Ear surgery (aural haematoma, ear canal ablation)
From surgery for an aural haematoma to complete removal of the ear canal in irreversible inflammation. The decision is preceded by video-otoscopy and an assessment of whether conservative treatment still makes sense.
What it involves
Ear surgery covers several different procedures. The most common is treatment of an aural haematoma — a “cushion” of blood between the skin and the cartilage of the ear, which forms through head shaking and scratching during an ear infection. We incise the haematoma, drain it and suture it so that the skin adheres to the cartilage and the haematoma does not refill.
The second group consists of procedures in the ear canal: removal of polyps (especially in cats), widening of a narrowed canal and, in irreversible cases, total ear canal ablation with bulla osteotomy (TECA-BO). This is removal of the diseased, calcified, infected canal in its entirety. The procedure sounds radical, but in a dog that has suffered for years with a painful, foul-smelling ear it brings lasting relief.
The decision to operate on the ear is always preceded by a careful assessment of the canal with a video-otoscope and an attempt at conservative treatment. We operate when treatment does not work or when the changes are already irreversible.
When it is used
Aural haematoma: when the ear is suddenly swollen, soft and warm — ideally within the first few days, before the blood begins to organise and distort the cartilage. Conservative treatment (drainage, medicines) is sometimes effective for small haematomas, but they often recur.
Canal ablation: for chronic, recurrent ear infection that has lasted for years despite correct treatment, when the canal is narrowed, calcified and painful, and video-otoscopy shows there is no chance of restoring its patency. Also for tumours of the ear canal.
Indications: symptoms that should prompt a visit
- A dog's or cat's ear has suddenly swollen like a cushion and is soft and warm.
- A dog has had a foul-smelling, painful ear for years, despite repeated courses of treatment.
- The ear canal is so narrow that it is impossible to look into it or to instil medicine.
- The dog tilts its head, does not allow the ear to be touched and growls when you try to clean it.
- A cat has a polyp in the ear: it tilts its head, sneezes, has discharge from the ear or difficulty breathing through the nose.
- A lump can be felt in the ear, or a growth is emerging from the canal.
- The dog repeatedly shakes its head and scratches its ear until it bleeds.
Conditions for which we use it in particular
Diagnostics beforehand
The basis is video-otoscopy under sedation: assessment of the whole length of the canal, the state of the eardrum, the presence of polyps and tumours, and sampling for cytology and culture. If we suspect otitis media, we take a skull X-ray in a projection that shows the tympanic bullae.
With a haematoma it is important to find the cause — most often an ear infection or allergy — because without treating it the haematoma returns. Pre-anaesthetic assessment under STD-01, with a blood test in older patients and before ablation.
How it proceeds
Haematoma: under sedation or a short general anaesthetic we incise the skin on the inner side of the ear flap, remove blood and clots, and then place a series of sutures through the full thickness of the ear that draw the skin towards the cartilage and prevent fluid from collecting again. The procedure takes about 30 minutes; the patient goes home the same day.
Ear canal ablation: under general anaesthesia with full monitoring (STD-02) and a nerve block around the ear (STD-04), the surgeon removes the ear canal in its entirety from the ear flap to the tympanic bulla, opens and cleans the bulla, and then closes the wound in layers, sometimes with a drain. The procedure takes 1,5–2,5 hours and requires care because of the facial nerve running right alongside.
After ablation the patient stays in hospital for a day for pain management and observation. In cats we remove polyps through the canal or by opening the tympanic bulla, depending on their position.
Aftercare
After haematoma surgery: a collar for 2–3 weeks, treatment of the ear infection that was the cause, a check-up every week; we remove the sutures after 2–3 weeks. The ear may remain slightly thickened.
After ablation: a collar, an antibiotic and painkillers as set out on the schedule, check-ups every 3–4 days, suture removal after 10 days. Call if swelling, leakage from the wound, a drooping eyelid or lip on the operated side, head tilt or loss of balance appears.
Frequently asked questions
Will my dog be deaf after ablation?
A dog with end-stage chronic ear infection already hears very poorly with that ear. After the procedure, air-conducted hearing on that side is lost, but bone conduction remains. Most owners notice no difference, but they do see a dog free of pain.
Will an aural haematoma go away on its own?
The blood is gradually absorbed, but the ear usually shrinks and becomes deformed (“cauliflower ear”), and haematomas tend to return. Early surgery gives a better cosmetic result and less pain.
What are the risks of ablation?
The main ones are temporary or permanent paralysis of the facial nerve (a drooping lip, inability to blink) and wound infection. The surgeon's experience and thorough cleaning of the tympanic bulla limit this risk; we discuss it in detail before the procedure.
Can a polyp in a cat come back?
After removal of the polyp alone through the canal, recurrences do occur. Opening the tympanic bulla and removing the base of the polyp reduces the risk of recurrence.
We manage every case individually. The scope, indications and course described above are indicative; we agree the exact diagnostic and treatment plan during the consultation. This content is for information only and does not replace a veterinary consultation.
Questions about ear surgery?
Call us or book a consultation. We will set out the diagnostic and treatment plan in writing, before you decide.