Sx of ear

Question 1

predisposing causes of aural hematoma, and what is the origin of the bleeding?

Answer 1

shaking/scratching ears

otitis externa

capillary fragility

blood vessels of ear

Question 2

treatment goals of aural hematoma, what are the non-surgical options and

surgical options and when would you choose one over another for treatment?

Answer 2

Tx goals:

remove blood or clot

prevnt reoccurrence

retain ear appearance

Non-sx option: recent & fluctuant hematomas, smaller

• aspiration w/ or w/o anti inflammatories

Sx option: chronic, larger

• drain tube placement
• incisional drainage
• practivet system

Question 3

treat lacerations of the pinna in dogs and cats?

Answer 3

if 1 skin surface:

2nd intention or suture

if 2 skin surfaces/cartilage:

primary closure

laceration at ear tip

Question 4

manage SCC of the pinna in a cat and what is the prognosis?

Answer 4

pinnectomy +/- vertical ear canal ablation

locally invasive but, can be curative!

Question 5

some of the causes and predispositions for otitis externa and when should

surgical intervention occur?

Answer 5

Primary causes

• Parasites (Otodectes)
• Foreign body
• Hypersensitivities
• Keratinization disorders
• Autoimmune

Predisposing factors

• Pendulous ears
• Narrow canals
• Excessive hair
• Excessive cerumen
• Chronic ear moisture
• Inappropriate abs
• Polyps or tumors

When medical mgmt fails!

Question 6

When is a lateral or vertical ear canal resection indicated and when is it contraindicated?

Answer 6

Indications
When skin changes are reversible
Tumor involving tragus or lateral wall of vertical canal

Question 7

What are the indications for a TECA and why do you perform a bulla osteotomy in conjunction with it?

Answer 7

Indications
Ceruminous gland adenocarcinoma
Extensive benign otitis
Failed lateral ear canal resection
Middle ear disease

Question 8

What structures do you need to avoid during a TECA and where are they located?

Answer 8

avoid facial nerve!

located right at base where vertical & lateral canal meet

Question 9

Should you use bandages and drains after TECA surgery?

Answer 9

Yes if indicated but make sure that location of sx site is indicated on bandage!

Question 10

What complications can occur with TECA and bulla osteotomy surgery, what is the incidence, and what is the prognosis for resolution?

Answer 10

Nerve damage:

Horner’s syndrome

Facial n. paralysis

Hearing loss

Hemorrhage, dehiscence, infection/draining tract

Question 11

What are the surgical diseases of the middle ear and how do you diagnose middle ear disease?

Answer 11

Otitis media
Middle ear polyps
Cholesteatoma
Neoplasia: Extremely rare

PE, LN, temporomandibular joint palpation, neuro exam

radiology, CT, MRI (most sensitive, detects early dz)

Question 12

What is the initial management of middle ear disease and when should you choose surgery?

Answer 12

medical mgmt:

clean ext ear

myringotomy, irrigate

topical & systemic non-ototoxic abs 4-6 wks

choose sx when:

Severe canal stenosis
Tympanic bone infection
Failure of medical management
Significant neurological signs

Question 13

What are inflammatory polyps, what patients do they affect, where are they located, what signs do they exhibit, what causes them, and how do you manage them?

Answer 13

non-neoplastic polyps in middle ear

young cats

tympanic bulla, auditory tube, nasopharynx

inflammatory & epithelial cells

traction extraction or ventral bulla osteotomy