Surgical Diseases of the Ear

Question 1

What is included in the external ear anatomy?

Answer 1

Pinna, auditory meatus and short canal

Question 2

What is included in the middle ear anatomy?

Answer 2

Tympanic membrane, auditory tube (Eustachian tube), tympanic cavity

Question 3

What is included in the inner ear anatomy?

Answer 3

Bony labyrinth, semicircular canals, auditory ossicles (stapes, incus, malleus)

Question 4

What is different in the bulla of cats?

Answer 4

They have 2 compartments vs one as in dogs

Question 5

What are good suture patterns to use for small lacerations to the ear?

Answer 5

Simple interrupted, figure 8 pattern, vertical mattress

Question 6

What do you need to worry about when performing mattress patterns?

Answer 6

Proper apposition- don’t want everting or inverting

Question 7

What is the treatment for deep fissures or small masses at or close to the margins of the ear?

Answer 7

Partial pinnectomy or wedge excision
- concern for vascular supply being compromised

Question 8

What reconstructive techniques could be considered for larger defects of the ear?

Answer 8

Local transposition flaps, distant pedicle flaps

Question 9

Define an aural hematoma

Answer 9

Often secondary to trauma the cartilage separates from the underlying skin and fills with either blood or serosanguinous fluid
-there is a theory that animals with autoimmune diseases are predisposed

Question 10

What is the primary clinical sign for an aural hematoma?

Answer 10

Soft fluctuant swelling +/- pain

Question 11

What are the options for drainage of aural hematomas

Answer 11

Drainage with intralesional steroids
Closed suction drainage
Surgical drainage with suture placement

Question 12

Describe the drainage with closed suction technique for aural hematomas?

Answer 12

Drain with large ga needle, flush with saline, +/- inject steroids (monitor for abscess formation), suture drain into place
-90% of patients have resolved signs and cosmetic appearance is maintained

Question 13

What do you have to consider about the bandage at this location?

Answer 13

You need it to be stiff to reduce movement and recurrence of signs

Question 14

Describe the drainage with suture placement technique for aural hematomas

Answer 14

Taking out a strip of tissue with scalpel blade to allow for drainage
-incise over swelling
-remove all fluid and fibrin
-leave incision open but tack down skin (oppose all layers)
-can use stents to reduce tension
-must place sutures in parallel to vascular supply

Question 15

What is a similar alternative to the drainage and suture placement technique?

Answer 15

Biopsy punch
- multiple holes for drainage
-more labor intensive

Question 16

What is a common cancer in cats that affects the ears?

Answer 16

Squamous cell carcinoma
-raised erosive lesions that are locally invasive in articular cartilage

Question 17

What is the treatment for squamous cell carcinoma on pinna of cats?

Answer 17

Partial or total pinnectomy +/- ablative procedure, cryotherapy, laser ablation or chemo

Question 18

What is the etiology behind hemangiomas and hemangiosarcomas on cat ears?

Answer 18

Associated with UV-B exposure

Question 19

What is the most common feline cutaneous neoplasm?

Answer 19

Basal cell tumors

Question 20

What is the second most common feline cutaneous neoplasm?

Answer 20

mast cell tumors

Question 21

What ear neoplasm are orange cats in particular affected with?

Answer 21

Sebaceous adenomas

Question 22

Define otitis externa

Answer 22

Inflammation of the ear canal

Question 23

What makes the canine ear particularly prone to otitis?

Answer 23

Its L shape- makes drainage of debris more difficult
-when debris builds up lining of the ear gets inflamed leading to further production of sebum

Question 24

What breeds are the most predisposed to otitis?

Answer 24

Spaniels, doodles (due to hair in ears), german shepards

Question 25

When to perform surgery for otitis externa cases?

Answer 25

Chronic end stage infections that have failed medical therapies
-have they seen a dermatologist yet? if not do this first

Question 26

What is often seen on otoscopic exam in these end stage cases?

Answer 26

Hypertrophic tissues, stenotic canals

Question 27

What should you do if worried about internal masses after otoscopic evaluation?

Answer 27

Imaging- Radiography, CT

Question 28

What can the different imaging modalities tell you in chronic otitis cases?

Answer 28

Radiographs: can show you stenosis or mineralization in the external canal. In the bulla can see increased soft tissue opacities, thickening, irregularities or bony lysis
CT: can give you a better image of the inner ear, as well as other portions. Can look for fluid accumulation, soft tissue proliferation, bony lysis or expansion

Question 29

What is lateral ear canal resection also known as?

Answer 29

A Zepp procedure

Question 30

What do you use a zepp procedure for?

Answer 30

Mildly affected patients
- owners may be having problems getting drops all the way in
-not showing signs of stenosis

Question 31

What are the goals of the Zepp procedure?

Answer 31

To improve ventilation, reduce secretions
-medical management still paramount
-eliminates the curve to deal with so can introduce drops more directly into the horizontal canal

Question 32

Describe vertical ear canal resection

Answer 32

Create a hole directly into the vertical canal
- can use only when horizontal ear canal is clear
-post-op complications are plentiful

Question 33

What are the indications for total ear canal ablation?

Answer 33

Unresponsive otitis externa with stenotic canals, previous resection failure, or neoplasia

Question 34

What is removed for total ear canal ablation?

Answer 34

Entire ear canal
- externally, pinna is only thing intact, tragus is gone, meatus is gone
-everything up to the tympanic membrane is removed

Question 35

What do you have to be careful to avoid with total ear canal ablation?

Answer 35

The facial nerve! Often can’t avoid as its already wrapped up in the infection
- look out for facial drooping, inability to blink, sunken lobes

Question 36

What always needs to be performed in conjunction with a total ear canal ablation?

Answer 36

A lateral bulla osteotomy
-secretory events start here, if not removed can lead to infection, swelling, redness, irritation, fistulas

Question 37

What are the main clinical signs associated with otitis media?

Answer 37

Head shaking, scratching, head tilt

Question 38

What are the clinical signs of feline inflammatory polyps?

Answer 38

Depends on location
If nasopharynx affected will see dyspnea, dysphagia, nasal discharge, sneezing, coughing
If bulla affected will see head shaking, scratching, otitis externa, horners syndrome

Question 39

What diagnostics should you use to determine if a cat has feline inflammatory polyps?

Answer 39

Physical exam, otoscopic exam, pharyngeal exam, imaging

Question 40

What is the treatment for feline inflammatory polyps?

Answer 40

If in nasopharynx- traction removal

If in bulla, ventral bulla osteotomy

Question 41

How do you find the polyp in the nasopharynx when performing nasopharyngoscopy?

Answer 41

Must pull back the soft palate

Question 42

How do you know that you are not leaving a part of the polyp behind?

Answer 42

Should appear comma shaped (how you know you got the stalk)

Question 43

Describe the ventral bulla osteotomy

Answer 43

Indicated when infection involvement is limited to the middle ear and canal is unaffected and the lesion is unresponsive to medical management
- must avoid hypoglossal nerve and linguofacial vein
-must remove both the mass and the epithelium
-can place a drain if there was a lot of pirulent debris
-take sample for C/S testing

Question 44

What are the clinical signs of otitis interna?

Answer 44

Vestibular signs

Question 45

Treatment for otitis interna?

Answer 45

Ventral bulla osteotomy if inner ear is only area affected
- if nerves affected, may not be able to reverse signs but can make animal feel better
-use antibiotics and steroids post op to help with nerve inflammation