16. Surgery of the Ear

inflammation of the vertical or horizontal ear canal or both

define otitis externa

inflammation of the tympanic cavity and membrane

define otitis media

inflammation of the inner ear that typically causes vestibular disease in dogs

otitis interna

extension of infection into the petrosal bone from otitis media

otitis interna is typically caused by....

age-related hearing loss

define presbycusis

diminished hearing

what can total ear canal ablation (TECA) result in which should be mentioned to the owners to understand their expectations for the procedure

reduces owner dissatisfaction associated with any perceived hearing loss after sx.

why should we be sure the owner is aware of the dog's hearing deficits before sx.

painful

ear disease and the surgical interventions that we use to treat them are _____

should be fully integrated into every phase of diagnosis, treatment, and recovery

in terms of pain management during ear procedures...

CRI delivery catheter kit for local anesthetic postoperative

what is shown here

find a pain scale that the staff can utilize quickly, easily, and consistently

no pain scale is perfect so it is important for you to....

guide analgesic therapy not deny it

what is the role of a pain scale

provide timely and adequate pain management

in terms of analgesic therapy, it can be helpful to...

do not spend too much time convincing yourself a patient is in pain just treat early

in terms of pain scales...

sicker

____ patients may need additional pain monitoring

1. inner ear: membranous and bony labyrinth for hearing and balance

2. middle ear: tympanic cavity and auditory tube

3. external: auditory meatus and short canal

what are the three primary parts of the ear

tympanic membrane

what structure separates the middle and external ear canal

opening of horizontal canal into middle ear

what is the external acoustic meatus

divided into two parts by thin bony septum...will need to be perforated to drain the ear

significance of the feline tympanic cavity

vulnerable location leading to the facial nerves often being traumatized during sx. causing Horner's syndrome

significance of location of nerves within the tympanic cavity

1. drooping of the eyelid on affected side-ptosis

2. pupil of affected eye will be constricted/miosis

3. affected eye appears sunken-enophthalmos

4. prominent third eyelid

most common C/s of Horner's Syndrome

1. diminished palpebral reflex

2. widened palpebral fissure

3. drooping of the ear and lip

4. excessive drooling

5. blepharospasm

6. elevation and wrinkling of the lip

7. caudal displacement of the labial commissure

8. elevation of the ear on the affected side

most common C/s of facial nerve paralysis

very common to happen but typically resolves within weeks-months

prognosis of facial nerve paralysis and horner syndrome in TECA-LBO

1. minimal hyperplasia of the ear canal epithelium

2. small neoplastic lesions of the lateral aspect of the vertical canal

indications for lateral ear canal resection

low

owner satisfaction for lateral ear canal resection in chronic otitis externa dogs is often ___

zep procedure (lateral ear canal resection) used to restrict hair growth at horizontal canal opening when there are small cancers found early on

what procedure is shown here and when is it typically used

it is not a cure and medical management will be needed for the remainder of the animals life

when doing a lateral ear canal resection, it is important for the owner to understand that....

entire vertical canal is diseased but the horizontal canal is normal

when might the vertical ear canal ablation be performed

1. neoplasia is confined to vertical canal

2. some animals with chronic otitis externa

when might the vertical ear canal ablation be the technique of choice

vertical ear canal ablation

does a vertical or lateral ear canal resection provide better cosmetic appearance

if you do not remove the avenue for drainage of exudative material by performing a TECA without treating otitis media...it is disastrous

why must a bulla osteotomy (LBO) always be performed in conjunction with a TECA for otitis externa and media

potential for serious complications due to nerve locations and vessels

why should TECA-LBO not be performed on animals with mild disease or by surgeons unfamiliar with ear anatomy

modified TECA-LBO in a cat

what procedure is shown here

lateral bulla osteotomy

what procedure is shown here

ideal when middle ear neoplasia is suspected in cats w/ nasopharyngeal polyps...allow both bullae to be opened without repositioning the animal

significance of a ventral bulla osteotomy

1. excessive swelling can impair respiration

2. need to note presence of abnormalities prior to sx. to avoid them being considered as surgical complications

3. Horner's syndrome and facial n. paralysis common in cats but typically transitory

in terms of complications associated with ventral bulla osteotomy

1. superficial wound infection

2. facial nerve paralysis

3. vestibular dysfunction

4. deafness

5. avascular necrosis of the skin of the pinna

6. chronic fistulations or abscessation

7. intraoperative arterial hemorrhage which may be life threatening

complications associated with TECA-LBO

1. usually resolves within a few weeks of sx

2. reported in 56% of cats aft TECA

3. permanent in approximately 1/4 of cats aft TECA

stats associated with facial nerve paralysis

aural hematoma-collection of blood in cartilage plate of the ear secondary typically to shaking and scratching

what condition is shown here

otodectes cynotis

aural hematomas in cats are usually secondary to....

underlying disease must be ID and tx.

how do we reduce likelihood of aural hematoma recurrence

1. incision tissue overlying the hematoma

2. evacuating blood clots and fibrin

3. holding cartilage in apposition until scar tissue can form

most common tx. of aural hematomas

placement of drain or cannula to provide drainage for several weeks during healing

what is an alternative method for sx. tx. of aural hematoma...though not really ideal unless owners can keep up with it

1. sutures placed vertically and offset to maintain blood supply-->parallel to major vessles

2. excision left open to drain for up to 3wks...do NOT suture incision closed

3. "s" shape incision on concave surface of ear from end-to-end of the hematoma

4. leave no pockets to collect fluid

5. do NOT ligate visible branches of great auricular aa.

characteristics of aural hematoma tx.

suture placement for repair of pinna lacerations

what is shown here

bandaging the ear after a surgical procedure

what procedure is shown here

aural hematoma pad placement

what procedure is shown here

1. uncommon in dogs and cats...but more aggressive in cats

2. benign or malignant

3. most common are from ceruminous glands

4. often associated with otitis externa, media, interna

neoplasia of the pinna and external ear canal...

malignant vs. benign neoplasia of the pinna and external ear canal

what is shown here

achieving wide margins to prevent local recurrence

what is the most important aspect of sx. of ear neoplasms

adjunctive therapy like radiation should be considered

if aggressive sx. therapy of ear neoplasms cannot provide clean margins...

cosmetic defects due to wide margins of normal tissue

what should owners be warned of prior to excision of malignant ear tumors

stopped on slide 78...anything beyond this was not on the objectives