Aural haematoma technique

RE: Aural haematoma technique

Julie Innes — Wed, 16 Sep 2020 12:53:15 GMT

I have operated using all the above in my past, but recent CPD etc has led me to leave them to resolve, treat ears, cover with steroid. The only downside of this is that owners are not happy, and I have been pressured into draining some (needle), while warning that they might (probably would) refill. Cue owner back on the phone in 2 days "It's filled up again!" Yeah, like I said...Some owners cannot be persuaded that this can be left "untreated" and have demanded surgery. Touch wood, I have generally had good results when I have done the surgery, but I'm not convinced it is necessary in all (most?) cases

RE: Aural haematoma technique

Neil Wheadon — Mon, 14 Sep 2020 07:38:23 GMT

X-Ray film

Drip tubing

Buttons

In fact anything we could lay our hands on

Neil

RE: Aural haematoma technique

Evelyn Barbour-Hill — Mon, 14 Sep 2020 00:10:56 GMT

[quote userid="2150" url="~/001/veterinary-clinical/small-animal/soft-tissue-surgery/f/discussions/29323/aural-haematoma-technique/225402#225402"]Anyone remember Ormerod buttons for this condition or am I am showing my age?!! [/quote]

Both

RE: Aural haematoma technique

Derek Lyon — Sun, 13 Sep 2020 12:54:36 GMT

Anyone remember Ormerod buttons for this condition or am I am showing my age?!!

RE: Aural haematoma technique

Joyce Whitehead — Fri, 11 Sep 2020 13:06:28 GMT

I’ve had a couple in the last few weeks that I’ve left. One was a second opinion, it had had 3 different surgeries in he previous 2 months, first the “traditional” cut then stitched with haematoma pads, second penrose drain and third the aural haematoma drain widget inserted. Despite this he still had a smallish haematoma. Crucially he also had terrible ears full of malassezia and wasn’t in any treatment for this. He went home on steroids and Otodine, the haematoma is shrinking nicely.

The second was one that came up and the whole ear flap was full. I warned the owner this might need draining, again it was a lab with chronic malassezia (and almost certainly is atopic). Home on preds and dex infused Otodine, and this week it was half the size. The owner is happy to continue medical treatment.

I’m old enough to have been through many methods of AH treatment, but increasingly tend toward the less is more approach. And always give steroids unless there is a very good reason why not.

RE: Aural haematoma technique

Neil Wheadon — Fri, 11 Sep 2020 10:54:14 GMT

[quote userid="3607" url="~/001/veterinary-clinical/small-animal/soft-tissue-surgery/f/discussions/29323/aural-haematoma-technique/225156#225156"]given the plethora of techniques either published or in frequent use[/quote]

Add ringworm treatment in cattle and dental products in pet shops

The reason, so many techniques are used/described is none of them work consistently

Neil

OK I'm painting with a broad brush but the sentiment is there

RE: Aural haematoma technique

Dinu Catilina — Thu, 10 Sep 2020 11:23:08 GMT

Hahaha, is @Anthony Todd on a mission here?

RE: Aural haematoma technique

Dinu Catilina — Wed, 09 Sep 2020 21:57:08 GMT

I used to drain them and inject depo and operate only on the very large painful ones but these days I advise O to leave as they are if the haematoma is small. They will heal, some will scar but if rugby players survive cauliflower ears so can dogs.

Treat underlying issues if there are any but many I see are traumatic from playing with other dogs.

RE: Aural haematoma technique

Mialee Blair — Wed, 09 Sep 2020 14:14:19 GMT

I’ve been doing that for years. Standard approach in an easy to handle dog, offer as option to owner. I usually stress may need a couple of drains. No sedation, just green needle, drain with syringe and inject depomed through same green needle. Fairly non invasive and stress free in amenable patients. Resee few days later and repeat drain only if required.

i would think about 80% plus success rate

generally would just go straight to surgery though if I thought dog wouldn’t tolerate without sedation.

RE: Aural haematoma technique

Beats — Tue, 08 Sep 2020 19:19:16 GMT

[quote userid="3094" url="~/001/veterinary-clinical/small-animal/soft-tissue-surgery/f/discussions/29323/aural-haematoma-technique/225317#225317"]but what do other people think please?[/quote]

Call me lazy, but I haven't "treated" an aural haematoma for >5 years I reckon.

Oddly, I actually don't see these often at all these days (perhaps just 3 a year?) for whatever reason. Or perhaps they have just become much less memorable as I don't tend to bother much with them.

The ones I do see, I tend to do nothing with (not strictly true, I will treat otitis if present and treat atopy if present and treat ear mites if present, and give steroids if pruritic; but I ignore the haematoma itself unless so large that I feel is likely to reduce ventilation in longer term by occluding the ear canal opening as it resolves).

Last week I had the joy of treating an aural abscess that had had a penrose drain inserted by a colleague about a week previously, back when it was a lowly haematoma. That's a rare event, but so it was, and most unpleasant for both me and the dog.

I have seen some other hideous complications of aural haematoma "treatment" over the years, and while these are undoubtedly rare and associated in the main with attention to detail on the part of the treating vet perhaps, I advise vet students on placement to at least consider the first do no harm principle before "treating" a given aural haematoma.

One of my favourite writings on the subject was a letter to JAVMA from a random vet in response to Pavletic's latest technique of the time, I've reproduced it below, I hope that is OK:

Approach to treatment of aural hematomas

I am writing to comment on the recent JAVMA article¹ describing the use of Jackson-Pratt drains to treat aural hematomas in dogs. In the article, the author reports that a variety of medical and surgical treatments have been described for the management of aural hematomas. One method that is not discussed is that of simply allowing the hematoma to resorb on its own. In my first 10 years of practice, I treated aural hematomas surgically. However, some owners declined surgery because of cost, and in those cases, the hematoma resolved without intervention within 2 months. I have not treated an aural hematoma surgically in 20 years but do treat any underlying ear disease that might be present. In my experience, surgical intervention is not indicated for most aural hematomas. However, if there was no improvement after 2 to 3 months, I would consider inserting drains at that time.

Rocky Deutsch, dvm

Signal Hill Animal Clinic Manassas, Va

1.	Pavletic MM. Use of laterally placed vacuum drains for management of aural hematomas in five dogs. J Am Vet Med Assoc 2015; 246: 112–117. [Google Scholar]

RE: Aural haematoma technique

Julian Earl — Tue, 08 Sep 2020 17:12:44 GMT

Have many people used the non-surgical treatment of AH? I think it was in a short communication in the vt Record a long time ago. Simply involving drainage via large gauge needle and syringe followed by the introduction of methylprednisolone injection, a.k.a 1ml of Depo-medrone. The theory is that a haematoma has an inflammatory aetiology rather than trauma. Hence the steroid injected between the skin and the auricular cartilage. It is straightforward to do , under sedation usually I.M.E., and aiming to avert the crumpled pinna caused by contracture of the damaged area. Although it is easy to do with the rapid improvement in removing the swelling, I could not fully accept the logic behind he therapy and most would start to swell again fairly soon, taking from hours to days? I think the dogs were in less discomfort than if they had received surgical drainage and compression with buttons etc. but what do other people think please?

RE: Aural haematoma technique

Malcolm Ness — Tue, 01 Sep 2020 15:51:02 GMT

[quote userid="8858" url="~/001/veterinary-clinical/small-animal/soft-tissue-surgery/f/discussions/29323/aural-haematoma-technique/225160#225160"]Should I delete it from here then? [/quote]

No, I don't think so. First, I am not a great fan of censorship or revising history in any form. Second, I think it stands as a useful exercise in critical review and finally, there might be some other interesting and contrary views that will be lost if you delete it.

RE: Aural haematoma technique

Jill Butterworth — Tue, 01 Sep 2020 15:34:01 GMT

Thank you! Should I delete it from here then?

RE: Aural haematoma technique

Malcolm Ness — Tue, 01 Sep 2020 11:45:29 GMT

Approach with extreme caution!

This was published some years ago in a local journal that is not hugely well thought of outside of Hungary. Not all journals are equal and the most common reason for publishing in less-respected journals is that the work is simply not good enough for publication elsewhere. The case numbers are low - a couple of dozen dogs collected over six years or so.Even a quiet single-handed practice in the UK would expect to see many more AH cases than this. One must wonder whether these are consecutive cases included in the study on an 'intention to treat' basis. More likely, some selection of cases (and therefore bias) has been applied. Regrettably, the write-up is so poor and it is not possible to know such essential detail. The authors claim that there was no recurrence during the follow-up period but that period is not defined. The placement of up to six buried continuous sutures within the haematoma cavity will be time-consuming - given the plethora of techniques either published or in frequent use that are quick, and similarly effective, that significant limitation should have been described and discussed - any decent reviewer would have required that. I am not persuaded that this is a sensible thing to consider -the notion of burying a substantial amount of absorbable suture within the auricular cartilage seems a high-risk strategy. A reasonable surgeon would demand much more and better detail before trying this: I do not find this account credible.

The work is shot through with errors. The Joyce and Day work did not show what these authors claim about allergy; the lesion is intra-chondral; the haematoma fluid is a modified transudate - all of this contrary to what these authors write. The authors have overlooked (or perhaps chosen to ignore) several relevant papers, any and all of which would have been revealed by perusal of the reference list of the older papers cited (the Kuwahara work or that by Joyce and Day) or even by a properly conducted electronic literature search.

At least this paper illustrates the need for clinicians to review published work critically!