Aural hematomas in small ruminants - clinical features, surgical treatment and outcome

Background: Aural or auricular hematoma is an important and prevalent surgical condition in small animals practice, and commonly reported in companion pets. The condition is characterized by blood accumulation between the pinnae's dermal surface and the underlying perichondrium. In farm animals, most cases present surgical treatment with drainage of serosanguineous fluid from acute cases with clinical evolution ranging from 1 to 5 days. Therefore, the present work reports the clinical features, surgical treatment and outcome of aural hematomas in 3 small ruminants with a chronic evolution (7 to 20 days), detailing the post-surgical complications, such as wound infection and recurrence, and final cosmetic appearance of the pinnae. Cases: Upon physical examination, all animals were alert and presenting a good body condition score. Clinical alteration was restricted to a bilateral (Case 1) or unilateral (Cases 2 & 3) painless, and fluid-filled swelling, presenting doughy consistency masses within the fluid during pinna manipulation. The fluid-filled swellings were located on the concave (Case 1 - left ear & Case 2) and convex (Case 1 - right ear & Case 3) surface of the pinna. No primary pruritic disorders of the pinna were detected, and a diagnosis of traumatic aural hematoma was proposed. Due to the chronicity of the cases, surgical approach was advisable. The small ruminants underwent general anesthesia, and a linear incision over the skin overlying the hematoma was performed (Cases 1 & 2). After removal of blood and fibrin clots, the cavity was flushed and captonated size 0 nylon mattress sutures were performed on either side of the incision, in order to obliterate the dead space. Due to recurrence after 14 days, Case 2 was submitted to a modified surgical approach using a S-shaped incision combined to multiple drainage holes (MDH) using a disposable 6 mm biopsy punch. The same approach has performed in Case 3. Then, size 0 nylon mattress sutures followed by a tight protective pressure and absorbent bandage combined with an Elizabethan collar was applied. Postoperatively, Case 1 presented surgical site infection and the antibiotic was changed after bacterial culture and antibiogram results. Hospital discharge varied from 14 to 19 days' post-surgery. All animals presented some degree of ear retraction and a linear or S-shaped scar on the affected ear, but final cosmetic appearance was satisfactory to all owners. Discussion: Aural or auricular hematomas are a frequent disorder in dogs and cats clinical practice. In sheep, the few reported cases have been associated with pruritic disorders of the pinna, such as ticks infestation and sarcoptic mange. Whilst in goats, traumatic injuries, such as ear tagging and trauma from others goats, are considered the main cause, especially in breeds with pendulous ear. In our cases with chronic evolution (> 7 days), the most important clinical feature was the presence of doughy consistency masses within the fluid, suggesting matured blood and fibrin clots. A linear incision with captonated size 0 nylon mattress sutures was associated to post-surgical complications, such as wound infection and aural hematoma recurrence. Therefore, a S-shaped incision associated to creation of MDH, in order to achieve better drainage, was the chosen approach in the second surgery (Case 2) and on the subsequent patient (Case 3). To the best of our knowledge, this is the first report using the MDH approach in farm animals, that appears to be an effective treatment for chronic aural hematomas in small ruminants.

Laser photobiomodulation and antimicrobial photodynamic therapy in the treatment of ovine otitis

Background: Otitis is a severe inflammation of the skin of the auditory canal which can impact animals of all ages. Insheep, this disease can occur in isolated cases or in the entire flock. Laser photobiomodulation can be used in combination with medication or as single therapy and the effects are analgesia, modulation of the inflammatory process, edemareduction, tissue restoration and stimulation of local microcirculation. Antimicrobial photodynamic therapy stands out asa promising alternative to antimicrobial drugs for the treatment of localized infections. This study aimed to report the useof laser phototherapies on a sheep with bacterial otitis.Case: A case of bacterial otitis in a 4-year-old sheep, Dorper, was treated at the Veterinary Hospital of the State Universityof Santa Cruz. In the anamnesis, the owner reported that the patient presented crusts in the auricular pavilions, and hadbeen medicated with oxytetracycline 20%, administered intramuscularly, for two days and the crusts cleaned with iodine10%, but the animal did not present clinical improvement. On physical examination, the animal presented constant headswaying, edema of the ears, otalgia, enlarged parotid lymph nodes and ear wounds. No ear discharge was observed, andthe initial diagnosis was aural hematoma. The treatment prescribed was laser photobiomodulation for three consecutivedays. The lesions were irradiated with a diode laser with a power of 0.1 W, irradiance of 3.5 W/cm2, continuous emission,spot area of 0.028 cm2, wavelength of 808 nm, energy of 4J/point, and fluency/point of 142.8J/cm2, with seven pointson the external surface and four points on the internal surface of both ears. Two points were also targeted on the parotidlymph nodes with infrared laser (λ = 808 nm), with energy of 2J/point. On the fourth day of hospitalization, there was areduction in lesions, decreased edema and absence of pain and on the sixth day...

Laser photobiomodulation and antimicrobial photodynamic therapy in the treatment of ovine otitis

Background: Otitis is a severe inflammation of the skin of the auditory canal which can impact animals of all ages. Insheep, this disease can occur in isolated cases or in the entire flock. Laser photobiomodulation can be used in combination with medication or as single therapy and the effects are analgesia, modulation of the inflammatory process, edemareduction, tissue restoration and stimulation of local microcirculation. Antimicrobial photodynamic therapy stands out asa promising alternative to antimicrobial drugs for the treatment of localized infections. This study aimed to report the useof laser phototherapies on a sheep with bacterial otitis.Case: A case of bacterial otitis in a 4-year-old sheep, Dorper, was treated at the Veterinary Hospital of the State Universityof Santa Cruz. In the anamnesis, the owner reported that the patient presented crusts in the auricular pavilions, and hadbeen medicated with oxytetracycline 20%, administered intramuscularly, for two days and the crusts cleaned with iodine10%, but the animal did not present clinical improvement. On physical examination, the animal presented constant headswaying, edema of the ears, otalgia, enlarged parotid lymph nodes and ear wounds. No ear discharge was observed, andthe initial diagnosis was aural hematoma. The treatment prescribed was laser photobiomodulation for three consecutivedays. The lesions were irradiated with a diode laser with a power of 0.1 W, irradiance of 3.5 W/cm2, continuous emission,spot area of 0.028 cm2, wavelength of 808 nm, energy of 4J/point, and fluency/point of 142.8J/cm2, with seven pointson the external surface and four points on the internal surface of both ears. Two points were also targeted on the parotidlymph nodes with infrared laser (λ = 808 nm), with energy of 2J/point. On the fourth day of hospitalization, there was areduction in lesions, decreased edema and absence of pain and on the sixth day...(AU)

Epidemiology and anesthetic risk in dogs with aural hematoma / Epidemiologia e risco anestésico de cães portadores de otohematoma

Background: Otohematoma or aural hematoma in dogs is blood pooling within the ear cartilage plate, and stems from several causes (ear infections, ectoparasites and others). The formation of hematoma is by vascular injury, causing bleeding, generated by self-injury. This disease occurs especially in dogs of pendulous ears, and the concave surface of the ear is considered as the most frequent. The therapy to correct the lesion can be a clinical procedure; however, surgical drainage is the treatment of choice. This work aims to record the epidemiological aspects related to aural hematoma in dogs, as well as classify such patients as to the physical condition and anesthetic risk. Materials, Methods & Results: Twenty five dogs with aural hematoma submitted to surgical procedure were followed. During the data collection period (seven months), surgery to correct aural hematoma represented 19% of surgeries performed in dogs (total of surgeries: 474). The percentage of canine breeds affected was: mixed breed (64%; 16/25), german shepherd (24%; 6/25), labrador (4%; 1/25), waimaraner (4%; 1/25) and daschund (4%; 1/25). Most occurrences were observed in females aged 3-12 years. Most of the animals showed only one pina affected (96%; 24/25), and 52% (13/25) had hematoma in the right and 44% (11/25) in the left ear. Some of the patients had no hematologic abnormalities (48%; 12/25) [...](AU)

Epidemiology and anesthetic risk in dogs with aural hematoma / Epidemiologia e risco anestésico de cães portadores de otohematoma

Background: Otohematoma or aural hematoma in dogs is blood pooling within the ear cartilage plate, and stems from several causes (ear infections, ectoparasites and others). The formation of hematoma is by vascular injury, causing bleeding, generated by self-injury. This disease occurs especially in dogs of pendulous ears, and the concave surface of the ear is considered as the most frequent. The therapy to correct the lesion can be a clinical procedure; however, surgical drainage is the treatment of choice. This work aims to record the epidemiological aspects related to aural hematoma in dogs, as well as classify such patients as to the physical condition and anesthetic risk. Materials, Methods & Results: Twenty five dogs with aural hematoma submitted to surgical procedure were followed. During the data collection period (seven months), surgery to correct aural hematoma represented 19% of surgeries performed in dogs (total of surgeries: 474). The percentage of canine breeds affected was: mixed breed (64%; 16/25), german shepherd (24%; 6/25), labrador (4%; 1/25), waimaraner (4%; 1/25) and daschund (4%; 1/25). Most occurrences were observed in females aged 3-12 years. Most of the animals showed only one pina affected (96%; 24/25), and 52% (13/25) had hematoma in the right and 44% (11/25) in the left ear. Some of the patients had no hematologic abnormalities (48%; 12/25) [...]

Necrose focal em pavilhão auricular após correção de otohematoma com o uso de botões em cão relato de caso / Focal necrosis in pinna after correction of aural hematoma using buttons on dog - case report

Objetivou-se descrever o caso de um cão que apresentou necrose focal em uma das pinas após cirurgia corretiva para otohematoma com a utilização de botões. O paciente, labrador, nove anos, apresentava otohematoma em pavilhão auricular direito e foi submetido ao tratamento cirúrgico. Aos 21 dias de pós-operatório observou-se necrose focal no ápice da pina, onde alguns botões estavam alocados. Conclui-se com este relato que embora a correção cirúrgica de otohematoma com o uso de botões seja bastante descrita na literatura e bem praticada pelos autores, não esta isenta de complicações e, nesta oportunidade, a necrose foi observada. (AU)

The objective was to describe the case of a dog that presented with focal necrosis of the pinna after corrective surgery for aural hematoma with the use of buttons. The patient, Labrador, nine years old, had aural hematoma in the right ear and underwent surgical treatment. At 21 days postoperatively there was focal necrosis at the apex of pinna, where some buttons were allocated. It concludes with this report that, although the surgical repair of aural hematoma using buttons is very well described in the literature and well practiced by the authors, it is not free of complications, and in this opportunity, necrosis was observed. (AU)

Necrose focal em pavilhão auricular após correção de otohematoma com o uso de botões em cão – relato de caso / Focal necrosis in pinna after correction of aural hematoma using buttons on dog - case report

Objetivou-se descrever o caso de um cão que apresentou necrose focal em uma das pinas após cirurgia corretiva para otohematoma com a utilização de botões. O paciente, labrador, nove anos, apresentava otohematoma em pavilhão auricular direito e foi submetido ao tratamento cirúrgico. Aos 21 dias de pós-operatório observou-se necrose focal no ápice da pina, onde alguns botões estavam alocados. Conclui-se com este relato que embora a correção cirúrgica de otohematoma com o uso de botões seja bastante descrita na literatura e bem praticada pelos autores, não esta isenta de complicações e, nesta oportunidade, a necrose foi observada.

The objective was to describe the case of a dog that presented with focal necrosis of the pinna after corrective surgery for aural hematoma with the use of buttons. The patient, Labrador, nine years old, had aural hematoma in the right ear and underwent surgical treatment. At 21 days postoperatively there was focal necrosis at the apex of pinna, where some buttons were allocated. It concludes with this report that, although the surgical repair of aural hematoma using buttons is very well described in the literature and well practiced by the authors, it is not free of complications, and in this opportunity, necrosis was observed.

Estudo retrospectivo do otohematoma em cães atendidos em um hospital veterinário universitário / Retrospective aural hematoma in dogs presented to a University Veterinary Hospital

O otohematoma canino é um caso clínico comum na rotina da clínica médica de pequenos animais. Os principais fatores predisponentes correspondem a raça, sexo, idade, anatomia do pavilhão auricular e presença de outras afecções concomitantes. O presente trabalho objetivou a caracterização epidemiológica do hematoma auricular na espécie canina. Realizou-se um estudo retrospectivo utilizando os dados recolhidos das fichas clínicas de 55 cães com otohematoma, atendidos no Hospital Veterinário da Universidade Federal do Piauí, no período compreendido entre janeiro de 2007 a dezembro de 2008. O sexo masculino foi o mais acometido, com 62% dos casos. A faixa etária de maior representação variou de 7 a 8 anos de idade (29%). Os animais Sem Raça Definida possuíram destaque em relação à frequência de otoematoma (41%), seguindo-se dos indivíduos da raça Pastor Alemão (34%) e Fila Brasileiro (5%). A maioria dos pacientes apresentou um peso corporal superior a 20 Kg (71%). Os resultados obtidos sugeriram que o hematoma auricular canino apresentou alguns fatores de risco, como a idade adulta e o porte elevado do animal.

The otohematoma canine is a common clinical case in routine clinical care of small animals. The main predisposing factors correspond to race, sex, age, anatomy of the ear and the presence of other concomitant conditions. This study aimed to characterize the epidemiological auricular hematoma in dogs. We conducted a retrospective study using data collected from the medical records of 55 dogs with otohematoma treated at the Veterinary Hospital of the Federal University of Piauí, in the period from January 2007 to December 2008. The male was the most affected, with 62% of cases. The age group most represented ranged from 7 to 8 years of age (29%). The animals possessed undefined breed featured in the frequency of otohematoma (41%), followed by the German Shepherd individuals (34%) and Fila (5%). Most patients showed a body weight above 20 kg (71%). The results suggest that the canine auricular hematoma presented some risk factors, such as age and size large adult animal.

Hematoma auricular em gato: relato de caso / Aural hematoma in cat: Case Report

O hematoma auricular ou oto-hematoma é um acúmulo de sangue dentro das camadas de cartilagem do pavilhão auricular e é frequentemente observado nos cães e raramente nos gatos. A causa dos oto-hematomas ainda não é bem compreendida, no entanto, em muitos casos, parece que a agitação da cabeça ou coçadura das orelhas causada por dor ou irritação associadas com otite externa (geralmente otite bacteriana em cães e otite parasitária por Otodectes cynotis em gatos) são os responsáveis. O objetivo terapêutico para o hematoma auricular consiste na identificação da origem da irritação, drenagem do hematoma, manutenção da aposição dos tecidos, redução da deposição de fibrina e impedimento da recidiva. O caso relatado é de um felino, Siamês, fêmea, 16 anos de idade, 4 kg de peso. A queixa do proprietário era prurido intenso nos ouvidos e aumento de volume no pavilhão auricular direito. No exame clínico foi diagnosticado hematoma auricular direito e observado presença de secreção otológica bilateralmente de coloração escura, aspecto seco e com grande quantidade de ácaros (visualizados macroscopicamente). Foi prescrito para o tratamento da otocaríase diazinon solução otológica e selamectina. O paciente foi encaminhado para cirurgia para a correção do oto-hematoma, apresentando bom resultado. Conclui-se que o procedimento cirúrgico foi adequado

Aural hematoma is a blood accumulation within the cartilage layers of the ear pinna. It is frequently observed in dogs and rarely in cats. The exact cause of aural hematoma is still poorly understood, however, in many cases, the reason seems to be the head shaking or ear scratching,from pain or irritation associated with external otitis (usually bacterial otitis in dogs and parasitary otitis for Otodectes cynotis in cats) are responsible. The therapy objective for aural hematoma consists on identification of the main reason of the irritation, the draining of hematoma, the maintaining of the tissue supply, the reduction the fibrin storage and to avoid recurrence of the hematoma. The reported case is about a 16-year-old female siamese cat, weighing 4 kg. The owner’s complaint was severe itching in both ears and an increase in volume on right aural pinna. Aural hematoma on right ear, presence of dry and dark secretion and a lot of mites in both ears (seen macroscopically), were diagnosticated on clinical examination. The prescripted treatment for ear infestation was diazinon aural solution and selamectine. The patient was taken to surgery to correct the aural hematoma. The result was really good, so the surgical procedure was appropriated.

Hematoma auricular em gato: relato de caso / Aural hematoma in cat: Case Report

O hematoma auricular ou oto-hematoma é um acúmulo de sangue dentro das camadas de cartilagem do pavilhão auricular e é frequentemente observado nos cães e raramente nos gatos. A causa dos oto-hematomas ainda não é bem compreendida, no entanto, em muitos casos, parece que a agitação da cabeça ou coçadura das orelhas causada por dor ou irritação associadas com otite externa (geralmente otite bacteriana em cães e otite parasitária por Otodectes cynotis em gatos) são os responsáveis. O objetivo terapêutico para o hematoma auricular consiste na identificação da origem da irritação, drenagem do hematoma, manutenção da aposição dos tecidos, redução da deposição de fibrina e impedimento da recidiva. O caso relatado é de um felino, Siamês, fêmea, 16 anos de idade, 4 kg de peso. A queixa do proprietário era prurido intenso nos ouvidos e aumento de volume no pavilhão auricular direito. No exame clínico foi diagnosticado hematoma auricular direito e observado presença de secreção otológica bilateralmente de coloração escura, aspecto seco e com grande quantidade de ácaros (visualizados macroscopicamente). Foi prescrito para o tratamento da otocaríase diazinon solução otológica e selamectina. O paciente foi encaminhado para cirurgia para a correção do oto-hematoma, apresentando bom resultado. Conclui-se que o procedimento cirúrgico foi adequado(AU)

Aural hematoma is a blood accumulation within the cartilage layers of the ear pinna. It is frequently observed in dogs and rarely in cats. The exact cause of aural hematoma is still poorly understood, however, in many cases, the reason seems to be the head shaking or ear scratching,from pain or irritation associated with external otitis (usually bacterial otitis in dogs and parasitary otitis for Otodectes cynotis in cats) are responsible. The therapy objective for aural hematoma consists on identification of the main reason of the irritation, the draining of hematoma, the maintaining of the tissue supply, the reduction the fibrin storage and to avoid recurrence of the hematoma. The reported case is about a 16-year-old female siamese cat, weighing 4 kg. The owners complaint was severe itching in both ears and an increase in volume on right aural pinna. Aural hematoma on right ear, presence of dry and dark secretion and a lot of mites in both ears (seen macroscopically), were diagnosticated on clinical examination. The prescripted treatment for ear infestation was diazinon aural solution and selamectine. The patient was taken to surgery to correct the aural hematoma. The result was really good, so the surgical procedure was appropriated.(AU)

Abordagem clínico-cirúrgica do otohematoma em felino doméstico (Felis catus domestica): aspectos etiopatogênicos e relato de caso / Clinical-surgical approach to aural hematoma in domestic feline (Felis catus domestica): etiopatogenic aspects and case report / Enfoque clínico-quirúrgico para otohematoma en felino doméstico (Felis catus domestica): aspectos etiopatogénicos y reporte de un caso

Otohematoma consiste no acúmulo de sangue entre a cartilagem e a pele do pavilhão auricular, decorrente de fraturas na cartilagem auricular e ruptura de vasos sanguíneos causando incomodo e dor. Ocorre com frequência em cães, porém é incomum em gatos. Normalmente, OH estão associadas aos processos traumáticos, infecções bacterianas, parasitárias ou fúngicas do ouvido, entretanto sua etiologia não está totalmente esclarecida, uma vez que nem todos os animais apresentam OH na presença de otite, mesmo em situações de prurido intenso. Este trabalho faz uma revisão sobre a enfermidade e relata um caso incomum de otohematoma em felino.(AU)

Aural hematoma is a blood accumulation between the ear cartilage and skin, as the result of auricular cartilage fractures and ruptured blood vessels causing discomfort and pain. It commonly occurs in dogs but rarein cats. Typically, OH are associated with traumatic, parasitic bacterial infections, fungal ear process, however, its etiology is not entirely clear, since not all animals have OH in the presence of otitis media, even under heavy itching. In this paper a review about the disease and is an unusual case of aural hematoma occurs in a cat.(AU)

Oto-hematoma (OH) es la acumulación de sangre entre el cartílago y la piel de la oreja, como el resultado de las fracturas del cartílago auricular y ruptura de vasos sanguíneos causando malestar y el dolor. Se produce con frecuencia en los perros, pero es poco común en gatos. Típicamente, OH están asociados con proceso traumático, bacterianas parasitarias infecciones, hongos en el oído, sin embargo, su etiología no está totalmente claro, ya que no todos los animales tienen OH en presencia de otitis media, incluso bajo fuerte picor. En este trabajo se hace una revisión acerca de la enfermedad y se presenta un caso inusual de hematoma aural en un gato.(AU)

Abordagem clínico-cirúrgica do otohematoma em felino doméstico (Felis catus domestica): aspectos etiopatogênicos e relato de caso / Clinical-surgical approach to aural hematoma in domestic feline (Felis catus domestica): etiopatogenic aspects and case report / Enfoque clínico-quirúrgico para otohematoma en felino doméstico (Felis catus domestica): aspectos etiopatogénicos y reporte de un caso

Otohematoma consiste no acúmulo de sangue entre a cartilagem e a pele do pavilhão auricular, decorrente de fraturas na cartilagem auricular e ruptura de vasos sanguíneos causando incomodo e dor. Ocorre com frequência em cães, porém é incomum em gatos. Normalmente, OH estão associadas aos processos traumáticos, infecções bacterianas, parasitárias ou fúngicas do ouvido, entretanto sua etiologia não está totalmente esclarecida, uma vez que nem todos os animais apresentam OH na presença de otite, mesmo em situações de prurido intenso. Este trabalho faz uma revisão sobre a enfermidade e relata um caso incomum de otohematoma em felino.

Aural hematoma is a blood accumulation between the ear cartilage and skin, as the result of auricular cartilage fractures and ruptured blood vessels causing discomfort and pain. It commonly occurs in dogs but rarein cats. Typically, OH are associated with traumatic, parasitic bacterial infections, fungal ear process, however, its etiology is not entirely clear, since not all animals have OH in the presence of otitis media, even under heavy itching. In this paper a review about the disease and is an unusual case of aural hematoma occurs in a cat.

Oto-hematoma (OH) es la acumulación de sangre entre el cartílago y la piel de la oreja, como el resultado de las fracturas del cartílago auricular y ruptura de vasos sanguíneos causando malestar y el dolor. Se produce con frecuencia en los perros, pero es poco común en gatos. Típicamente, OH están asociados con proceso traumático, bacterianas parasitarias infecciones, hongos en el oído, sin embargo, su etiología no está totalmente claro, ya que no todos los animales tienen OH en presencia de otitis media, incluso bajo fuerte picor. En este trabajo se hace una revisión acerca de la enfermedad y se presenta un caso inusual de hematoma aural en un gato.

Proposição de técnica para drenagem de otohematoma em cães / Planteamiento de técnica para drenaje de otohematoma en perros / Technical proposition for the drainage of aural hematoma in dogs

Cães que apresentam otohematoma, requerem uma intervenção clínica ou cirúrgica, que permita o restabelecimento da condição fisiológica e estética da orelha. No presente estudo são abordados os procedimentos utilizados na técnica para drenagem do otohematoma em 20 cães. Todos foram submetidos à drenagem e colocação de dreno, possibilitando o restabelecimento definitivo do pavilhão auricular, sem deformações por contração da pele, nos pontos de incisão cirúrgica(AU)

Dogs having aural hematoma need a quick clinical or surgical intervention which will allow the reestablishment of the physiological and esthetical condition of their ear. The present study approaches the procedures used in the draining technique of the aural hematoma in twenty dogs. All of those were submitted to the use of a drain, permitting the definitive reestablishment of the ear pinna without any deformations by contracting skin(AU)

Perros que presentan otohematoma requieren una intervención clínica o quirúrgica, que permita El reestablecimiento de la condición fisiológica y estética de la oreja. En el presente estudio son abordados los procedimientos utilizados en la técnica para drenaje de otohematoma en 20 perros. Todos fueron sometidos a drenaje y colocación de dreno, posibilitando el reestablecimiento definitivo del pabellón auricular, sin deformaciones por contracción de la piel(AU)