In dogs with aural haematoma does draining and injecting corticosteroids versus drainage alone reduce the risk of recurrence?

PICO question In dogs with aural haematomas does draining and injecting corticosteroids versus drainage alone reduce the risk of recurrence?   Clinical bottom line Category of research question Treatment The number and type of study designs reviewed Three papers were critically reviewed, a retrospective multi-centre cohort study, a randomised case control trial and an observational survey Strength of evidence Weak Outcomes reported Drainage alone at daily or weekly frequency consistently resulted in aural haematoma (AH) recurrence and lack of resolution. Corticosteroid instillation alongside drainage reduced the risk of rapid recurrence for AHs, across both the cohort and the case control studies, provided drainage was frequent Conclusion The strength of evidence for local steroid instillation was weak given the type of studies reviewed, alongside small sample sizes and variations in treatment protocol. However, consistently drainage alone appears an insufficient means of addressing AHs in dogs. In cases where frequent drainage was the chosen treatment option, the addition of local corticosteroid application appeared to improve the outcome compared to drainage alone. However, as systemic treatment was often employed alongside local corticosteroid instillation, success cannot necessarily be attributed solely to local treatment. Larger, randomised control trials would be required to assess the effect of each individual intervention providing clearer evidence for the most effective medical protocol for treating aural haematomas in dogs   How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.