Ear Flashcards
Blood supply to the pinna?
Cranial and caudal auricular artery/vein
What causes a articular hematoma?
Physical injury
-head shaking, scratchy
Immune mediated or inflammatory
Leading to hemorrhage from the great articular artery within the cartilage plate
What will happen in an aural hematoma is left untreated?
Forms fibrin depots is resulting in a thickened, deformed ear
“Cauliflower” contracture
What are the conservative methods of management for an auricular hematoma?
Oral prednisolone +/- aspiration
-for small fluctuations hematoma
Needle aspiration and instillation of corticosteroid
Indwelling drains
- recent, flu taint hematomas that can be completely evacuated
How do you place an indwelling drain for an aural hematoma?
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)
What is the prognosis for using conservative methods to treat an aural hematoma?
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
What are the surgical treatments for aural hematoma?
Incision - straight or S-shaped
Dermal punch — create fenestrations on concave side of ear
Laser fenestrations — provide multiple sites for drainage avoiding suture placement
When doing a surgical incision you cut on the __________ surface of the ear.
How would you place sutures following?
Concave
Sutures must be oriented parallel to the long axis of the pinna or you will compromise blood supply
What are the advantages and disadvantages to suturing through the cartilage layer when repairing an ear laceration?
Advantages — more support and better alignment
Disadvantages — may get thickening around suture
When is partial amputation of the pinna indicated?
Avulsion of portion of pinna
Ear fissures
Ear tip dermatitis
Acticic (solar dermatitis)
Cold/frostbit
Neoplasia
What surgical method can help treat otitis externa?
Lateral ear canal resection
What cases are appropriate for lateral ear canal resection?
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
How is a lateral ear canal resection done?
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
What is the most common cause of failure for lateral ear canal resection?
Inappropriate case selection
What are the indications for vertical ear canal ablation?
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)
What nerve and gland are you working in close proximity to when doing a vertical ear canal ablation?
Facial nerve
Parotid gland
What procedure is indicated in end stage ears with calcification ?
Total ear canal ablation with lateral bulla osteotomy (TECA- BO)
Watch out for facial nerve!
What are complications to a TECA- BO?
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
What are diseases of the middle ear?
Otitis media
Cholesteatoma
Nasopharyngeal polyps
Neoplasia
What are the surgical treatments for middle ear diseases?
Myringotomy
Bulla osteotomy
- ventral (confined to middle ear)
- lateral (conjunction with TECA)
Where do feline inflammatory polyps arise from?
Middle ear or auditory tube
Most cats have nasopharyngeal polyps
Signalment for nasopharyngeal polyps?
Young— mean age around 2 yrs
DSH
Clinical signs associated with nasopharyngeal polymers?
Stertor Nasal discharge Sneezing Voice change Dyspnea Dysphagia
What are the clinical signs associated with ear canal polyps?
Otorrhea
Head shaking
Mass in ear canal
Otitis media or interna —> vestibular
Treatment for feline inflammatory polyps??
Traction— avulsion
Per-endodontic trans-tympanic traction
Ventral bulla osteotomy
—significant middle ear disease
—failed traction-avulsion
What are the recurrence rates for feline inflammatory polyps?
50% recurrence with traction alone
Improved with corticosteroids postop
Bulla osteotomy allows more complete resection of tissue and has low recurrence rate
Indications for ventral bulla osteotomy?
Chronic, recurrent, recalcitrant otitis media
Inflammatory polyps
Cholesteatoma
Neoplasia
What nerves and arteries do you approach when doing ventral bulla osteotomy?
Hypoglossal nerve
Lingual artery and linguofacial vein
What are complications for ventral bulla osteotomy?
Vestibular signs
Horners syndrome — more frequent in cats because sympathetic nerves run more superficially
