Ear surgery Flashcards
What conditions affect the pinna of the ear?
Haematoma
trauma-lacerations
Vascuilitis
neoplasia
What conditions affect the otitis externa?
Primarily dermatological disease in dogs immune mediated parasite inciting inflammation poor aeration secondary to middle ear problems (cats)
What types of neoplasia can affect the ear?
squarmous cell carnioma
Ceriuminous gland adenoma
melanoma
Basal cell carcinoma
What conditions affect the middle ear?
bacterial otitis media mechanical perforation of the tympanic membrane tumours (rare) cats inflammatory polyps
What is the most common mass found within the ear in cats?
Inflammatory polyps (pharyngeal and external ear canal)
Three main presentations
In the bulla
protruding through tympanic membrane
Nasopharyngeal growing from the eustachain tube
What is the typical presentation of polyps?
Cats
less than 3 years
URT (pharyngeal)
Neuro (if middle ear involved, horners, head tilt)
OE signs if poly protrudes through tympanic membrane
What are the surgical treatment options for auricular haemotoma?
Prevent further fluid accumulation and allow fibrosis of the cartilage surface to the overlying skin closed suction drain penrose drain open drainage with mattress sutures punch biopsy perforation treat underlying cause of self trauma
How may a pinna neoplasia be surgically treated?
Pinnectomy
those at the base of the pinna
Ventral canal ablalation
Total Ear Canal Albation
What is LWR in surgical ear treatment and what does it do?
Lateral wall resection
vertical canal alone
removal of the secretory epithelium and lateral cartilage of the vertical canal
What are the complications of LWR?
Wound dehisence
insufficient drainage
failure to treat concurrent otits media
What is a VCA what does it do?
Ventral canal ablation
excision of the whole auricular cartilage and formation of a stoma at the level of the horizontal canal
retains hearing fuction
Complications of the VCA
Dehiscence
infection
narrow drainage
unprepared imaging, horizontal ear canal involvement
What is a TECA and LBO?
Total Ear Canal Ablation and Lateral Bulla Osteotomy
removal of all the epithelium lining and vertical and horizontal canal cartilages
permanently affects the hearing
What are the complications with TECA-LBO?
Wound dehiscence infection small drainage hole Horners syndrome cosmetic
When is a TECA-LBO preformed?
Non responsive to medical management chronic otitis externa
What must you consider during the post-operative care of a TECA patient?
Analgesia
(opiates, local wound infiltration, NSAID)
Antibiotics
What are the intra-operative complications of a TECA?
Haemorrhage
Iatrogenic facial nerve injury
Trauma to local tissues
(linguinal/maxillary vessles, hypoglossal nerve)
What are the post-operative complications of a TECA?
Infection Fistula formation Facial nerve paralysis Horners syndrome Vestibular disease
What is a VBO?
Ventral bulla osteotomy
usually just for cats middle ear disease
Pots-operative corticosteriods have reduced re-occurrence rates
What is a Cholesteatoma?
Epidermoid cyst expansile lesion of the middle ear locally destructive non-neoplastic can be primary most commonly secondary to TECA-LBO erodes bone structures
What are the symptoms of a Cholesteatoma
Similar to sings of OE/OM head tilt scratching pain opening mouth discharge from aural and sinus tracts facial palsy ataxia Nystamgus draining tracts
What are the treatment options for a Cholesteatoma?
wide surgical resection
remove all abnormal tissue
antibiotics long term
neurological factors and bone lysis poor prognisitc factors
What is Primary secretory otits media?
CKC have fluid in their middle ear
Glue ear
How is primary secretory otits media treated?
Gromitt placement to allow drainage
TECA-LBO (not treating the cause)
What is a subtotal TECA?
Modification of the TECA technique to preserve most of the proximal portion of external ear canal
What are the causes of a para-aural abscess/fistula?
inadequate debridement of the middle ear
failure to remove all of the ear canal cartilage
osteomyelitits
parotid gland damage
cholesteatoma
What are the symptoms of a para-aural abscess?
Head tilt Pain on opening of the mouth pain around head lethargy swelling/drainage over surgical site 3 to 9 months post-op
What is the differential diagnosis of an para-aural abscess?
Migrating foreign body
neoplasm
How is a para-aural abscess treated?
antibiotic therapy
Surgical
lateral approach
or ventral approach
What are the complications associated with para-aural abscess surgical treatment?
facial nerve paralysis
otits interna
head tilt
What are the indications for the Ventral bulla osteotomy in the dog?
Diseases limited to the bulla
recurrance of choleastoma
