Aural surgery Flashcards
Main Surgical Diseases
- Aural Hematoma
- Surgery of the Pinna
- Feline Inflammatory Polyps
- Otitis
Aural Hematoma cuase
- Violent head shaking or scratching
- Usually due to otitis externa
- Cartilage fractures
- Branches of the great auricular artery rupture and create a hematoma within the cartilage
Aural Hematoma treatment optoins
Needle Drainage
vs Surgical Tx
Surgery of the Pinna can involve what structures
Can involve skin on concave, convex side or cartilage or all three
Pinnal neoplasias that could require surgery:
▸ Actinic keratoses➝Dysplasia➝Squamous
cell carcinoma
▸ Hemangiosarcoma
▸ Mast cell tumor
▸ Basal cell carcinoma
▸ Histiocytomas
Otitis Externa
- inflammation of the vertical and horizontal ear canal
Otitis Media
- inflammation of the tympanic cavity and membrane
Otitis Interna
- inflammation of the inner ear; caused by extension of infection into the petrosal bone from otitis media
Otitis Externa - Treatment
Medical Management
* Underlying cause?
* Cleaning/flushing the ear
* Drying agents
* Topical medications
Surgical Management
* When Medical Management Fails
* Cases with neoplastic cause or stenotic canals
* Need to evaluate for concurrent Otitis Media
Otitis Media and Interna
- cause in dogs and cats
Dogs:
Extension of Otitis Externa
Bacterial infection
()
Cats:
Extension of Otitis Externa Nasopharyngeal Polyp
Otitis Interna - History/Clinical Signs
- Similar to Otitis Media
- Peripheral Vestibular Disease
> Head Tilt
> Circling/Rolling/Falling to one side
> Nystagmus (Fast phase away from lesion)
Otitis Media and Interna - Treatment options
medical or surgery
Otitis Media and Interna - Medical Treatment
- Underlying cause?
- Remove infected tissue/exudate
- Myringotomy?
- Systemic Antibiotics
Most cases will require surgery
Otitis Media and Interna - surgical Treatment
- Bulla osteotomy (with total ear canal ablation in dogs / ventral bulla osteotomy cats)
- Remove affected tissue
- Culture
- Antibiotics
Lateral Ear Canal Resection purpose
- Increased drainage and ventilation
- Facilitates administration of topical agents
Lateral Ear Canal Resection indications? contraindications? owner satisfaction?
Indications:
- Minimal hyperplasia
- Small neoplastic lesion on lateral canal
Contraindications:
- Otitis Media
Owner satisfaction is low
Vertical Canal Ablation indications? contraindications?
Indications:
- Vertical canal diseased, horizontal canal is normal (rare)
- Benign tumor of vertical canal
Contraindications:
- Otitis Media
BOTH, lateral and vertical canal ablations will fail if …
if the underlying dermatologic disease is not addressed
Total Ear Canal Ablation (TECA) and Lateral Bulla Osteotomy (BO) indications
(TECA-BO)
- Severe end-stage otitis externa
- Cockers!!
- Neoplasia confined to the external canal
(TECA-BO) Post-operative Care
- Multimodal analgesia required!
- +/- Head bandage
- Eye lubricants
- Empirical antimicrobial therapy
- Monitor airway
TECA-BO Complications
Facial Nerve Paralysis
Horner’s Syndrome
Incisional infection
Chronic draining tract – etiology??
Nasopharyngeal Polyps in Cats - what is it, what can it cause?
- Benign mass of the nasopharynx, auditory tube and/or tympanic cavity
- Cause of otitis media in cats
- Pedunculated, smooth, shiny pink mass
Nasopharyngeal Polyps in Cats - locations
1) Behind soft palate
2) Protruding from ear canal
Nasopharyngeal Polyps in Cats cause?
Cause unknown – Infectious?? vs Congential??
Nasopharyngeal Polyps in Cats
- signalment
- history
- PE
Signalment:
- <2years of age most commonly
History:
- Upper respiratory obstruction (Stertor)
- Dysphagia/Gagging
- Signs of otitis externa/media
PE:
- Mass in ear canal or dorsal to soft palate
Conservative Management of Nasopharyngeal polyps? recurrence rate?
Traction + prednisolone: 10% recurrence
Conservative Management of external ear polyps? recurrence?
Traction + prednisolone: 50% recurrence
Ventral Bulla Osteotomy (VBO) should be considered for polyps when:
Neurologic signs
High risk of recurrence (Aural location?)
Recurrent case!!
Recurrence with VBO is <2%
VBO Complications
Horners syndrome!
– Most cases resolve but can be permanent
