Surgical Diseases of the Ear

Question 1

What are the 3 regions of the ear and what do each consist of?

Answer 1

1. External ear (pinna, auditory meatus, and short canal)
2. Middle ear (tympanic membrane, auditory tube, and tympanic cavity)
3. Inner ear (bony labyrinth, semicircular canals, & auditory ossicles – stapes, incus, malleus)

Question 2

what is the difference between the canine and feline bulla?

Answer 2

feline has 2 compartments
the ventromedial compartment is larger and cannot be forgotten during procedures!

Question 3

What are a few of the most important anatomical areas of the pinna that are important for surgical landmarks?

Answer 3

helices
tragus
antitragus

Question 4

If a patient presents to you with a small laceration on their ear, what is your treatment plan?

Answer 4

suture it closed with a simple interrupted, figure 8, or mattress pattern.

Question 5

If a patient presents to your clinic with a deep fissure or small mass at or close to the margin of the ear, what is your treatment plan?

Answer 5

partial pinnectomy or wedge excision

Question 6

If a patient presents to your clinic with a large ear defect, what is your treatment plan?

Answer 6

reconstructive surgery such as a local transposition flap or distant pedicle flap

Question 7

what is the MOST common injury to the pinna?

Answer 7

aural hematoma – hemorrhage that occurs between the cartilage and the skin secondary to trauma or head-shaking secondary to otitis.
This can hemorrhagic or serosanguinous fluid

Question 8

What are the 3 treatment options for an aural hematoma?

Answer 8

1. drain with intralesional steroid injection (triamcinolone or dexamethasone)
2. drain with closed-suction
3. surgical drainage + suture placement

Question 9

what is the concern for injecting steroid into an aural hematoma?

Answer 9

abscess formation due to the glucocorticoids

Question 10

Describe the method of “drainage with suture” for aural hematoma repair.

Answer 10

incise over the swelling
remove all fluid and fibrin
leave incision open and cut off a ~2 mm strip of tissue (so that it will not heal too fast)
place sutures that oppose all of the layers (skin, cartilage)
you can place stents if necessary.

Question 11

T/F: you can use a biopsy punch to punch out circles of tissue on the concave side of the ear to repair an aural hematoma

Answer 11

true

Question 12

in what direction should you place your sutures when repairing an aural hematoma?

Answer 12

parallel to the vasculature

Question 13

An orange cat presents to your clinic with a raised, erosive lesion along the ear margin. After reviewing the histology, you diagnose this cat with squamous cell carcinoma.
What is your treatment plan?

Answer 13

partial or total pinnectomy +/- ablative procedure, cryosurgery, laser ablation, RT or chemotherapy.

Question 14

what is the MOST common feline cutaneous neoplasia?

Answer 14

basal cell tumor

Question 15

what is the 2nd most common feline cutaneous neoplasm?

Answer 15

mast cell tumor

Question 16

describe the appearance of a sebaceous adenoma

Answer 16

gray/black raised nodule/mass.

Question 17

FNA results usually determine the surgical plan. But, what do most aural neoplasms require as far as treatment goes?

Answer 17

pinnectomy

Question 18

When is surgical intervention appropriate for otitis externa?

Answer 18

chronic, end-stage infectious otitis externa in which medical management has failed.

Question 19

what do radiographs typically show in cases of otitis externa?
what is the limitation of radiography?

Answer 19

external canal stenosis and mineralization
increased soft tissue opacity, thickening, bony lysis, and irregularities of the bullae.

but radiography is not great for looking at internal ear structures/abnormalities.

Question 20

Lateral ear canal resection (Zepp procedure) is indicated for mildly affected patients with otitis externa. It essentially makes the ear canal no longer “L” shaped by cutting the vertical canal.
What are the goals of the Zepp procedure?

Answer 20

to improve ventilation, reduce secretions, and make cleaning and medication placement easier for the owner.

Question 21

In what instance would we use the vertical ear canal resection surgery?

Answer 21

this surgery is rare because it is indicated when the vertical ear canal is affected but the horizontal is clear.

Question 22

what are the indications for a total ear canal ablation?

Answer 22

1. pt who is has unresponsive chronic otitis externa and has stenotic canals preventing medication application
2. failed previous resections
3. neoplasia

Question 23

What procedure is described by the following:
Make a T incision at the base of the ear.
Dissect around the cartilages of the ear canals to the internal meatus.
Remove tragus + ear canals, but maintain the pinna
Close T incision and place drain

Answer 23

total ear canal ablation

Question 24

What procedure is usually performed in conjunctive with a TECA and why?

Answer 24

lateral bulla osteotomy to improve the drainage by removing the secretory epithelium. If you did not do this, you would likely get an abscess and/or fistula.

Question 25

A cat presents to your clinic and the owner reports that he has been having trouble breathing, wont eat, has nasal discharge, has been sneezing and coughing.
You do a physical exam, otoscopic exam, and pharyngeal exam. You already have your diagnosis based on your pharyngeal exam. What is the diagnosis?

Answer 25

feline inflammatory nasopharyngeal polyps

Question 26

how do you treat feline inflammatory nasopharyngeal polyps?

Answer 26

nasopharyngoscopy + traction removal

Question 27

A cat presents to your clinic for head shaking. You recently diagnosed this cat with otitis externa that has not resolved with treatment. You perform a CT and diagnose this cat with feline inflammatory bulla polyps.
What is the treatment?

Answer 27

ventral bull osteotomy
this is where the patient is in dorsal recumbency and you go in ventrally. Remove the polyp and the bulla epithelium. Submit these samples to culture and histopathology.

Question 28

What important structures must you be careful not to damage during a VBO?

Answer 28

linguofacial vein
hypoglossal nerve
facial vein

Question 29

Leaving behind remnants of polyps is a very common complication of polyp removal.
How do you know you successfully removed the entire polyp?

Answer 29

inspect it post removal, it is comma shaped.

Question 30

what is the treatment for otitis interna that is refractory to treatment?

Answer 30

VBO