Treatment of canine aural haematoma by UK veterinarians

Platelet- Rich Plasma Treatment Supported by Ultrasound Detection of Septa in Recurrent Canine Aural Hematoma: A Case Series

Aural hematoma is a common pathological condition in veterinary practice with a high incidence rate in dogs. Drainage, corticosteroid injections, and surgical approaches represent the common treatments in these clinical cases. However, surgery leaves visible signs and is usually correlated with recurrence, scars, and deformation of the treated pinna. For this reason, more effective and less invasive methods have been proposed over the years. Platelet-Rich Plasma (PRP) is one of the most promising options due to its pro-regenerative properties and capability to modulate the inflammatory state. The present work reports 12 cases of canine aural hematoma treated with PRP. The PRP treatment was combined with an ultrasound evaluation of the pinna to detect and treat all involved septa. The results show that relatively large volumes (2 mL) of PRP associated with an ultrasound guide are safe and efficacious in the treatment of canine aural hematoma requiring a maximum of two infiltrations, both in acute and chronic conditions. All the patients recovered their normal ear thickness (compared with the controlateral one) without relapses, averaging 38.5 days from their first treatment (10-90 days; SD: 24.7). The key role of PRP combined with a tailored diagnosis process carried out by the veterinarian, which included using an ultrasound system and the proper bandage, suggests that this approach may represent a valid alternative to surgery and corticosteroids.

Reporting the epidemiology of aural haematoma in dogs and proposing a novel aetiopathogenetic pathway

To evaluate the incidence and risk factors for aural haematoma in dogs under primary veterinary care in the UK. A cohort study design. Dogs diagnosed with aural haematoma during 2016 were identified from the VetCompass database. Univariable and multivariable logistic regression modelling were used for risk factor analysis. There were 2,249/905,554 dogs diagnosed with aural haematoma during 2016. The estimated one-year incidence risk for aural haematoma was 0.25% (95% confidence interval 0.24–0.26). After accounting for confounding factors, 14 breeds showed increased odds and 20 breeds showed reduced odds of aural haematoma compared with crossbred dogs. Breeds with the highest odds included Bull Terrier (OR 7.42, 95% confidence interval 4.39–12.54), Saint Bernard (OR 7.28, 95% confidence interval 3.58–14.81) and French Bulldog (OR 6.95, 95% confidence interval 5.55–8.70). Increasing age, increasing bodyweight and breeds with V-shaped drop and semi-erect ear carriage also showed increased odds of aural haematoma. Associations between ear carriage within breeds and the risk of aural haematoma suggest that trauma along the line of cartilage folding within V-shaped and semi-erect ears may trigger aural haematoma. New knowledge of key breed predispositions will contribute to improved breed health control strategies.

Surgical management of bilateral ear pinna lesions associated with traumatic aural hematoma in a 3-day-old goat kid

Background:

Aural hematomas are not uncommon in ruminants’ clinical practice; however, there is a lack of information regarding their management in newborn ruminants, especially for complicated cases with rupture of the hematoma and secondary ear pinna necrosis.

Case Description:

A 3-day-old orphan goat kid was admitted due to swelling on the left ear pinna and trauma on the right pina caused by biting by other goats. The swelling on the left ear which was located at the convex surface was soft, painless, and fluid-filled, suggestive of aural hematoma located at the convex surface. The right pinna was swollen, bleeding, and extremely painful at palpation. The skin was necrotized at the distal 2/3rd of the convex surface and the 1/2 of the concave surface. Underneath the necrotized skin of the convex surface, blood, and blood clots were trapped, and there was a pocket between the remaining normal skin and the cartilage indicating possible rupture of aural hematoma. The kid was surgically treated under general anesthesia with xylazine and ketamine. The aural hematoma was drained by the convex surface using a Penrose tube after flushing the cavity with 2 mg dexamethasone. The trauma of the right pinna was left to heal by secondary intention after resection of all necrotized, edematous tissues, and blood clots. Post-surgery, the animal was treated with parenteral antibiotic administration and daily application of a topical antiseptic solution. The Penrose tube was removed after 5 days, and the animal recovered uneventfully.

Conclusions:

The present case indicates that aural hematoma can occur in newborn goat kids secondary to ear pinna biting and might evolve to pinna necrosis. In addition, tube drainage after flushing the cavity with corticosteroids appears to be an effective treatment approach without requiring bandaging post-operatively.

Use of Autologous Leucocyte- and Platelet-Rich Plasma (L-PRP) in the Treatment of Aural Hematoma in Dogs

Leukocyte- and platelet-rich plasma (L-PRP) can accelerate the healing process by providing increased concentrations of platelet-derived growth factors. The objective of this study was to evaluate the clinical effect of L-PRP in the treatment of canine aural hematomas associated with otitis externa. Twenty mL of citrated whole blood was collected from each of the 17 dogs included and autologous L-PRP was produced. The aural hematoma was drained and 0.5–1 mL of L-PRP was injected. The dogs were examined weekly until 7 days after complete clinical healing. A final clinical follow-up was performed 6 weeks after the first treatment with L-PRP. If there was recurrence of the aural hematoma at the first follow-up, the treatment was repeated. In total, 2/17 cases were lost after the first follow-up. In 5/17 dogs, a short-term recurrence occurred. In 12/15 cases, complete clinical resolution was achieved with a single L-PRP application (Group A1) and in 3/15 with two treatments (Group A2). The mean time to complete clinical resolution was 16 ± 8.7 days (A1) and 23.3 ± 4 days (A2), respectively. No side effects were reported. The in situ administration of autologous L-PRP resulted in a complete resolution of the aural hematoma in all dogs that completed the clinical trial.

Clinical features, treatment, and outcome of aural hematomas in horses: 7 cases (2008-2019)

OBJECTIVE

To characterize the clinical features, treatment, and outcome of aural hematomas in horses.

ANIMALS

7 horses with 1 or 2 aural hematomas (8 ears in total) treated at a veterinary teaching hospital in 2008 through 2019.

PROCEDURES

Data retrieved from medical records included signalment, pertinent historical information, clinical signs, diagnostic procedures (including dermatologic assessment), and treatments. Case outcome was determined from documentation in the medical record or via telephone communication with owners or referring veterinarians.

RESULTS

3 horses were presented after recurrence of aural hematoma following treatment by the referring veterinarian. Four horses had a history of allergic skin disease prior to aural hematoma development. Most (6/7) horses were unilaterally affected. Diagnostic assessments included otoscopic evaluation (3 horses), ultrasonography (3 horses), cytologic examination of ear canal swab samples (3 horses), and histologic examination of a pinnal biopsy specimen (1 horse). Of the 8 pinnae, 2 were treated by nonsurgical needle drainage (1 with concurrent corticosteroid injection) and the remaining 6 underwent surgical incision and placement of compressive sutures. Follow-up information was available for 6 horses, and all affected pinnae were fibrotic with 4 horses having permanent drooping of the pinna. One horse developed a hematoma in the contralateral pinna 1 year after hospital discharge.

CONCLUSIONS AND CLINICAL RELEVANCE

Equine aural hematoma is a rare condition. The main principle of treatment is drainage, and treatment options commonly used in small animal practice can be successfully applied in horses. Permanent changes in the cosmetic appearance of the pinna are likely to develop owing to secondary fibrosis.

On the nature of canine aural haematoma and its treatment with continuous vacuum drainage

OBJECTIVES

To evaluate continuous vacuum drainage from the convex side of the pinna for surgical treatment of aural haematoma in dogs. To investigate aural haematoma fluid and cartilage samples harvested during surgery in an attempt to elucidate the etiopathogenesis of the lesion.

MATERIALS AND METHODS

Ten client-owned dogs with aural haematoma were treated by convex-side vacuum drainage using different types of vacuum drains and containers and were followed-up for at least 6 months. Systemic blood samples and aural haematoma fluids were analysed for biochemical, haematologic and electrophoretic content. Cartilage samples were examined histologically.

RESULTS

Nine of the 10 dogs were successfully treated without recurrence at 6 months postoperatively and with excellent cosmetic results. In one case, infection required early drain removal and delayed healing was associated with wrinkling of the pinna. Fluid sample analysis suggested that "aural haematoma" contains a transudate that accumulates within a cartilage-lined cavity. Histologic examination of the tissue samples revealed clefts of the pinna cartilage, with the luminal surface often lined with granulation tissue. Fluids and cartilage lacked evidence of inflammation.

CLINICAL SIGNIFICANCE

This technique was characterised by patient comfort, tolerance of drains, absence of dressings and good cosmetic outcome. The results of fluid analysis suggest that the term "aural seroma" would be more appropriate for this condition.