The Evidence-Based Veterinary Medicine Association (EBVMA) is continuing to try and support evidence-based medicine for veterinarians, and the latest activity in that effort is producing a series of brief, pragmatic literature reviews on common clinical problems and therapies. The first in the series is now available:
Aural Hematomas in Dogs. Prepared by Annette O’Connor, DV and Teresa Hershey, DVM. Sept., 2011
The review illustrates well the process of locating and evaluating the available evidence for a particular intervention. It found, as is all too often the case, that the evidence was not sufficient for a definitive conclusion to be made.
There are many ways that aural hematomas are treated in dogs. The articles reviewed examined hematoma drainage in combination with either oral or local injections of steroids and traditional surgical treatment. There was no evidence that adding steroids to treatment protocols reduced the number of dogs that needed to be retreated. The quality of the evidence was poor which limits any interpretation that may be made.
This is often the case in veterinary medicine, and even in human medicine. However, it is important to understand the true meaning of this outcome. It is not that any and all approaches to aural hematomas are equally likely to be useful. The application of magnets or color therapy, for example, is not justified by the fact that the evidence is not strong enough to clearly say whether or not adding a steroid to treatment improves outcomes. The fact that the evidence concerning a particular question is of limited quality and quantity means only that sweeping and definitive statements about the efficacy of particular treatments aren’t supported, not that anything anyone can dream up is reasonable.
The EBVMA is also beginning to collect other educational materials from members and make them available to the public and other veterinarians. The most recent additions include two excellent lectures by Bob Larson, a professor at the Kansas State University veterinary college.
Evidence-Based Medicine-An Introduction
Here’s my favorite slide:
Four Myths of Small Numbers and Other Biases
My favorite slide:
Hello Skeptvet, this is Daniel Whitton with Auralsplint.org. I look forward to publishing an extensive field trial study for the Auralsplint: Descriptive Report: Auralsplint Corrective Treatment for Aural Hematoma in Canine. The study has around 200 voluntary participants agreeing to use the auralsplint to attempt to heal an aural hematoma with criteria for use: hematoma present for less than 7 days without a hypodermic needle aspiration; hematoma present previously aspirated by hypodermic needle and on schedule for needle aspiration no longer than four day intervals. 50 returned surveys assembled from the participants will generate the results for the Report. Some participants and returned surveys are from cases where the criteria was overlooked as to provide control for the study as well as help for some participants with no other means for treatment for their animal either due to cost of treatments offered or health reasons not able to undergo anesthesia. I look forward to hearing back from you and your site to recognize the potential for alternative treatment for aural hematoma and the efficacy for the auralsplint in the veterinary marketplace.
Once the results are in and published, I look forward to reading the study and evaluating the results.
@ Skeptvet I returned to your site to find I have not responded. Sorry for the delay. The manuscript is still yet unpublished. I have however published the Abstract on my website Auralsplint.org. I hope you like what you read and request reviewing the manuscript. Continue the good work.
I have published the manuscript at Researchgate.com. Please read and evaluate and get back to me. Thank you. Also is a persuasive essay touting the advantages of splinting versus surgery. Interesting read.
Study Manuscript: Auralsplint Descriptive Report – DOI: 10.13140/RG.2.2.13717.55520
There is much I can say. As you acknowledge, this is just trial-and-error, not a scientific study, and there is no comparison to any other treatment or to a group not treated at all, so we can’t draw any conclusions about whether this method is better, worse, or equivalent to other methods. It is an interesting idea, though on a practical level I can see problems with applying the device and keeping it in place with a variety of ear confirmations and temperaments. It would be interesting to see if you could interest someone with the resources and expertise necessary to study this in a controlled manner.
there was a study in the days before the internet that they are seromas not hematomas. not sure if that matters or if everyone is on board. maybe a pathologist can comment.
found this in my files and thought someone might be interested in level of evidence for human treatment.
1: Cochrane Database Syst Rev. 2004(2):CD004166. Related Articles, Links
Interventions for acute auricular haematoma.
Jones SE, Mahendran S.
Department of Otolaryngology, Addenbrooke’s Hospital, Hill’s Road, Cambridge, Cambridgeshire, UK, CB2 2QQ.
BACKGROUND: Acute haematoma of the pinna is a condition where a collection of blood forms beneath the perichondrial layer of the pinna. It is usually caused by blunt trauma, and if untreated will ultimately result in a deformity commonly known as ‘cauliflower ear’ or ‘wrestler’s ear’. Various treatments are employed to relieve the haematoma but no clear consensus exists on the best way to do so in order to produce the best cosmetic result with the least permanent deformity. OBJECTIVES: To assess the effectiveness of treatment options in acute auricular haematoma. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library Issue 2, 2003), MEDLINE (1966 – 2003) and EMBASE (1966 – 2003) with pre-specified terms. The date of the last search was April 2003. SELECTION CRITERIA: Randomised controlled trials, case controlled trials and cohort studies including children and adults undergoing any intervention for acute auricular haematoma. DATA COLLECTION AND ANALYSIS: Fifty-nine references were identified from the searches. Forty-eight were retrieved and assessed for eligibility by the authors. None met the inclusion criteria. MAIN RESULTS: Due to the lack of data from trials fulfilling selection criteria no results could be presented. REVIEWERS’ CONCLUSIONS: There is no clearly defined best treatment for acute auricular haematoma. There are no good quality data to determine either the optimal management strategy or even whether post-drainage intervention (such as splinting or bandaging) is necessary. Further research is required before any specific treatment may be recommended.
There is no argument that the animal heals the hematoma using its own resources in its whole blood arsenal. Evidence of this is the healed, shriveled, mangled mess of ears not treated by any means. Using this as your control, treatments ranging from surgical open wounds to non-surgical medical splints can be useful in correcting the appearance of the healed ear. Now, the only matter is how much wounding needs to occur to assist the animal in its healing. I propose no wounding by using the splint. Surgical interventions appear to generate revenue more than healing, seeing as the whole blood is released (calling it discharge) from ear pinna during recovery and the recurrence rate is at or above 50%. These 2 facts alone should make everyone consider medical management splinting over surgical every time the need occurs.