Surgical Conditions of the Ear

Question 1

What conditions can affect the pinnae?

Answer 1

Trauma - lacerations
Aural haematoma
Neoplasia (sun exposure)

Question 2

Who is most at risk of developing neoplasia of the pinnae?

Answer 2

White fur
Hairless
Unpigmented skin

Question 3

What is otitis externa?

Answer 3

Condition affecting the external ear canal
Primarily dermatological disease
Most common infection in dogs - easiest to treat

Question 4

What are some causes of otitis externa?

Answer 4

Immune-mediated (allergic - pollens/moulds)
Parasitic infections, inflammation - e.g. ear mites
Poor aeration - floppy ears, mechanical obstruction (hairs/foreign body), neoplasia limiting aeration, chronic inflammatory changes (calcification/thickening)
Secondary to middle ear problems in cats

Question 5

What types of neoplasia can affect the ear canal?

Answer 5

Squamous cell carcinoma - can metastasis/be multicentric
Ceruminous gland - adenoma (benign) / adenocarcinoma (malignant)
Melanoma - spreads quickly
Basal cell carcinoma - normally benign but can grow quickly

Question 6

What middle ear diseases can dogs get?

Answer 6

Bacterial otitis media - chronic otitis externa
Tympanic membrane trauma allowing bacterial infection
Rarely tumours

Question 7

What middle ear diseases can cats get?

Answer 7

Otitis media without otitis externa
Neoplasia - rare
Polyps - pharyngeal/EE canal, common

Question 8

How can polyps in cats present?

Answer 8

Only in bulla
Protruding through tympanic membrane causing concurrent otitis externa
Nasopharyngeal - growing from eustachian tube

Question 9

What considerations should we have for treating laceration of the pinnae?

Answer 9

Contamination - flush!

Cartilage takes longer to heal - poor blood supply

Question 10

How can we treat an auricular haematoma?

Answer 10

Prevent further accumulation and deformity
Allow fibrosis of skin to cartilage
Can resolve without treatment
Suction and drainage
Massage and flushing

Question 11

How can we treat a pinna neoplasia?

Answer 11

Consider size, site and histology

Pinnectomy - full removal essential for invasive tumours

Question 12

Describe a lateral wall resection.

Answer 12

Removal of secretory epithelium
Removal of lateral cartilage of the vertical canal
Increase drainage and ventilation
Medical management still required
Clip entire pinna and side of head
Flush ear to remove debris
Lateral recumbency, head elevated

Question 13

Describe a vertical canal ablation.

Answer 13

Excision of whole auricular cartilage and formation of stoma at the level of the horizontal canal
Disease affecting the entire vertical canal but not the horizontal canal
Neoplasia
Preparation as for lateral wall resection
Consider collecting histology samples - pot size!

Question 14

Describe a Total Ear Canal Ablation (TECA) and Lateral Bulla Osteotomy (LBO) (TECA-LBO).

Answer 14

Most common ear procedure in dogs
Treatment of chronic otitis externa unresponsive to medical treatment/trauma/neoplasia
Removal of all epithelial lining and vertical/horizontal canal cartilages
A salvage procedure

Question 15

How do we prep for a TECA-LBO?

Answer 15

Clip entire pinna - caudal border of eyelid to lateral side of neck
Prep entire pinna
Will need to support pinna during prep

Question 16

What are some possible complications of a TECA-LBO procedure?

Answer 16

Haemorrhage
Iatrogenic facial nerve injury
Vestibular problems
Trauma to deeper structures e.g. lingual/maxillary vessels, hypoglossal nerve
Facial nerve paralysis - self-limiting
Horner's syndrome - self-limiting
Infection (wound dehiscence)
Fistula formation
Cholesteatoma - keratinising epithelium

Question 17

Describe a ventral bulla osteotomy and its possible complications.

Answer 17

Reserved for cats with middle ear disease
Successful for treating middle ear polyps
Complications = Horner’s syndrome, vestibular disease, haemorrhage, infection