Aural Haematoma

RE: Aural Haematoma

Anthony Dennison — Thu, 26 Nov 2015 18:01:38 GMT

I have to say I don't often get the problem, because I wear a scrum cap.

But if it is tight in the scrum (my team has just changed their scrummaging technique and it's a lot more solid) you can definitely feel it. I don't normally wear my cap for training and if you take a few knocks your ears go very red and warm. Sometimes it can be a haematoma build up, sometimes it can be chronic rubbing causing thickened cartilage?

On of the older players at my first club had horrendous cauliflower ears - just lumps of misformed cartilage either side of his head. He said they don't really feel part of him - if he's lying on a pillow it just feels like his head is resting on something on the pillow.

The main problem I get is rubbing by my eyes taking the skin off. On Sunday mornings after a game my eyes are very swollen and puffy, by Monday it goes down and I've just got a large, thin scab on the side of my face which heals just in time for the next game.

RE: Aural Haematoma

Anthony Todd — Thu, 26 Nov 2015 17:56:12 GMT

[quote user="Anthony Dennison"]Not really blunt trauma, more from the rubbing in the scrum, or pressure on the ears.[/quote]

Do they swell up more after the game? [ie continual serum leak/blood leak?

Are they, initially, a true haematoma or more organised like a sort of callus on the pinna?

Is the end result [see the pundits on the TV] hard to start with ie a seroma or are they solid once they form?

Just wondering if the aetiology is exactly the same.....

RE: Aural Haematoma

Anthony Dennison — Thu, 26 Nov 2015 11:28:55 GMT

[quote user="Anthony Todd"]

Sure, I always thought it was trauma of some sort, as a result of an injury or head shaking causing injury.

Isn't it injury in rugby players?

[/quote]

Not really blunt trauma, more from the rubbing in the scrum, or pressure on the ears. Why I wear a scrum cap to protect my lugs.

I had a cat where I used the penrose drain method on one ear, then drained and depo's the other after the penrose drain ear went all crinkly. Drain and depo had a better cosmetic appearance.

RE: Aural Haematoma

Anthony Todd — Thu, 26 Nov 2015 09:43:26 GMT

[quote user="Michael Woodhouse"]It's NOT frank blood. It is not just a simple burst blood vessel in the pinnae.[/quote]

Can you explain the pathological sequence then please [not a conflict, just wanting to know 'cos I was a "initial frank blood" believer,

[quote user="Michael Woodhouse"]I've seen them in dogs with spotless ears - it's not a simple head shaking aetiology. I'm convinced of that.[/quote]

Sure, I always thought it was trauma of some sort, as a result of an injury or head shaking causing injury.

Isn't it injury in rugby players?

[quote user="Michael Woodhouse"]and the PCV was very low).[/quote]

When you open one up or drain it, if you can, it sure looks like mainly blood but I accept your evidence [mind you it may have clotted leaving mainly serum?]

[quote user="Michael Woodhouse"]I've seen them in dogs with spotless ears - it's not a simple head shaking aetiology. I'm convinced of that.[/quote]

Sure, hence my postulating trauma. The irritation causing head shaking just exacerbates them via the centrifugal force.

[quote user="Michael Woodhouse"]I've had good results with the penrose drain technique and that doesn't close any deadspace.[/quote]

No. but it stops the dead space filling up.

That technique works fine BUT you are likely to get pinna distortion which is all I was always trying to eliminate and the "contour mould" achieves that.

[quote user="Michael Woodhouse"]I'd estimate 60% cure with 1 drainage, 90% with two goes - I don't think we have operated on one this year, as a new grad I did more of these than bitch spays)[/quote]

I only ever operated once and the results with one op. were cosmetically and surgically 100%. [leave the mould and stitches on for 6 weeks or so]

I postulate that the reduced incidence might be due to the virtual elimination of ear mites via modern insecticides, but I've got no evidence to support that.

Are ear mites rarer these days?

RE: Aural Haematoma

ruths — Thu, 26 Nov 2015 08:05:40 GMT

I have done all sorts over the years but more latterly, I've done nothing with the smaller ones.

if they are t painful and not going to occlude the ear canal then I feel the pain of correction is not warranted. I would give this option to the owner and most times they would take it

The worst one I had to do was to do the surgical technique on an ear that had been drained and depo injected. Thst thing refused to heal and became I cd red and wS a bloody nightmare for weeks. Obviously, it was just one case- tho it was about the 5th or 6th I did with depo. It put me right off depo in the ear after that. obvs it may have beem Nothing to do with the steroids but I've never seen angthing like it before I started using it not again after I stopped.

RE: Aural Haematoma

Michael Woodhouse — Thu, 26 Nov 2015 01:30:20 GMT

[quote user="Anthony Todd"]Come to think of it, the clue is in the name viz: "aural haematoma" which may become a seroma later.[/quote]

It's NOT frank blood. It is not just a simple burst blood vessel in the pinnae.

(I read this on here, collected all the fluid from a fresh one myself (happened that morning) and the PCV was very low).

Malcolm Ness talks about the penrose drain technique AND corticosteroids. I believe postulating some kind of immune system involvement. I'm sure he said he or his wife did a paper, but I have never been able to find it.

I've seen them in dogs with spotless ears - it's not a simple head shaking aetiology. I'm convinced of that.

Corticosteroids seem to be important in addition to drainage.

I've had good results with the penrose drain technique and that doesn't close any deadspace.

I agree this would be a superb area for data mining, but I don't think the forum is the answer. I think these programmes running in the background are the way forwards. If we all added cases here you would get a very biased subset that would make the data rather meaningless.

(personally we drain twice and instil depomedrone and then operate - I'd estimate 60% cure with 1 drainage, 90% with two goes - I don't think we have operated on one this year, as a new grad I did more of these than bitch spays)

RE: Aural Haematoma

Anthony Todd — Thu, 26 Nov 2015 00:04:43 GMT

[quote user="Kate Richardson"]Equally there are some owners who like the fact their dog looks a bit quirky, gives them something to talk about![/quote]

Just google "cats with crumpled ears" and see how owners react. Also on vet. sites describing cleaning of them; surprising, and most owners seem unhappy about it too.l

RE: Aural Haematoma

Anthony Todd — Wed, 25 Nov 2015 17:12:44 GMT

Yes, sorry, red rags and bulls etc.

Mind you I had a client in Dalston E8 who said he'd pay me anything if I put a gold ring in his big staffie's ear.

Can't tell you these days, client confidentiality....

RE: Aural Haematoma

Kate Richardson — Wed, 25 Nov 2015 17:07:19 GMT

[quote user="Anthony Todd"]

[quote user="Kate Richardson"] Equally there are some owners who like the fact their dog looks a bit quirky, gives them something to talk about![/quote]

Come on, just give in gracefully,

[/quote]

??? Was just trying to be light hearted.

RE: Aural Haematoma

Anthony Todd — Wed, 25 Nov 2015 16:24:54 GMT

[quote user="Kate Richardson"] Equally there are some owners who like the fact their dog looks a bit quirky, gives them something to talk about![/quote]

Come on, just give in gracefully, mind you I've done some things that ended up a bit quirky... and a colleague, many years ago using the old trick of bandaging both spaniel ears together over the head managed to snip through one pinna completely... Stretching quirky a bit, but he got away with it with the client, by insisting it was to improve the canal ventilation...

Ah, the good ol' days.

RE: Aural Haematoma

Kate Richardson — Wed, 25 Nov 2015 15:53:52 GMT

[quote user="Anthony Todd"]No difficulty at all in assessing procedure success in an aural haematoma by my aforementioned full-frontal picture.[/quote]

Yes, that's a good way, someone unbiased could then assess outcome.

[quote user="Anthony Todd"]I'm sure every cat or dog owner of a prick eared animal would prefer normal ears after drainage of an aural haematoma![/quote]

Assuming you mean cosmetically normal, then I'm sure they would, but it should be 3rd in line after pain free and functional. But I guess if they look cosmetically normal then they should be pain free and functional anyway! Equally there are some owners who like the fact their dog looks a bit quirky, gives them something to talk about!

RE: Aural Haematoma

Anthony Todd — Wed, 25 Nov 2015 15:39:41 GMT

I thought a "seroma" was a collection of serum and, depending on the circumstances, was formed in a dead space, which naturally filled with serum or a tissue haemorrhage when the cellular elements were either resorbed, leaving just serum, or organised into a "granuloma" if not resorbed, or if the tissue haemorrhage continues, as it will with an aural haematoma, because of the centrifugal force of head-shaking.

Come to think of it, the clue is in the name viz: "aural haematoma" which may become a seroma later.

No difficulty at all in assessing procedure success in an aural haematoma by my aforementioned full-frontal picture.

The owner shouldn't be able to tell the difference between ears....

I'm sure every cat or dog owner of a prick eared animal would prefer normal ears after drainage of an aural haematoma!

RE: Aural Haematoma

Kate Richardson — Wed, 25 Nov 2015 15:12:41 GMT

[quote user="Kate Richardson"]

[quote user="dachsie_4"]They do say not to drain seromas elsewhere in the body, so guess this might be similar???[/quote]

Who says this?

[/quote]

Thought I ought to elaborate on this- I think there are some seromas that do require drainage, and some that don't. Size and location are factors. I have seen plenty under surgical wounds where dead space hasn't been closed effectively, and this can lead to wound breakdown, ether of internal closure or of external skin closure. Can be pretty dramatic as well, have seen abdominal herniation as a result. So I do tend to drain a lot of them, but as [quote user="Will McMullan"] a seroma indicates dead space, so if you drain it isn't it likely to just refill with inflammatory exudate[/quote] you do need to reduce the dead space if possible by pressure bandaging and usually provide an external drainage hole to allow the fluid to escape, sometimes just as simple as removing 1-2 skin sutures (if that is how the wound has been closed. Othertimes by a simple stab incision, othertimes by surgically placing a drain. But I agree they do need to [quote user="Will McMullan"]dealt with on a case by case basis (same with aural haematoma). [/quote]

There has been talk of doing practice based collection of data on different conditions and treatment options, aural haematoma management would be an ideal one to do, as I can't imagine many get referred. Would be interesting to collect data on different approaches and outcomes. Difficulty is however assessing outcome objectively, there is likely to be some bias however it is done if everyone assesses their own outcomes! Any one up got any ideas how this could be achieved? Or would the info still be useful taking this into account?

RE: Aural Haematoma

Julian Earl — Wed, 25 Nov 2015 14:15:30 GMT

All haematomas resolve spontaneously given time. The case for treatment is that they are painful, plus there may well, of course, be underlying otitis that needs examining and treating. Surgical drainage is also painful, and a couple of suturesthat tack the pinna to the top of the head stop it flapping about. I have used intra-pinnal steroids a lot of times but although it mmpresumably reduces distortion, so what? A crinkle pinna is not an issuefor the dog. Surely the steroids should delay the natural healing that is involved? So in short, examine the ear canal as best as you can; drain surgically if necessary and warn the owner that they can be recurrent. and that arge ones can take 6-8 weeks to completely disappear.Would the owners be able to apply topical ear treatments?

RE: Aural Haematoma

Will McMullan — Wed, 25 Nov 2015 08:54:05 GMT

I don't know who's been saying what, but thinking about it, a seroma indicates dead space, so if you drain it isn't it likely to just refill with inflammatory exudate? I have drained seromas but I've also left them alone. I think things like this can be dealt with on a case by case basis (same with aural haematoma). Have a full discussion with the owner and assess the animal and make a decision about how to tackle the presenting problem. After talking through aural haematoma with my clients, many of them are happier to leave alone, knowing there may be some distortion of the pinna than to put their animal through multiple drainings/sedations/surgery. I don't think I've ever seen one distort to the extent that it compromises the canal. If a dog with pre-existing stenosis of the canal or recurrent ear issues presented with a large haematoma, I'd explain the more pressing need to operate.

RE: Aural Haematoma

Anthony Todd — Tue, 24 Nov 2015 20:45:23 GMT

Yeah, I always thought this, if you can compress them as well, or where organisation and a lump doesn't matter. Of course with ears you can't hence the cauliflower result unless you apply pressure via through and through sutures plus or minus the disputed mould/splint.....

If you drain them without some sort of compression they just form again was the logic, I assumed.

RE: Aural Haematoma

Anthony Todd — Tue, 24 Nov 2015 20:43:48 GMT

sorry duplicated

RE: Aural Haematoma

Robin Grimmer — Tue, 24 Nov 2015 19:53:30 GMT

[quote user="Kate Richardson"]

[quote user="dachsie_4"]They do say not to drain seromas elsewhere in the body, so guess this might be similar???[/quote]

Who says this?

[/quote]

Don't know, but I've also heard this.

RE: Aural Haematoma

Kate Richardson — Tue, 24 Nov 2015 18:38:44 GMT

[quote user="dachsie_4"]They do say not to drain seromas elsewhere in the body, so guess this might be similar???[/quote]

Who says this?

RE: Aural Haematoma

Anthony Todd — Tue, 24 Nov 2015 18:34:53 GMT

[quote user="dachsie_4"]They do say not to drain seromas elsewhere in the body, so guess this might be similar???[/quote]

Would be OK elsewhere but the ear pinna always distorts to a greater or lesser degree.

What is needed is some full frontal pics [to compare ears for those prurient!] and then I can retreat under my dinorock.

RE: Aural Haematoma

dachsie_4 — Tue, 24 Nov 2015 17:54:19 GMT

Thank you Will, most helpful post to date. They do say not to drain seromas elsewhere in the body, so guess this might be similar???

RE: Aural Haematoma

Anthony Todd — Tue, 24 Nov 2015 17:37:11 GMT

I suppose, if you drain them a percentage won't refill, particularly if you are lucky enough to have a concurrent ear-mite infestation or otitis externa so you can stop the irritation and the head shaking. Same as draining a large haematoma anywhere, I guess.

If this is so then just draining will work. Trouble is once you've got organisation of the clot you'll get deformation as the recent world cup pundits showed

Mind you I suppose no ALL Black would be seen dead with a bit of a plastic container stitched to the medial side of his ear.....

RE: Aural Haematoma

Will McMullan — Tue, 24 Nov 2015 17:05:24 GMT

I have left plenty alone and often they heal right back down to look like a normal pinna, possibly a little thicker but certainly not a front-row cauliflower ear. If they are painful or v large/getting bigger I'll operate. I did a literature search on this topic once and was extremely disappointed with how little evidence there is for any treatments. In particular the idea of injecting steroids after drainage.

RE: Aural Haematoma

Thomas Johnson — Tue, 24 Nov 2015 16:57:54 GMT

I have come to the conclusion that draining does very little other than giving the owner the impression that you're doing something, I've seen several that I've drained, have re-filled over the next few days, and then resolved in another week on their own. They will end up with a cauliflower ear, but in a lot of cases it makes very little difference to the shape of the ear, and a lot of owners will choose that over a GA and surgery.

I've operated on one today as it was getting bigger and involving more and more of the pinna. It's a 13 year old collie with elevated renal values so I wanted to keep the GA as short as possible so tried the Penrose drain method for the first time, it took me about 3 minutes, 2 holes made with a biopsy punch, passed drain through, sutured at each end, home on pred. I'll let you know how it gets on!

RE: Aural Haematoma

Anthony Todd — Tue, 24 Nov 2015 14:43:18 GMT

Not if the picture is cosmetically perfect, mate......