Aural Surgery

T/F pinna ulceration is painful?

True

What are causes of pinna ulceration?

Squamous cell carcinoma

Infectious / parasitic

Inflammatory

T/F pinnal masses are painful?

False

What are some ddx for pinnal masses?

Aural hematoma

SCC

Hemangioma/sarcoma

Mast cell tumor

Histiocytomas

Sebaceous adenomas

Infection

What infection can cause a pinnal mass?

Mycobacterium

What are the goals of treating an aural hematoma?

Remove clot

Prevent clot recurrence

Preserve natural shape of ear

Treat underlying cause

How do you conservatively treat aural hematomas?

Needle aspiration and a bandage for 2 weeks

Intra-lesional or systemic corticosteroids helps prevent recurrence

What can be given to help prevent the recurrence of aural hematomas?

Intra-lesional or systemic corticosteroids

How do you use incisional drainage on an aural hematoma?

Classic technique with suture and stents with a laser

Fenestration of concave surface by suturing to the underlying cartilage

How do you suture a aural hematoma after incising?

Longitudinal NOT transverse

Why do you not suture transverse when fixing an aural hematoma?

You can cut off blood vessels

How do you use passive drainage to fix an aural hematoma?

Small incision

Closed suction drains

Teat cannula or penrose drain

What do you do post-op after draining an aural hematoma?

2-3 weeks of bandaging

What are complications of aural hematomas?

Recurrence

Devascularization of the pinna

Infection

Scarring

What side of the ear is easier to close after marginal excision?

Convex

What side of the ear can be left open after a marginal excision?

Concave

What can you do if you have a lesion near the center of the ear?

Marginal excision

Total pinnectomy

What are C/S of ear canal disease?

Visible mass

Head shaking

Otic discharge

Swelling at base of ear

Pain on eating or opening mouth

Neurologic signs

What are your ddx for ear canal disease?

Otitis externa or media

Foreign body

Parasites

Masses

Trauma

How do you diagnose ear canal disease?

Otoscopy/cytology

Can do radiographs, CT, or MRI if needed

What animal gets otitis externa the most?

Dogs

What is otitis externa secondary to?

Atopic dermatitis or food allergy

What is a sequelae to otitis externa?

Otitis media

What is the first way to deal with otitis externa?

Medical management

When is otitis surgical?

Stenosis of canal

Irreversible disease of canal epithelium

Refractory to medical management

Par-aural abscess development

Neurologic signs

What species gets inflammatory ear canal polyps?

Cats

What species get ceruminous gland adenocarcionma/adenoma?

Dogs and cats

What are the common ear canal masses?

Inflammatory polyps

Ceruminous gland adenocarcinoma/adenoma

SCC

Sabaceous adenocarcinoma

What is a lateral wall resection?

Remove lateral wall of ear to get better access to horizontal canal to administer medications

What is a vertical canal ablation?

Removal of entire vertical canal only if disease is localized to vertical canal ablation

What is the surgical techniques for masses in the ear or severe otitis?

Total ear canal ablation/lateral bulla osteotomy

What are some complications of a total ear canal ablation/lateral bulla osteotomy?

Neurologic dz

Dehiscence

Ear carriage

Draining tract

Persistent otitis

What neurologic disease can be caused by a total ear canal ablation/lateral bulla osteotomy?

Horners

Facial nerve paralysis

Deafness

Vestibular disease

What are inflammatory polyps?

Masses in the middle ear that can extend to external ear or nasopharynx that are only seen in cats

How do you treat inflammatory polyps?

Traction technique

Ventral bulla osteotomy

When do you use the traction technique for inflammatory polyps?

Nasopharyngeal polyps and aural polyps

When do you use a ventral bulla osteotomy for inflammatory polyps?

Disease originating in middle ear