Surgery from the Point of View of a Client and AHNA Staff - Ear Hematoma

A Client’s View:

My Golden Retriever, Beau, who is 12 years old, has always had ear issues. Even when he was a little puppy and we lived in New Orleans, we seemed to always be treating him for one ear malady or another. So when I noticed him scratching his ear more than usual and even rubbing his ear against the carpet, I wasn’t surprised. However, I was surprised when I inspected his ear. It was huge!

There was a big pocket in his ear that seemed to be full of liquid. The swollen area was slightly warm to the touch. Beau has typical Golden ears in that they are floppy and very furry so it wasn’t until I touched and held his ear that I realized the extent of the problem. I immediately called Animal Hospital of North Asheville for an appointment.

Dr. Duncan confirmed my suspicion that Beau had an ear infection and then went on to explain to me that Beau also had an ear hematoma, which are often caused by ear infections and increased shaking of the head. We talked over all our options, including surgery, while Dr. Duncan and Dot fed a very happy Beau lots of treats. Because I wanted a quick and definitive treatment, I decided to move forward with surgery.

I brought Beau in for his surgery a few days later. Beau absolutely loves his trips to the animal hospital! He sees it as an opportunity to get loved on by as many people as possible, eat lots of treats, and socialize with as many dogs as possible. Beau is a very trusting, laidback guy, and he just takes it for granted that everyone loves him – and I have to admit, they do!

Before surgery, Beau got to spend some time in the waiting area with one of his favorite people, Dot. She and I had lots of fun making him do his ‘Elvis’ impression. There is a certain place on his face that when scratched causes him to lift his lip in an Elvis sneer. Dot and I were cracking up and Beau soaked in the attention.

When it was time for Beau to receive his pre-surgery drugs to relax him (although I don’t know how he could be more relaxed!), I was invited to accompany him to the treatment area to a nice glassed in area with his bed in it where I could sit with him as long as I wanted to. I petted him and talked to him as the drugs took effect until I got a phone call and had to return to work. I left confident that he was in good hands.

As the day went on, I never got the chance to be worried about Beau. I received phone calls from Dr. Duncan and Dot letting me know how my big guy was doing. Even though I had to leave him to go to work, I never once felt disconnected from what was going on.  It was also nice that I could have stayed with him the whole time except while he was actually in surgery or recovery, if my work situation had allowed.

Later that evening, I went back to the hospital to see Beau and bring him home once he was ready for discharge. He was groggy from the drugs and he looked both funny and adorable with his head all wrapped up in a bandage. As always, he was quite happy to see me, so I sat by his bed while the staff monitored him and he became more and more alert.
As we waited for Beau to become steadier on his feet, Lorraine, the Patient Care Coordinator at AHNA, talked to me about the medication that I would have to give Beau for the next week and the special care that he would need. She also explained that Beau might whine a bit for the first 24 hours after surgery, that the whining would not be an indication of pain because he was on strong medication to prevent pain, and that some dogs whine because they don’t understand why they feel “funny” from the pain medications. I’m so glad that Lorraine explained this to me! Beau did indeed whine, and it was reassuring to know that what he needed was love and attention from us.

We followed all of Dr. Duncan’s and Lorraine’s instructions and Beau’s ear is now fully healed! His fur has grown back on his ear and you would never know that there was anything amiss with his ear.

I’m so grateful to every team member who took such excellent care of Beau that day. This is his second surgery at AHNA (the first was to remove a mass from his side), and both experiences were smooth and pleasant for Beau. I have no doubt that when it’s time for me to take him to the hospital again he will be just as excited to visit everyone at AHNA as he has always been.

From the Staff Point of View:

Good Morning Beau and Brandi! Today is a big day, the day Dr. Duncan surgically corrects Beau's ear problem. Beau has an aural hematoma, which will be explained a little later. On the morning of surgery, many things take place before the actual surgery.

After being greeted by our client care team, Brandi and Beau joined Dr. Duncan's exam room assistant, Dot, to begin the check in. Beau was in pretty good spirits but he did wonder where the famous cookies were that he normally gets when he comes to visit. Unfortunately, he wasn’t able to have any cookies this morning since he would be receiving anesthesia later.

Prior to surgery, the exam room assistants begin the admittal process by obtaining that patient’s weight, family contact information, history of how the patient is feeling recently and if any medications or food have been given. The surgeon gives the patient a physical exam and answers any questions the family may have prior to surgery.

One of the many things we are proud of at AHNA is the ability to have families stay with their pets while at AHNA. Brandi and Beau stayed together in one of our new patient glass pods. It was their very own room while Beau was at the hospital. The nursing team is able to monitor the patients while giving families room to relax. Each patient is provided soft, clean and comfortable bedding, water, and whatever else they need to have a low stress stay.  Human family members are also provided with comfortable chairs, water or soda, and magazines to help pass the time. It helps decrease both the family and the patient's stress by being able to stay together, and Beau really enjoyed having his mom there.  Whether a patient is in the hospital for a surgical or dental procedure or for an illness, our nursing staff monitors and records vitals, administers medications, and observes the patients while they stay with us. They work hand in hand with the veterinarians to give individual care to each patient. The nurses also spend time comforting patients, reassuring them, keeping them company, walking dogs outside in our dog walk area, cuddling with the dogs and cats, and keeping the beds neat and clean among numerous other tasks. Beau rested with his mom before his surgery.

About 30 minutes before his surgery time, Beau received an injection of a mild tranquilizer to help him relax, and a narcotic to help prevent pain. After Beau was relaxed from his pre-medications, he joined Jen, our lead surgery technician, in the surgery prep area. Once a patient is moved to surgery prep, we want all our attention focused on the patient, so families are asked to wait in the treatment room or waiting room.  In this area, Beau is prepared for surgery. With Mick’s help, Jen starts by shaving an area on Beau's leg to place the intravenous catheter. The hair is clipped to allow us to see the vein and clean the skin for placement of the IV catheter.

After the catheter was placed, Beau received a short acting IV injection to make him immediately fall asleep. This injection allows an endotracheal tube to be placed for the delivery of oxygen and the gas anesthesia that will keep him under anesthesia for the procedure. He was also hooked up to the monitors that record his respiratory and heart rates, temperature, oxygen saturation, and blood pressure. This allows the technicians and doctor to monitor, adjust vitals and drugs as needed. Beau also received fluids through his IV catheter to help support his kidneys.

Before surgery the ear must be shaved and cleaned for the incision site. Jen patiently shaves Beau's ear (see above photos). You can see how swollen the ear is. (photo below) Poor Beau. He is asleep so it doesn't bother him to have it shaved.

After the cleaning of the surgery site, Jen injects a local anesthetic to numb the nerve that supplies the ear.  Even though he’s asleep during the surgery and won’t feel anything, this injection, called a nerve block, will allow a lower plane of general anesthesia (safer) and prevent any discomfort in the ear when he wakes up. The whole time Jen is monitoring and recording Beau's vitals.

Once finished in the surgery prep area, Jen accompanies Beau into the sterile surgery suite with Dr. Duncan.

Dr. Duncan Explains Aural Hematomas (ear hematomas):

Ear hematomas are caused by increased shaking of the head or trauma to the ear flaps. Discomfort from an ear infection is the most common cause of the head shaking and scratching or rubbing the ears. The ear flap contains two layers of cartilage with small blood vessels between them, so the centrifugal force of shaking or the trauma of scratching or rubbing can cause rupture of these very small blood vessels resulting in pooling of blood between the layers of cartilage. This accumulation of fluid can be reabsorbed by the body, but it is a very slow process. Meanwhile, there is pain due to pressure of fluid within the space.

Diagnosis of an ear hematoma is relatively easy based on clinical signs and palpation of the ear. Ear swabs and ear otoscopy are very important diagnostic tools to check for infections of the ear canal or other underlying causes such as ear polyps. Video otoscopy, where the ear canal and drum can be seen on a screen, is a specialized instrument that helps us to visualize the deeper ear canal and ear drum to identify abnormalities that may not be possible with a simple handheld otoscope.  We are fortunate to have this technology available to our patients at AHNA so that we can fully examine the ear drum and detect middle ear infections.

Correction of an ear hematoma is typically accomplished with surgery. Many different techniques can be performed. In Beau’s case, the procedure involved making an incision in the ear flap to drain the fluid, then placing sutures through the affected portions of the ear flap.  These sutures create scar tissue to seal the cartilage back together with the goal of preventing fluid accumulation. The incision was left open to heal on its own. A light pressure bandage was placed around the head to help control bleeding. Sutures are usually removed in 2-4 weeks.

Post-operative pain management is very important. This may include anti-inflammatories, pain medications and antibiotics. In addition, treatment of any ear infection or any other underlying cause is imperative in prevention of future ear hematomas.  The prognosis for complete recovery, just like Beau had, is very good.

Staff Point of View Continued:

Jen then finishes the surgery with cleaning and bandaging Beau's head. The bandage helps put pressure on the incision to reduce post-operative bleeding, and keeps Beau from shaking his head and reinjuring his ear.

Emily, one of our Certified Veterinary Technicians, sat with Beau after surgery in our recovery area. All of our patients who receive anesthesia have a technician sit with them, monitoring and recording vitals and keeping them warm and comfortable as they wake up. Emily removed the endotracheal tube once he was awake enough. Beau was nice and snuggly warm while lying on the warm water circulating mat, along with a warm air Bair hugger (blanket) on top of him. He enjoyed being cozy. Beau stayed in recovery until he was stable and awake enough to go back to bed. Once Beau was out of recovery, Brandi was able to sit with him until he was ready to go home.

When Beau was ready to go home, Lorraine went over Beau's discharge instructions with Brandi and made sure she knew what to watch for at home. Beau was a great patient. Brandi was a great support for Beau!