Otic surgery Flashcards
What are the main indications for ear surgery?
- Trauma (mainly pinna but sometimes external ear canal)
- Aural haematoma
- Neoplasia (pinna, external ear canal, middle ear, etc.)
- Certain cases with chronic otitis externa
- Chronic otitis media
- Infection (extension of chronic otitis externa)
- Middle ear polyps
- Cholesteatoma
What is this condition? What surgical options have we got to resolve it? What complications are common?
Aural haematoma
Surgical options
* Surgical incision, drainage, and suture (most effective)
* Drainage with an indwelling drain (Penrose, tube, teat tube, etc.)
* Drainage and glucocorticoid instillation
* Closed-suction drainage
Complications
* Cosmetic alterations
* Recurrence of haematoma
* Pinna necrosis
What are the 2 surgical procedures of the external ear canal?
- lateral wall resection (LWR)
- vertical canal ablation (VCA)
When is a lateral wall resection indicated? What are important considerations when undertaking the procedure? What complications can occur following the surgery?
- Neoplasia of the lateral wall of the vertical canal
- Very rarely in the management of otitis media to facilitate flushing and drainage of the bulla
Important considerations
- LWR will fail if there are chronic, irreversible, hyperplastic changes to the luminal epithelium or if there is ongoing otic inflammation
- The procedure does not cure the animal of its underlying disease but improves the micro-environment of the ear
Complications
* Postoperative pain/discomfort
* Incisional dehiscence
* Persistent otitis externa
* Persistent, unrecognised otitis media
* Failure to provide adequate drainage of the horizontal canal
What complication has occured following a lateral wall resection?
Horizontal canal stenosis
When is a vertical canal ablation indicated? What complications can occur?
Indications
* Only rarely indicated
* Vertical canal only is diseased
* Neoplastic disease and polyps restricted to the vertical ear canal
Complications
- Postoperative pain/discomfort
* Incisional dehiscence
* Persistent otitis externa
* Persistent, unrecognised otitis media
* Stenosis of horizontal canal
What surgical management is available for chronic otitis externa/otitis media?
- Total ear canal ablation and lateral bulla osteotomy (LBO)
- Ventral bulla osteotomy (VBO)
What can chronic otitis external develop into?
Otitis media - gone through tympanic membrane and into the tympanic bulla
Why do chronic otitis externa cases need to be radiographed?
To checl for signs of otitis media - tympanic bulla changes
What imaging option is often used nowadays in chronic otitis externa cases?
CT
How does the cat ty,panic bulla differ from the dog bulla?
Larger lateral compartment & smaller medial compartment
When is a total ear canal ablation - bulla osteotomy indicated?
- Chronic, or recurrent, otitis externa associated with irreversible, hyperplastic changes in the luminal epithelium
- Failure of more conservative surgery to alleviate otitis externa or media
- Neoplasia of the external ear canal
- Otitis media
Why is a bulla osteotomy needwhen doing a complete ear canal ablation?
- To remove the remaining external ear canal and what is left of the tympnaic membrane
- Size of the bulla osteotomy is related to whether there is disease in the middle ear
What are possible complications of TECA BO?
- Postoperative pain/discomfort
- Deafness
- Incisional dehiscence
- Facial nerve paralysis
- Vestibular disturbances (circle to affected side)
- Haemorrhage
- Horner’s syndrome
- Recurrence/abscess formation
What are the classic features of Horner’s syndrome?
- Anisocoria with ipsilateral (affected side) miosis
- Ptosis of the upper eyelid
- Narrowing of the palpebral fissure
- Enophthalmos
- Protrusion of the third eyelid
When is a ventral bulla osteotomy indicated?
In cases with middle ear disease and the following circumstances
* Cases in which a TECA is not required
* Certain brachycephalic breeds of dog
* Often used in the cat
* anatomy of the bulla
* inflammatory polypoid disease in the absence of chronic otitis externa
What complications are common with VBO?
- Postoperative pain/discomfort
- Deafness
- Incisional dehiscence
- Facial nerve paralysis
- Vestibular disturbances
- Haemorrhage
- Horner’s syndrome - much more likely with this approach due to the high risk of dmamaging the ganglions to the eye as it is near the bulla
- Recurrence/abscess formation
What are cholesteatomas? How are they treated?
- Slowly enlarging, cystic lesions within the middle ear cavity
- Lined with stratified squamous epithelium and keratin squames
- Thought to arise when a pocket of the tympanic membrane comes into contact with, and adheres to, inflamed mucosa within the middle ear.
- Treatment – TECA BO or VBO
Where do inflammatory polyps occur in cats? How does it present? How is it treated?
Often emanate from tympanic bulla
* Nasopharyngeal
* Horizontal ear canal
Presents as otitis media
- mouth breathing, difficulty swallowing food if polyp has grown into the nasopharyngeal area
Treat:
* Push caudal direction into cranial oesophagus with forceps so you get stalk out of middle ear
* Do not forget to examine the ear canals in cases of nasopharyngeal polyps and the nasopharynx in cases of polyps in the external ear canal
What is primary secretory otitis media? How does it present? How is it treated?
- Cavalier King Charles spaniels
- Syringomyelia (Chiari-like malformation of the calvarium/caudal fossa)
- Commonly bilateral
- Affected dogs will have reduced hearing
- Bulging pars flaccida because of material in the middle ear
- Myringotomy + flushing of affected tympanic bulla
- May require multiple treatments because it can reform
