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CFT II > Exam 2 - Surgical Management of Ear Disease > Flashcards

Exam 2 - Surgical Management of Ear Disease Flashcards

1
Q

what are the important anatomic structures that make up the external ear?

A

pinna

auditory meatus

vertical canal

horizontal canal

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2
Q

where does the external ear terminate & the middle ear begins?

A

terminates the the level of the tympanic membrane

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3
Q

what are the important anatomic structures that make up the middle ear?

A

tympanic membrane

tympanic cavity within the bulla

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4
Q

where does the middle ear connect to the pharynx?

A

connects to the pharynx via the auditory tube

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5
Q

what are the major functions of the inner ear?

A

sound perception & balance

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6
Q

what are the important anatomic structures that make up the inner ear?

A

bony labyrinth

membranous labyrinth - vestibule, cochlea, & semicircular canals

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7
Q

in the cat, which compartment of the tympanic cavity is larger?

A

ventromedial compartment

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8
Q

what separates the tympanic cavity in cats?

A

bony septum - that is patent dorsally & has the sympathetic plexus more exposed

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9
Q

what is the importance of the dorsolateral compartment of the tympanic cavity in cats?

A

contains the ossicles & communicates with the tympanic membrane

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10
Q

where does the facial nerve lie in regards to the ear canals?

A

caudoventral to the canal at the level of the terminal horizontal canal

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11
Q

what is the main concern regarding vasculature around the ears of dogs & cats when considering surgery?

A

there are a lot of very large vessels in your surgical field

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12
Q

what are the 2 broad categories that indicate the need for ear surgery in companion animals?

A
  1. primary disease - either space occupying lesions or trauma
  2. secondary diseases - dermatological stuff
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13
Q

what is the most common neoplasia of the ear canal?

A

adenocarcinoma

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14
Q

what are some neoplasias that commonly occur on the pinna that are a primary disease?

A

SCC, mast cell tumors

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15
Q

what are some primary non-neoplastic growths that occur on the ears that require surgical intervention?

A

aural polyps & epithelial hyperplasia

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16
Q

what are some examples of how trauma indicates the need for surgical intervention regarding the ear?

A

pinna lacerations

separation of the vertical & horizontal ear canals

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17
Q

for otitis externa/media, when should you consider the need for surgery for correcting this secondary disease?

A

ear canal is calcified

ear canal is too stenotic to medicate

patient will not tolerate medications

poor client compliance

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18
Q

T/F: after surgical correction for otitis externa/media, you still need to address the underlying cause of disease

A

true

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19
Q

what is the minimum database for working up a patient for ear surgery?

A

otoscopic exam

advanced imaging - especially with neoplasia, CT

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20
Q

what is another name for the Zepp procedure?

A

lateral ear canal resection

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21
Q

when should you not do a lateral ear canal resection surgery?

A

in cases where the horizontal ear canal is obstructed!!!

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22
Q

T/F: there is an 86% unacceptable outcome in a lateral ear canal resection surgery in cocker spaniels

A

true

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23
Q

why is success variable in lateral ear canal resection surgeries?

A

lifelong medications are still necessary in most cases - need to educate owners on this

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24
Q

what is the purpose of a lateral ear canal resection procedure? what must be addressed?

A

aids in the managemnet of mild cases of non-proliferative otitis externa

facilitates cleaning & medicine application, increases ventilation

must address otitis media!!!!

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25
the picture shows the approach used for what procedure?
lateral ear canal resection
26
when is a vertical ear canal resection used? what is the advantage of this compared to TECA?
used when the vertical canal is DISEASED but the horizontal canal is NORMAL preservation of anatomy!!!
27
what are the specific indications for a vertical ear canal resection?
neoplasia of the vertical canal ONLY - rare (think about margins) traumatic separation of the vertical & horizontal ear canal!!!
28
the picture shows the approach used for what procedure?
vertical ear canal resection
29
what procedure is required alongside a TECA? why?
concurrent bulla osteotomy - need to remove exudate & secretory epithelium
30
what are the indications for performing a TECA-LBA?
irreversible chronic otitis - with calcification of the ear canal & epithelial hyperplasia neoplasia owner or patient compliance issues
31
what does TECA-LBO stand for?
total ear canal ablation & lateral bulla osteotomy
32
the picture shows the approach used for what procedure?
TECA-LBO
33
T/F: in a TECA-LBO surgery, you should always submit the ear canal for histopathology once it is removed
true
34
what must you do with the cuff of tissue around the osseous meatus when doing a TECA-LBO surgery? why?
remove the cuff of tissue - risk of causing a draining tract
35
what should you avoid doing around the tympanic cavity when doing a TECA-LBO surgery?
avoid aggressive curettage of the dorsal & medial aspect of the tympanic cavity
36
what should you do prior to closure of a TECA-LBO surgery?
lavage the site thoroughly & then obtain a culture of the surgical site
37
if a drain is placed after a TECA-LBO surgery, how long is it left in? what is very important to do alongside drain placement?
3-5 days (penrose) - bandaging!!!
38
T/F: there is no significant difference in complications following TECA-LBO surgeries with primary closure vs. drain placement
true
39
what happens if you bandage a dog too tight after TECA-LBO surgery?
they can't breath
40
is this correct for bandaging? why?
yes - doesn't close off the ear
41
what are the indications for ventral bullae osteotomies?
indicated for middle ear disease - inflammatory polyps in cats & otitis media with mild otitis externa issues
42
what is the difference between a nasopharyngeal polyps & aural polyps?
nasopharyngeal - originate at the auditory tube & passively grow into the nasopharynx or nose aural - extend from the middle ear through the tympanic membrane into the ear canal
43
what is the etiology for inflammatory polyps in cats?
not too sure - we think chronic inflammation/viral causes
44
what is the common signalment of cats affected by inflammatory polyps?
young cats - 1.5-3 years old
45
what type of exam should you always do if you think a young cat may have an inflammatory polyp? why?
pharyngeal exam - may be hiding behind the soft palate
46
what are the clinical signs of nasopharyngeal inflammatory polyps in cats?
stertorous breathing, upper airway obstruction, & nasal discharge
47
what are the clinical signs of aural inflammatory polyps in cats?
otitis externa/media/interna signs (discharge from ear, painful ear, head tilt, nystagmus, horner's syndrome)
48
why will you never do a bilateral vertical bulla osteotomy in a cat with aural inflammatory polyps?
significant risk for airway obstruction & death!!!!!!!
49
what treatment is used for nasopharyngeal inflammatory polyps in cats?
traction removal followed by prednisolone for 2-4 weeks - 33-57% recurrence rate
50
what treatment is used for aural inflammatory polyps in cats?
traction assisted by video endoscopy - recurrence 13.5% vertical bulla osteotomy for surgical correction - 0-33% recurrence
51
what should you consider when choosing a surgery for ear disease?
1. overall systemic health - consider a biopsy if cancer is a concern 2. owner compliance & goals - communication & education 3. consider advanced imaging & know what you're getting yourself into
52
what is the surgical approach used for a ventral bulla osteotomy?
cat is placed in dorsal recumbency with cervical support to extend the neck to maximize surgical access skin incision is made over the ventral aspect of the bulla & dissection of muscles is done, mandibular salivary gland & bifurcation of the linguofacial & maxillary veins are retracted from the surgical field - avoid manipulation of the hypoglossal nerve which is close to the lingual artery after the bulla is located, the periosteal covering is stripped & osteotomy is done with removal of mucus & dismantling of the bony septum separating the two compartments of the tympanic cavity of the cat & the polyp is removed & any residual debris is removed with gentle irrigation
53
how is antimicrobial therapy used for surgical correction of ear diseases?
empirical treatment to start until you get culture results for at least 4 weeks!!!! large variation of isolates between external ear & middle ear - need to base choice off of culture & sensitivity
54
T/F: otitis media impairs hearing without surgery
true
55
clients usually are concerned about their pet's ability to hear after ear surgery - how do you respond to this?
otitis media impairs hearing without surgery TECA-LBO surgery dogs still respond to loud and/or high pitched voices/noises cats can still hear after VBO bottom line - if the disease is already severe, owners are unlikely to notice a difference
56
how is incisional dehiscence +/- infection treated as a complication following ear surgery?
need to treat the underlying disease - often leave it open to granulate
57
how are draining tracts treated as a complication following ear surgery?
these can occur up to several months after surgery due to the incomplete removal of secretory epithelium & debris which causes the formation of a fistula! go back in & get it out
58
T/F: nerve damage as a complication of ear surgery is not always permanent
true
59
what are some signs of facial nerve damage following ear surgery?
damage in up to 40% of dogs & 60% of cats loss of palpebral reflex & lip droop
60
what are the signs of horner's in cats? what causes this following ear surgery?
damage to the sympathetic trunk during surgery - way more common in cats, up to 42% miosis, ptosis, enophthalmos, & protrusion of the 3rd eyelid
61
why is a pre-op exam before surgery important to perform in regards to nerve damage?
pre-existing nerve dysfunction is unlikely to resolve after surgery - need to see if it is present to start with
62
what are signs of damage to the cochlea/semicircular canals following ear surgery?
vestibular signs - nystagmus, ataxia, circling, head tilt
63
what animals have a higher risk of airway obstruction during ear surgery? what do you do if there is bilateral disease present?
cats & brachycephalic dogs!!!! need to stage sides in at risk animals
64
what animals are at risk of the collapse of the ear carriage following ear surgery?
cats & dogs with erect ears
65
what complication are you concerned about following lateral or vertical resection of the ear canals?
collapse of remaining external ear canal or stenosis of the opening created (lateral & vertical resection)
66
T/F: after a lateral ear canal resection, medical therapy is done
false
67
should you perform lateral ear canal resections if the vertical & horizontal canals are significantly affected by disease?
NOPE
68
these animals are displaying neurological signs after ear surgery - what is this condition called? why is it happening?
horner's syndrome - damage occurred on the sympathetic trunk

CFT II (28 decks)

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