Ear

Question 1

Blood supply to the pinna?

Answer 1

Cranial and caudal auricular artery/vein

Question 2

What causes a articular hematoma?

Answer 2

Physical injury
-head shaking, scratchy

Immune mediated or inflammatory

Leading to hemorrhage from the great articular artery within the cartilage plate

Question 3

What will happen in an aural hematoma is left untreated?

Answer 3

Forms fibrin depots is resulting in a thickened, deformed ear

“Cauliflower” contracture

Question 4

What are the conservative methods of management for an auricular hematoma?

Answer 4

Oral prednisolone +/- aspiration
-for small fluctuations hematoma

Needle aspiration and instillation of corticosteroid

Indwelling drains
- recent, flu taint hematomas that can be completely evacuated

Question 5

How do you place an indwelling drain for an aural hematoma?

Answer 5

At the distal end of ear, place —> Evacuate and flush with sterile saline to removed fiberous material

Larson teat tube
Place drain tube.
Leave in until cavity heals except for drain tract (2-3weeks)

Question 6

What is the prognosis for using conservative methods to treat an aural hematoma?

Answer 6

Oral pred — good response but recurrence rate unknown

Aspiration and instillation of corticosteroid
— good prog, may need more than one treatment

Larson teat tube and indwelling drains — recurrence of hematoma common if removed too soon

Question 7

What are the surgical treatments for aural hematoma?

Answer 7

Incision - straight or S-shaped

Dermal punch — create fenestrations on concave side of ear

Laser fenestrations — provide multiple sites for drainage avoiding suture placement

Question 8

When doing a surgical incision you cut on the __________ surface of the ear.

How would you place sutures following?

Answer 8

Concave

Sutures must be oriented parallel to the long axis of the pinna or you will compromise blood supply

Question 9

What are the advantages and disadvantages to suturing through the cartilage layer when repairing an ear laceration?

Answer 9

Advantages — more support and better alignment

Disadvantages — may get thickening around suture

Question 10

When is partial amputation of the pinna indicated?

Answer 10

Avulsion of portion of pinna

Ear fissures

Ear tip dermatitis

Acticic (solar dermatitis)

Cold/frostbit

Neoplasia

Question 11

What surgical method can help treat otitis externa?

Answer 11

Lateral ear canal resection

Question 12

What cases are appropriate for lateral ear canal resection?

Answer 12

Ear must be anatomically normal or will be normal with treatment

NOT for cockers

Shar pei, chow, and bulldogs have narrow canals but do well with this surgery

Question 13

How is a lateral ear canal resection done?

Answer 13

From the base of the ear - the tissue overlaying ear canal is elevated (flap)

The vertical canal is incised to level of horizontal ear canal opening

Remaining flaps are sutured over opening

Question 14

What is the most common cause of failure for lateral ear canal resection?

Answer 14

Inappropriate case selection

Question 15

What are the indications for vertical ear canal ablation?

Answer 15

Otitis externa

Neoplasia affecting the vertical canal —> benign masses or malignant masses that can be excised with adequate margins

—vertical canal is affected but horizontal canal is normal (rare)

Question 16

What nerve and gland are you working in close proximity to when doing a vertical ear canal ablation?

Answer 16

Facial nerve

Parotid gland

Question 17

What procedure is indicated in end stage ears with calcification ?

Answer 17

Total ear canal ablation with lateral bulla osteotomy (TECA- BO)

Watch out for facial nerve!

Question 18

What are complications to a TECA- BO?

Answer 18

Facial nerve paralysis

Vestibular signs- usually transient

Hearing — decreased transmission of sound down ear canal and filling of fiberous tissue

Wound infection

Chronic draining tract — usually due to incomplete removal of external ear canal epithelium

Question 19

What are diseases of the middle ear?

Answer 19

Otitis media
Cholesteatoma
Nasopharyngeal polyps
Neoplasia

Question 20

What are the surgical treatments for middle ear diseases?

Answer 20

Myringotomy

Bulla osteotomy

• ventral (confined to middle ear)
• lateral (conjunction with TECA)

Question 21

Where do feline inflammatory polyps arise from?

Answer 21

Middle ear or auditory tube

Most cats have nasopharyngeal polyps

Question 22

Signalment for nasopharyngeal polyps?

Answer 22

Young— mean age around 2 yrs

DSH

Question 23

Clinical signs associated with nasopharyngeal polymers?

Answer 23

Stertor 
Nasal discharge 
Sneezing 
Voice change 
Dyspnea 
Dysphagia

Question 24

What are the clinical signs associated with ear canal polyps?

Answer 24

Otorrhea
Head shaking
Mass in ear canal

Otitis media or interna —> vestibular

Question 25

Treatment for feline inflammatory polyps??

Answer 25

Traction— avulsion

Per-endodontic trans-tympanic traction

Ventral bulla osteotomy
—significant middle ear disease
—failed traction-avulsion

Question 26

What are the recurrence rates for feline inflammatory polyps?

Answer 26

50% recurrence with traction alone

Improved with corticosteroids postop

Bulla osteotomy allows more complete resection of tissue and has low recurrence rate

Question 27

Indications for ventral bulla osteotomy?

Answer 27

Chronic, recurrent, recalcitrant otitis media

Inflammatory polyps

Cholesteatoma

Neoplasia

Question 28

What nerves and arteries do you approach when doing ventral bulla osteotomy?

Answer 28

Hypoglossal nerve

Lingual artery and linguofacial vein

Question 29

What are complications for ventral bulla osteotomy?

Answer 29

Vestibular signs

Horners syndrome — more frequent in cats because sympathetic nerves run more superficially