Dog Ear Hematomas: Should You Be Worried About a Bubble on Your Dog’s Ear?

Ear hematomas in dogs can seem strange and dramatic. One day your dog’s ear is normal, and the next it’s blown up like a balloon—what’s going on here?! Hematomas (that’s the name for the bubble on your dog’s ear flap) are one condition that’s fairly common in dogs, but there’s lots to know about what causes them, how they’re treated, and how to prevent them in the first place. Let’s get started!

A hematoma occurs when blood collects outside a blood vessel anywhere in the body. It is usually due to blunt trauma. A dog ear hematoma, otherwise known as an aural hematoma, is what occurs when blood vessels burst inside a dog’s ear flap, or the part veterinarians call the pinna.

When blood vessels burst, blood pools within the skin of the ear flap, filling the space under the skin. The blood accumulates under the skin, creating that blood-filled bubble you’re seeing on your dog’s ear.

Does your dog have an ear hematoma? Here are a few common characteristics:

• What they look like: A swollen area of the ear flap. Many people think it looks like the ear flap has a bubble in it.
• What they feel like: Soft, squishy or spongy. Some aural hematomas can feel firm if they’re very full of blood.
• Where they occur: Hematomas can affect the entire ear flap, or just a small portion of it.
• The onset: Hematomas usually occur all of a sudden—one day it isn’t there, and the next it is.

Dog ear hematomas are often painful. The ear is usually red and sensitive to the touch, so your dog may act “head shy,” aka not want to be touched around their head. Because most aural hematomas are caused by excessive head shaking associated with ear infections (more on that below), the signs of ear infections often accompany an ear hematoma. These include:

• Discharge from the ear
• Redness
• Odor
• Head shaking
• Scratching

A dog’s ear flap has many blood vessels that run through two layers of skin and one layer of cartilage. When a dog’s ear is irritated, pups try to remedy the problem by shaking their head vigorously. That can cause the blood vessels in the ear flap to burst, which causes bleeding to pool in the space between the cartilage and skin, causing a hematoma.

Anything that irritates a dog’s ear enough to cause excessive head shaking and scratching can potentially cause an ear hematoma. However, the most common causes are:

• External bacterial or fungal ear infections: Underlying ear infections are itchy and painful and are the leading cause of ear hematomas in dogs. Dogs with floppy ears, dogs with allergies, and dogs who swim are at increased risk of external ear problems. Signs of an ear infection include head shaking, scratching or rubbing ears, red ears, ear discharge and odor from the ears.
• Seasonal allergies: Seasonal allergies (aka atopy or atopic dermatitis) can cause very itchy ears even without an ear infection, and predispose a dog to developing an aural hematoma. Early warning signs of seasonal allergies include incessantly scratching, chewing, ear scratching and head shaking.
• Bite wounds: A bite wound on an ear flap can easily break blood vessels and cause a hematoma. Dogs with bite wounds will usually have puncture wounds on their ear.
• Foreign objects in the ear: A piece of grass or a tick in the ear can be very irritating and can easily cause a dog to shake their head enough to cause a hematoma. Dogs who spend time in tall grass or around foxtail grass are at increased risk.

Dogs who have bleeding disorders due to a variety of origins (genetic disease, accidental ingestion of rat poison, liver disease, etc.) are at increased risk of bleeding and ear hematomas, even without any trauma. Early warning signs of clotting disorders include bruising easily, bloody stool, excessive tiredness and bleeding gums. Sometimes, you may see no signs but your veterinarian may catch abnormalities on bloodwork.

Because aural hematomas in dogs can be painful, if you notice one, take your dog to the vet as soon as possible, the same day if possible. There is no treatment you can do at home for ear hematomas.

While there are several ways to treat ear hematomas, the quickest and best way is surgical treatment under anesthesia. Surgery usually involves the following steps:

1. Dog is placed under anesthesia.
2. The vet removes the blood from the ear flap by making an incision in the ear.
3. The vet may place a drain tube or another drainage device called a teat cannula to let any additional blood or bodily fluids drain from the ear after surgery. Sometimes, the incision is left open to let the ear drain. Even though this is messy, this is an important aspect of treatment because without proper drainage, a second hematoma may form after surgery.
4. The vet then removes the space under the skin where blood accumulated. Veterinarians have a variety of techniques to accomplish this, but suturing the space in between the skin layers closed is common.
5. The ear is bandaged or otherwise stabilized to prevent the dog from shaking their head and further traumatizing the ear.

Dogs usually recover from anesthesia within 24 to 48 hours. Right after surgery, they will be tired and likely want to sleep when they get home. You can give them a small (1/2 the regular potion) meal before they go to bed.

• If your dog has surgery, be prepared for them to wear an Elizabethan collar at all times to prevent them from scratching sutures out of their ear for 10-14 days. Some dogs may need to have sutures left in longer.
• Your dog will need to return to the veterinarian for a recheck after surgery.
• If your dog has a drainage tube in their ear, that will be removed 3-14 days after surgery.
• While the drains are in place, your dog must wear the Elizabethan collar.
• Before and after sutures or drains are removed, there will likely still be a healing incision in your dog’s ear. This should be cleaned daily to keep it open and draining until it has healed.
• If your dog has an ear infection, medication will be prescribed for that as well. If your dog has bite wounds, antibiotics will likely be prescribed.

If your dog isn’t a good candidate for surgery, there are other treatment options. Small ear hematomas may be treated by draining the hematoma and then injecting steroids into the empty space in between the skin layers. (This usually has to be done a few times to fully heal the hematoma.) Some veterinarians may treat small hematomas with oral steroids, but this treatment will take longer than surgery. Your veterinarian will evaluate your dog and advise you on the best treatment for your dog.

Remember that ear hematomas don’t occur on their own—they are the result of other underlying issues. An important aspect of treating (and preventing) ear hematomas is to resolve the underlying cause, whether it be an ear infection, allergies or a piece of grass in the ear. Your veterinarian will determine what the underlying cause is and treat it.

If you don’t have the hematoma surgically corrected, be prepared for your dog’s ear to be swollen and painful for a long time and for the ear to be disfigured. If left untreated, the body can resorb the blood from an ear hematoma over time, but it will scar and twist the ear flap causing the appearance of the ear to resemble cauliflower ear, potentially predisposing the ear to further problems, such as recurrent infections. Small ear hematomas may not require treatment, but you should always have any hematoma checked by your veterinarian, to resolve both the hematoma and the underlying cause of the head shaking or bleeding that caused it.

It’s gross, but it happens! So, what should you do if their dog’s hematoma bursts? Follow these steps:

• Stay calm. While it will probably look dramatic and bloody, it is not a life-threatening problem, and bleeding will likely slow down and mostly stop on its own fairly quickly (unless the dog has a bleeding or clotting disorder).
• Clean the blood from your dog’s ear, if your dog will let you.
• Put moderate pressure on the ear for 5 minutes, if your dog will let you
• Call your veterinarian for advice.

Until treatment is administered, your dog’s ear will likely continue to leak small amounts of blood because the blood vessels are broken.

If the cause of the hematoma hasn’t been determined, schedule an appointment with your vet. If your dog is already under treatment for an ear infection, call your vet for advice.

If your dog’s hematoma bursts after hours or on the weekend and the bleeding doesn’t stop within 10-15 minutes, call an emergency veterinary hospital for advice.

Fortunately, ear hematomas are fairly easy to prevent in most dogs. Remember that most ear hematomas are caused by excessive head shaking. The best thing to do if you notice any signs of excessive head shaking or scratching at ears is to get your dog treated by a veterinarian as soon as possible.

Additional ways to prevent future hematomas:

• Use ear drops that dry and acidify the ear canals after swimming or bathing your dog
• Use cotton balls in your dog’s ears when you give them a bath (don’t forget to remove them!)
• Have any seasonal allergies addressed by your veterinarian
• If your dog is bitten on the ear, have a veterinarian take a look at the ear and treat the wound if necessary

If your dog is predisposed to ear hematomas or recurrent ear infections, talk to your vet about corrective surgery that can solve the problem.