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JJ > Surgical Conditions of The Ear > Flashcards

Surgical Conditions of The Ear Flashcards

1
Q

what are the main conditions affecting the pinnae?

A

trauma - lacerations
aural haematoma
neoplasia

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2
Q

what causes aural haematoma?

A

head shaking causing bleeding between the skin of the ear and the cartilage

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3
Q

when does aural haematoma arise?

A

usually secondary to other conditions which are causing the dog to shake it’s head

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4
Q

what are the 2 main types of neoplasia seen on the pinna?

A

squamous cell carcinoma

melanoma

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5
Q

what animals are more prone to neoplasia of the pinna?

A

white haired
hairless
unpigmented skin

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6
Q

what can be used to protect at risk skin on the pinna from neoplasia?

A

high factor childs sun cream

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7
Q

what makes up the external ear canal?

A

vertical and horizontal canals

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8
Q

what is otitis externa?

A

dermatological disease affecting the ear

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9
Q

what is the most common infection in dogs?

A

otitis externa

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10
Q

what are the main causes of otitis externa?

A

immune mediated (allergic)
parasitic infection
poor aeration due to conformation
seconday to middle ear infection (cats)

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11
Q

what is the name of the ear mite of dogs, cats, rabbits and ferrets?

A

otodectes cynotis

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12
Q

how can poor aeration of the ears be caused and lead to otitis externa?

A

floppy ears
mechanical obstruction (hair/FB)
neoplasia
chronic inflammatory changes due to previous otitis externa leading to calcification and thickening

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13
Q

when is otitis externa seen in cats?

A

secondary to middle ear problems

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14
Q

what is the most common condition of the ears in cats?

A

middle ear issues

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15
Q

what are the main types of neoplasia which affect the ear canals?

A

squamous cell carcinoma
melanoma
basal cell carcinoma
ceruminous gland adenoma (benign) or adenocarcinoma (malignant)

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16
Q

what is the survival rate for squamous cell carcinoma of the ear canal?

A

at least one year after surgery

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17
Q

why is squamous cell carcinoma invasive?

A

may metastasize

if multi centeric further lesions can appear after removal

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18
Q

where is the ceruminous gland found?

A

sub-dermal layers of the ear canal

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19
Q

what is the role of the ceruminous gland?

A

helps produce wax

protects ear

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20
Q

what is the issue with melanoma?

A

more deadly as spreads quickly

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21
Q

what is the most common skin tumor in dogs and cats?

A

basal cell carcinoma

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22
Q

how severe is basal cell carcinoma?

A

normally benign but can grow quickly

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23
Q

what are the main middle ear diseases of dogs?

A

bacterial otitis media
tympanic membrane trauma allowing bacterial infection
tumors are rare unless an extension of another tumor

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24
Q

what is otitis media?

A

inflammation in the middle ear

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25
Q

what is bacterial otitis media most often caused by in dogs?

A

development of chronic otitis externa

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26
Q

what are the most common middle ear diseases in cats?

A

otitis media without otitis externa
neoplasia (rare)
polyps

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27
Q

what is otitis externa in cats normally due to?

A

primary middle ear disease

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28
Q

what is the most common mass diagnosed in cats?

A

polyps

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29
Q

what are the areas in cats affected by polyps?

A

pharyngeal

external ear canal

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30
Q

what causes polyps in cats?

A

unknown aetiology

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31
Q

what are the 3 common presentations of polyps?

A

only in bulla (middle ear)
protruding through tympanic membrane
nasopharyngeal

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32
Q

what is caused by polyps protruding through tympanic membrane?

A

concurrent otitis externa

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33
Q

where do nasopharyngeal polyps grow from?

A

eustachian tube

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34
Q

what is involved in the surgical treatment of all issues with the pinnae?

A

treatment of underlying case

35
Q

what lacerations will be treated surgically?

A

full thickness lacerations or epithelium torn away from cartilage

36
Q

what must be considered about ear lacerations?

A

need for flushing as there is infection risk

37
Q

why does cartilage take longer to heal?

A

poor blood supply

38
Q

what is the purpose of surgical correction of auricular haematoma?

A

prevent further accumulation and deformity

allow fibrosis of the skin and cartialge

39
Q

how can an aural haematoma be prevented from reforming after drainage?

A

use correctly placed sutures to hold skin and cartilage together

40
Q

what is involved in correction of auricular haematoma?

A

suction and drainage

massage and flush

41
Q

can auricular haematoma resolve without treatment?

A

yes in some cases

42
Q

what surgical prep is needed for auricular haematoma?

A

full clip of pinna

43
Q

what positioning is required for auricular haematoma surgery?

A

lateral recumbancy

44
Q

what post of care is needed for the auricular haematoma patient?

A

bandaging to immobilise pinna

buster collar

45
Q

what is the issue with ear bandages?

A

affect ventilation of ear canal and so can lead to otitis externa

46
Q

when performing pinna neoplasia surgery what must be considered?

A

site
size
histology needed and so pot size

47
Q

what is pinnectomy?

A

full removal of pinnae

48
Q

what is pinnectomy used for?

A

removal of invasive tumors

49
Q

what is a significant side effect of pinnectomy?

A

bleed profusely so bipolar cautery needed for haemostasis

50
Q

what is removed during a lateral wall resection?

A

secretory epithelium of vertical canal

lateral cartilage of vertical canal

51
Q

in what animals is lateral wall resection used?

A

chronic OE
patients not responding to treatment
external canal disease

52
Q

when must lateral wall resection be performed?

A

early before any stenosis (thickening)

53
Q

what is the purpose of a lateral wall resection?

A

increases drainage and ventilation

54
Q

what is required post lateral wall resection?

A

medical management as non-curative

55
Q

what clip is needed for lateral wall resection?

A

entire pinna and side of head

56
Q

what should be done prior to lateral wall resection prep?

A

flush ear to remove debris

57
Q

what position should animals be in for lateral wall resection?

A

lateral recumbency

head elevated

58
Q

what is involved in a vertical canal ablation?

A

excision of whole auricular cartilage and formation of a stoma at the level of the horizontal canal

59
Q

what is vertical canal ablation used to treat?

A

disease affecting the entire vertical canal but not the horizontal
e.g. neoplasia

60
Q

what may be needed in vertical canal ablation?

A

histology samples

61
Q

how is the patient prepped for vertical canal ablation/

A

as for lateral wall resection

62
Q

what is the most common procedure performed on the ear in dogs?

A

total ear canal ablation (TECA)

63
Q

when is a TECA performed on cats?

A

alongside lateral bulla osteotomy (LBO)

64
Q

what is TECA and TECA-LBO used to treat?

A

chronic otitis externa that is unresponsive to medical treatment
trauma
neoplasia

65
Q

what happens during TECA-LBO?

A

removal of all epithelial lining and vertical and horizontal canal cartilages

66
Q

what are the potential serious complications associated with TECA-LBO?

A

neurological - facial nerve paralysis and hearing loss
infection
cosmetic

67
Q

what is essential when conversing with owners about facial surgery?

A

prepare them for what their animal may look like
meeting with owners who have had experience
never let owners take a cat home without taking them out and showing them the surgical area

68
Q

how should patients be prepped for TECA-LBO?

A

clip entire pinna, caudal boarder of eyelid and lateral side of neck
prep entire pinna

69
Q

what will need to be done throughout TECA-LBO prep?

A

pinna supported with towel clamp so it is held out of the way

70
Q

how can hair be prevented from falling in the ear canal during clipping for surgery?

A

plug ear

71
Q

what are the complications associated with TECA?

A 
haemorrhage
iatrogenic facial nerve injury
vestibular problems
trauma to deeper structures
facial nerve paralysis
Horner's syndrome
infection 
fistula formation
cholesteatoma
72
Q

why is haemorrhage likely in TECA surgery?

A

limited visualisation

73
Q

how can haemorrhage be prevented in TECA?

A

cautery
swabbing
suction
(scrub nurse role)

74
Q

what deeper structures may be injured following TECA?

A

lingual / maxillary vessels

hypoglossal nerve

75
Q

what TECA complications are often self limiting?

A

facial nerve paralysis

Horner’s syndrome

76
Q

what is the most common TECA complication?

A

infection

77
Q

what can infection lead to?

A

wound dehiscence

78
Q

what is cholesteatoma?

A

keratinising epithelium that has been left behind by the surgeon that must be removed

79
Q

in what animals is a ventral bulla osteotomy performed?

A

cats with middle ear disease

80
Q

why is ventral bulla ostotomy not often performed in dogs?

A

rare for dogs to have isolated middle ear diease

81
Q

what is ventral bulla osteotomy useful to treat?

A

middle ear polyps

82
Q

what are the complications of ventral bulla osteotomy?

A

Horner’s syndrome
vestibular disease
haemorrhage
infection

83
Q

why is communication with the owner of a surgical ear patient vital?

A

complications are common and frustrating to manage

informed owner will be more understanding if complications do occur

84
Q

what is the role of the VN in surgical ear conditions?

A

prep of patient
intra-operative support
counseling of owners with VS
post op care and observations

JJ (33 decks)

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