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Why is my dog’s ear flap swollen?
If your dog’s ear is swollen making the ear flap look like a soft balloon, this is the result of blood filling the space between the ear cartilage and skin. The medical term is called an aural hematoma. The blood which fills the ear flap develops because of trauma to the capillaries in the ear flap: most often from vigorous head shaking.
The most common trigger for the vigorous head shaking is an underlying ear infection. In order to treat the swollen ear, the cause for the head shaking should be determined and addressed. The aural hematoma responds best to medical drainage ( a quick procedure that can be done in your vet’s office) if treated promptly. Some aural hematomas that are refractory to drainage may require surgery. Procedures to address the swelling are considered mostly cosemetic to retain the shape of the ear flap (pinna).
Triggers for inflammation/irritation that can lead to ear swelling include:
- Bug bite reactions
- allergies
- Parasites (ear mites)
- Ear infections (yeast, bacteria)
- foreign bodies ( grass awns are common ear foreign bodies)
- trauma (bite wound or blunt trauma)
- immune mediated diseases
The most common underlying cause for an aural hematoma in a dog is an ear infection.
While you may bring your dog to the vet to treat the balloon on your dog’s ear, your vet will be more interested to find and treat the underlying trigger. You may be tasked with treating an underlying ear infection if that is detected.
When to bring in your dog for a swollen ear? Addressing an ear hematoma early provides a better chance that the swollen ear will respond to medical management: drainage with a needle and placement of a head wrap
Treatment for a swollen ear:
Dogs that shake their head excessively do so to relieve an itch in their ears. So, the cause of the head shaking should be the most important first step to help treat your dog.
Your veterinarian will want to check your dog for an ear infection. The most common triggers for an ear infection are environmental allergies or food allergies. Ear infections can be readily diagnosed by your veterinarian with an ear swab collected from your pet’s ear.
Addressing and treating the underlying cause for the itchy ear is tantamount to resolving the infection and discomfort that led to the swollen ear. Decompressing the swollen ear can make your dog more comfortable and provide a better cosmetic outcome.
If the ear is not decompressed to remove the fluid from the ear flap, then there is a high risk of scarring and deformity of the ear flap. While this generally will not hurt your pet, it will produce a more unsightly result. Excessive scarring of the pinna from an old aural hematoma can look like this:
To decompress the swollen ear, there are two main approaches: medical management and surgical management.
Medical management of your dog’s swollen ear (aural hemaotma):
Medical management of swollen ear flaps (aural hematomas) is the most common initial treatment choice and is minimally invasive.
Aural hematomas that are acute (less than 48 hours old) respond to drainage and pressure dressings better than ears that have been swollen for more than 7 days.
This treatment involves draining the blood tinged fluid from the hematoma with a needle to decompress the ear flap followed by instilling a steroid medication into the ear flap. This can easily be accomplished by using a butterfly needle to drain the ear and then instilling the medication. Pets are often sent home with oral steroid to continue at home.
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Surgical treatment for dog’s swollen ear:
Surgery is the most common treatment choice for aural hematomas that are persistent.
There are two main surgical procedures performed to treat the swollen ear flap:
- Placement of a tube to drain the fluid via a collection vial. A very simple method is placing fenestrated butterfly tubing into the ear and plugging the needle end of the butterfly needle into a blood collection tube which can be changed as needed. The blood collection tube gently provides negative pressure to help draw fluid out of the ear as it builds up. A drain is most often kept in place for 3 to 14 days or until there is at least 24 hours of minimal fluid drainage.
- The second procedure is to make a long central incision to drain and remove the fluid and blood clots. Then the ear flap is “tacked” down like a mattress to prevent fluid from being able to build up inside. The tacking sutures are kept in place for about 10 to 14 days before they are removed.
Both of these surgeries must be done when the patient is anesthetized. Following the surgery a head wrap is placed. This can be made out of bandage material wrapped gently around the head (avoiding a wrap that is too tight to cause trouble breathing or eating), or a prefabricated head wrap can be placed. The purpose of the wrap is to position the ear flap ideally on top of the head to keep it from moving if the dog shakes their head and also to provide gentle pressure on the ear.
You dog will most likely be sent home with a pain reliever and an anti-inflammatory medication. A removable head wrap like the Surgisox aural compression wrap can be useful to take on and off if you need to treat an ear infection with drops. This is available on Amazon. Another type of wrap is the No Flap Wrap.
Examples of commonly used ear medications:
Ear drops that treat both yeast and bacteria:
Tresaderm: Thiabendazole 40mg/ml, Dexamethasone 1mg/ml, Neomycin 3.2 mg/ml
Otomax: 3 mg/ml gentamicin base; 1 mg/ml betamethasone; and 10 mg/ml clotrimazole
Mometamax: 3 mg/ml gentamicin; mometasone 1 mg/ml mometasone furoate; and 10 mg/ml clotrimazole
Ear drops that treat only yeast:
Miconazole with dexamethasone prepared at the veterinary office: Miconazole 1mg/ml with Dexamethasone 0.1mg/ml
Ear drops that are instilled once that treat yeast and bacteria:
Claro: florfenicol, terbinafine, and mometasone; A single use product designed to treat the ear for 30 days; labeled for dogs only. Treats yeast and bacteria.
Ear drops that are instilled once a week for two weeks that treats yeast:
KC otopack: Thermally activated gel with 0.15% Ketoconazole USP and 1.0% Hydrocortisone USP; is instilled once weekly as needed. Commonly used for 2 treatments. Keep in the fridge until use. Treats only yeast.
A useful medicated ear drop that is available without a prescription:
Zymox enzymatic solution WITH hydrocortisone: The product can be purchased on Amazon with 0.5 and up to 1% hydrocortisone. I recommend 1% hydrocortisone.
Prevention of aural hematomas in dogs:
Routine ear cleaning:
Routine ear cleaning is helpful to remove waxy debris and mechanically remove infectious bacteria/yeast. Some ear cleansers also have antiseptic properties. The ear cleaner I like best is Epi-Otic Advanced ear cleaner:
Over 60% of dogs with inflamed ears with pus or heavy waxy buildup treated for two weeks with epi-otic advanced ear wash had no detectable infection two weeks later in a published study.
Reduce chronic ear inflammation:
Addressing possible underlying causes of the ear inflammation involves diagnosing the condition first to determine if underlying environmental allergies, food allergy, or other issue (ear mites, foreign body, structural problem (narrowed ear canal) is contributing to the development of the inflammation. Environmental allergies are often the cause . Dogs that have recurrent ear infections due to environmental allergies sometimes benefit from 1-2 times weekly application of a steroid containing ear solution in the ears to reduce recurrence.
There are a variety of different steroid containing solutions. One that is available over the counter with a less potent steroid is called Zymox enzymatic solution with 0.5 to 1% hydrocortisone. More potent steroid solutions such as mometasone furoate 0.1% solution may be prescribed by your veterinarian.
To summarize aural hematomas in dogs:
While aural hematomas may be frustrating and annoying, the good news is that they are not a threat to your dog’s overall health.
The most important factor is to treat the underlying cause of your pet’s discomfort. Look for an infection, foreign material in your dog’s ear or an allergic reaction etc.
Decompressing the ear flap will help ensure a more cosmetic outcome. If the ear is left untreated, the fluid build-up will eventually be reabsorbed by the body. The pinna will scar down, giving it a more crumpled appearance.
For more information and options best tailored to your dog, always consult your veterinarian.