematoma-what do you do???

Niall Taylor — Fri, 18 May 2012 10:44:25 GMT

We've done 2 using this technique but both dogs had floppy ears (both have done well btw). What is the particular concern re prick eared animals (or am I missing something here)?

Niall

Re: Aural haematoma-what do you do???

Anthony Todd — Fri, 18 May 2012 10:37:21 GMT

Still no full frontals of prick eared dogs and cats post op; must be someone with a camera?

Re: Aural haematoma-what do you do???

Niall Taylor — Fri, 18 May 2012 09:54:12 GMT

[quote user="Malcolm Ness"]

Ongoing research project at our hospital led by a colleague started lots of years ago because of discussions like this featuring loads of firmly held (and often contradictory) opinion underpinned by a hatred of the conventional surgery which is barbaric, painful, irrational and frequently ineffective.

SNIP ...

Joyce J A (1994) Treatment of canine aural hematoma using an indwelling drain and corticosteroids. JSAP 34 , 341-344.

[/quote]

The volume number is wrong in this citation Malcolm. The correct reference is:

Joyce, J.A., (1994) Treatment of canine aural hematoma using an indwelling drain and corticosteroids Journal of Small Animal Practice Vol. 35 no. 7 pp. 341-344

The reference can be found on the JSAP section of the Wiley website here - http://onlinelibrary.wiley.com/doi/10.1111/j.1748-5827.1994.tb01711.x/abstract

Hope that helps,

Niall

Re: Aural haematoma-what do you do???

Rob Davis — Wed, 16 May 2012 16:39:38 GMT

Floppy-eared dog, so can't help you there I'm afraid!

Re: Aural haematoma-what do you do???

Anthony Todd — Wed, 16 May 2012 16:07:07 GMT

[quote user="Rob Davis"]good results so far.[/quote]Still waiting for some full frontal pictures of prick-eared dogs or cats.

Re: Aural haematoma-what do you do???

Rob Davis — Wed, 16 May 2012 15:44:26 GMT

[quote user="Malcolm Ness"]The technique involves using a 6mm skin biopsy punch to make two holes through which a penrose drain is passed (and through which any clots etc that might be there can be removed) and sutured with 2x SI nylon. Stays in for 2 weeks and pred at 1mg/kg for 2 weeks then 0.5mg/kg for a further week.[/quote]

Thanks for this Malcolm. I tried this technique for the first time recently and he's just finished the third week of pred having removed the drain one week ago. It was very quick and easy to do (previously I've always used mattress sutures previously which always seem to take much longer than I think they will), well tolerated by the dog and good results so far.

Re: Aural haematoma-what do you do???

Malcolm Ness — Thu, 05 Apr 2012 09:29:02 GMT

[quote user="CatherineBoden"]

Malcolm,

When you do this method do you keep them on antibiotics for the whole 2 weeks that the drain is in?

[/quote]

We don't use antibiotics at all. The patients are on steroids anyway and there is well-established drainage.

Re: Aural haematoma-what do you do???

Anthony Todd — Thu, 05 Apr 2012 00:03:53 GMT

No pictures of "good cosmetic results" around?

I've certainly seen some very crumpled cats ears and dogs with a large medial scar and distortion too.

Re: Aural haematoma-what do you do???

CatherineThomas — Wed, 04 Apr 2012 19:44:13 GMT

Malcolm,

When you do this method do you keep them on antibiotics for the whole 2 weeks that the drain is in?

Re: Aural haematoma-what do you do???

Anthony Todd — Tue, 03 Apr 2012 08:30:12 GMT

[quote user="Malcolm Ness"]

The original report in JSAP of the drain and oral corticosteroid technique cites good cosmetic results. That remains our experience (even in cats) after several hundred cases. AH does seem less common now.[/quote]

Can't argue with that unless I fall back on peer-reviews an' all.

It certainly sounds much simpler, but I'd love to see a few full frontal head shots of cats or prick eared dogs 3 months after your procedure and mine....

Some do well on drain by needle and depomed instilled [and correct the irritation ie mites in cats, usually].

Re: Aural haematoma-what do you do???

Malcolm Ness — Tue, 03 Apr 2012 06:43:41 GMT

Re: Aural haematoma-what do you do???

Anthony Todd — Tue, 03 Apr 2012 02:24:20 GMT

[quote user="Simon Neuhoff"]I for one regard my own conclusions drawn from my own experiences with a healthy amount of suspicion[/quote]

Well so do I to an extent, but when you've done things which seemed to work and seen your colleagues do others that don't your own conclusions do strengthen a bit.

[Aural haematomata are less common now. I think, than they were when steroids, chronic otitis externa and ear mite control via drop on flea control were incompatible.]

Nobody has mentioned the final results of the techniques described which all end up with a crumpled or distorted pinna to a greater or lesser extent, noticeably in cats.

I'm sure I've described what I did before on this forum but it involved a solid plastic "splint" cut and matched to the original pinna shape and stitched through after draining and "clearing" the clot. I remember X-ray film being used, but that breaks up in days, and buttons still give crumpling.

This method seemed to work for me, and gave a perfectly formed pinna at the end allbeit with a series of small nodules of reaction round each suture penetration which gradually resolved.

Please, I can't sleep, or stop crying, after even one red star so be gentle.

Re: Aural haematoma-what do you do???

Simon Neuhoff — Mon, 02 Apr 2012 20:56:24 GMT

[quote user="Malcolm Ness"]

pompous outpourings of unsubstantiated opinion.

[/quote]

Brilliant! Don't hold back Mr Ness ;-)

I for one regard my own conclusions drawn from my own experiences with a healthy amount of suspicion - and I treat anecdotal evidence from colleagues in the same way. Trouble is though there is so much out there that is based on dogma and common practice and precious little evidence!

Re: Aural haematoma-what do you do???

Mark Holmes — Mon, 02 Apr 2012 15:32:32 GMT

I have done this technique on a few since Malcolm suggested it and it is much better than my previous method of opening and suturing. Works as far as I am concerned much quicker to perform and better tollerated as well.

Re: Aural haematoma-what do you do???

CatherineThomas — Mon, 02 Apr 2012 15:04:18 GMT

It was someone from Dick White Referrals. He said that Dick White doesn't think this technique works.

Re: Aural haematoma-what do you do???

Malcolm Ness — Mon, 02 Apr 2012 14:31:31 GMT

[quote user="CatherineBoden"]'m quite annoyed that they did this. What do you think?[/quote]

I think you are right to be annoyed. Who was the surgeon?

Re: Aural haematoma-what do you do???

CatherineThomas — Mon, 02 Apr 2012 14:11:18 GMT

[quote user="Malcolm Ness"]

The technique involves using a 6mm skin biopsy punch to make two holes through which a penrose drain is passed (and through which any clots etc that might be there can be removed) and sutured with 2x SI nylon. Stays in for 2 weeks and pred at 1mg/kg for 2 weeks then 0.5mg/kg for a further week.

Well tolerated, first-time resolution in more than 90% cases; very few long term recurrences and excellent cosmetic results.

[/quote]

Well I thought I would give this method a go on Friday. Everything seemed to go well with the op but then later in the afternoon she suddenly went off her back legs. So she was immediately referred to the neurologist at our local referral centre. This morning I got a phonecall from one of the surgeons at the centre about her. He doesn't know what is going on with the neurological side of things other than the neurologist is happy with her progress and is planning to discharge her this morning. The reason he called is that he's looked at the ear this morning. Basically the head surgeon doesn't believe that this method will work and he wants to know if I want him to suggest to the owners that they remove the drain and perform a different surgical proceddure to treat it. I told him that I would rather he left it as it is and we will see if it works, if not we will cross that bridge when we get to it. I felt like he was saying that I was stupid for having done this proceedure and there was no chance it's going to work but they could fix it for me.

The owners then brought the dog to us for it's post op check on their way home and my colleague saw it and says the ear looks fine, she can't see any reason why they would say it's causing a problem as it is.

I'm quite annoyed that they did this. What do you think?