Wound Healing and Brain Stem Auditory Evoked Potentials After Experimental Ventral Tympanic Bulla Osteotomy in Dogs

Ventral tympanic bulla osteotomy was performed in 13 normal dogs to evaluate healing and retention of brain stem auditory evoked potentials (BSAEP). Healing was evaluated by gross and microscopic examination of the middle ears after 1 (n = 2), 4 (n = 8), 5 (n = 1), and 6 (n = 1) weeks. One dog was eliminated from the study. Brain stem auditory evoked potentials were measured using an air-conducted sound stimulus before and after surgery and before killing. Nine of 12 dogs re-formed the tympanic bulla by formation of fibrous connective tissue lined with cuboidal epithelium in the osteotomy site. Four of the nine dogs had a reduced tympanic bulla volume (estimated 20% to 40% volume reduction) caused by soft tissue ingrowth through the osteotomy. Nine of 12 dogs had proliferation of subperiosteal new bone from the inner surface of the tympanic bulla that varied in severity. Three of these nine dogs had nearly complete obliteration of the tympanic cavity by proliferating subperiosteal new bone. Eight dogs had nodules of granulation tissue containing new bone and mineralization diffusely distributed on the surfaces of the middle ear. The measured BSAEP sensitivity before killing was equivalent to preoperative levels in 11 dogs. The remaining dog had no change in auditory sensitivity after surgery but had a markedly reduced BSAEP detection threshold before killing. This appeared to be attributable to mechanical impingement on the ossicles and tympanic membrane by proliferating bone within the tympanic cavity. This study showed that after ventral tympanic bulla osteotomy the tympanic bulla rapidly re-forms with no deleterious effect on hearing in most dogs treated. However, the internal surfaces of the middle ear appear to be sensitive to surgical trauma, and extensive new bone proliferation is easily induced. This response may be extreme, resulting in middle ear obliteration and reduced auditory sensitivity.     

Chronic Otitis Externa and Otitis Media Treated by Total Ear Canal Ablation and Ventral Bulla Osteotomy in Thirteen Dogs

Ventral bulla osteotomy was combined with total ear canal ablation for the treatment of chronic otitis externa and otitis media in 13 dogs (14 ears) that had been refractory to medical and surgical treatments. Resolution of disease occurred in 11 dogs (12 ears). One dog with unilateral disease underwent a second operation before achieving a good result. One dog was euthanatized for persistent unilateral disease after three surgical procedures. The recurrence of disease in these two dogs (15%) was associated with remnants of ear canal integument within the osseous horizontal canal or tympanic bulla. Facial paralysis occurred in four dogs (31%) and there were no complications in eight dogs (62%). This technique shows no advantage over lateral bulla osteotomy combined with total ear canal ablation for the treatment of chronic otitis externa and otitis media.     

Inflammatory polyps of the middle ear in 5 dogs

OBJECTIVE: To describe inflammatory polyps of the middle ear in 5 dogs. STUDY DESIGN: Case series. ANIMALS: Five dogs with ear disease. METHODS: Medical records (1995-2001) were reviewed to identify dogs with inflammatory polyps of the middle ear. Signalment, clinical signs, ancillary diagnostic procedures, treatment, postoperative complications, and outcome were recorded. Owners and referring veterinarians were contacted to document outcome. RESULTS: Dogs with inflammatory polyps of the middle ear were male and aged 4 to 13 years. Two dogs had bilateral polyps, whereas 3 had unilateral polyps. The most common clinical presentation was otitis externa and media, with radiographic evidence of otitis media. Polyps were treated by ventral bulla osteotomy (VBO) in 1 dog and total ear canal ablation with lateral bulla osteotomy (TECA-LBO) in 4 dogs. Polyps consisted of a fibrovascular stroma infiltrated with neutrophils, macrophages, lymphocytes, and plasma cells. The overlying epithelium was frequently ulcerated. Immediate postoperative complications included a seroma after VBO (1 dog) and transient unilateral facial nerve paralysis after bilateral TECA-LBO (1 dog). No recurrence occurred within 9 to 69 months. CONCLUSIONS: Unilateral or bilateral, inflammatory polyps can occur in the middle ear of dogs in association with otitis externa and media. No recurrence occurred after surgical removal of the polyps. CLINICAL RELEVANCE: Inflammatory polyps of the middle ear in dogs can be a cause of otitis externa/media. Surgical removal of aural polyps has a good prognosis.     

Aural Cholesteatoma in Twenty Dogs

Objective— To determine the clinical course in dogs with aural cholesteatoma. Study Design— Case series. Animals— Dogs (n=20) with aural cholesteatoma. Methods— Case review (1998–2007). Results— Twenty dogs were identified. Clinical signs other than those of chronic otitis externa included head tilt (6 dogs), unilateral facial palsy (4), pain on opening or inability to open the mouth (4), and ataxia (3). Computed tomography (CT) was performed in 19 dogs, abnormalities included osteoproliferation (13 dogs), lysis of the bulla (12), expansion of the bulla (11), bone lysis in the squamous or petrosal portion of the temporal bone (4) and enlargement of associated lymph nodes (7). Nineteen dogs had total ear canal ablation–lateral bulla osteotomy or ventral bulla osteotomy with the intent to cure; 9 dogs had no further signs of middle ear disease whereas 10 had persistent or recurrent clinical signs. Risk factors for recurrence after surgery were inability to open the mouth or neurologic signs on admission and lysis of any portion of the temporal bone on CT imaging. Dogs admitted with neurologic signs or inability to open the mouth had a median survival of 16 months. Conclusions— Early surgical treatment of aural cholesteatoma may be curative. Recurrence after surgery is associated with advanced disease, typically indicated by inability to open the jaw, neurologic disease, or bone lysis on CT imaging. Clinical Relevance— Presence of aural cholesteatoma may affect the prognosis for successful surgical treatment of middle ear disease.     

Middle ear tumours with brainstem extension treated by ventral bulla osteotomy and craniectomy in two cats

Two geriatric domestic shorthaired cats (DSH) were treated surgically with a ventral bulla osteotomy and craniectomy for middle ear tumours that invaded the calvarium. Both cats had a history of vestibular disease. One cat had a normal neurological examination. Both cats underwent computed tomographic imaging of the head. After intravenous injection of an iodinated contrast material, one cat had a ring‐enhancing intracranial lesion and the other had a uniform contrast‐enhancing intracranial lesion, which either communicated with the bulla or was associated with bulla osseous lysis/production. One cat had a papillary adenoma and the other had an adenocarcinoma. Both cats had prolonged survivals (630 days; alive and lost to follow‐up at 840 days), which is longer than reported in cats with middle ear neoplasia. Craniectomy, in addition to ventral bulla osteotomy, may be part of the treatment plan for middle ear tumours that invade the calvarium.     

Wound Healing and Brain Stem Auditory Evoked Potentials After Experimental Total Ear Canal Ablation With Lateral Tympanic Bulla Osteotomy in Dogs

Experimental total ear canal ablation with lateral tympanic bulla osteotomy (TECA-LBO) was performed in 13 normal dogs to evaluate healing and retention of brain stem auditory evoked potentials (BSAEP) after surgery. Healing was evaluated by gross and microscopic examination of the surgery sites after 1 (n = 2), 4 (n = 8), 5 (n = 1), and 6 (n = 1) weeks. One dog was eliminated from the study. Brain stem auditory evoked potentials were measured using an air-conducted sound stimulus before and after surgery and before killing. Two dogs had nearly complete obliteration of the tympanic cavity by immature fibrous connective tissue. Eight dogs responded to surgery by either complete or partial re-formation of the tympanic cavity. Retention of the tympanic membrane in three dogs promoted re-formation of the tympanic cavity and blind epithelialized pockets in the surgery site with accumulation of keratinized debris. Granulation tissue formation and extensive proliferation of new bone on the internal surface of the tympanic bulla was seen in 10 dogs. Proliferative bone completely obliterated the tympanic cavity in two of these dogs. Eleven of 13 dogs had no detectable air-conducted BSAEP after surgery. There was no change in BSAEP measurements before killing compared with postoperative measurements in any dog. Two dogs with retained tympanic membranes had measurable BSAEP after surgery. This study shows that healing after TECA-LBO may be highly variable. Retention of the tympanic membrane and small osteotomies appeared to promote reformation of tympanic cavities and prevent ingrowth of granulation tissue. New bone proliferation was frequently observed in response to curettage of the epithelium lining the tympanic bulla. Hearing, as determined by BSAEP measurements, was lost except when the tympanic membrane and ossicles were retained. Retained tympanic membranes promoted accumulation of keratinized cellular debris that could become a nidus for infection or late abscessation in some dogs. These results indicate that resection of as much of the lateral and ventral tympanic bulla as possible and removal of the tympanic membrane may provide consistently improved results after TECA-LBO.     

Surgical management of 43 cases of chronic otitis externa in the dog

: Over a seven-year period, chronic otitis externa was surgically managed in 43 dogs at the University Veterinary Hospital of University College Dublin. Lateral ear canal resection (LECR) was undertaken in nine of the 43 dogs: results were unsatisfactory, with a failure of the surgery in five of eight dogs and one dog lost to follow-up. Once end-stage otitis externa, with or without otitis media, is diagnosed, total ear canal ablation and lateral bulla osteotomy (TECA/LBO) is the best treatment option. In this series, 37 of 43 dogs underwent TECA/LBO and of the 29 dogs for which follow-up results were obtained 27 (93%) had an excellent or improved outcome to surgery. Complications following all procedures were most common in cases with a concurrent dermatopathy; therefore, definitive diagnosis and medical treatment for skin and ear disease is essential.     

Expansile, inflammatory middle ear disease causing nasopharyngeal obstruction in a cat

A 7-year-old, entire female, domestic shorthair cat presented with recurrent upper respiratory tract problems. Infectious otitis media caused expansion of the middle ear which ultimately resulted in complete obstruction of the nasopharynx. A ventral bulla osteotomy was successful in relieving the clinical signs.     

Total Ear Canal Ablation Combined with Lateral Bulla Osteotomy for End-Stage Otitis in Dogs Results in Thirty Dogs

Thirty dogs with end-stage otitis were treated by either unilateral or bilateral total ear canal ablation and lateral bulla osteotomy. Otitis was considered end stage when the horizontal ear canal was collapsed, stenotic, or occluded in conjunction with chronic infection of the external and middle ear. The dogs were evaluated clinically and radiographically for 4 to 63 months. The frequency of scratching, head shaking, aural drainage, and para-aural fistulation was significantly decreased. Abnormal ear carriage and head tilt were not changed. The results in 23 dogs were graded as excellent or improved. One dog died of intraoperative hemorrhage. Complications during the period from suture removal to follow-up included para-aural fistulation (3 dogs), facial nerve paralysis (5 dogs), and head tilt (3 dogs).     

COMPUTED TOMOGRAPHIC APPEARANCE OF INFLAMMATORY POLYPS IN THREE CATS

This report describes the use of computed tomography (CT) to evaluate the inner ear, tympanic bullae, nasopharyngeal area, and external ear canals of three cats. All cats presented for evaluation of upper respiratory signs or chronic ear infection. Nasopharyngeal masses were present in two cats, and a mass in the external ear canal was present in the third cat. In all three cats, CT was able to define the extent of osseous bulla involvement, which was confirmed at surgery. Computed tomography also defined the extent of the polyp in the nasopharyngeal area in two cats, and in the external ear canal in one cat. Surgical removal of the polyps was accomplished with a combined oral approach and ventral bulla osteotomy in cats 1 and 2. The polyp was removed from cat 3 using a combination of ventral bulla osteotomy and excision of the mass through the external ear canal. Microscopic examination confirmed all masses as nasopharyngeal (inflammatory) polyps.     

Para-aural abscessation following traumatic ear canal separation in a dog

Traumatic ear canal separation is rare in animals, with only eight dogs and one cat reported with the condition in the English language literature. Para-aural abscessation occurred in six of these nine animals. Diagnosis was made on otoscopic observation of a shortened, abruptly ending external ear canal that was free from advanced disease. Radiographs in those cases which have been described showed a disruption of the normal air opacity of the affected ear canal. Drainage, by creating a separate opening for the horizontal ear canal, or total ear canal ablation and lateral bulla osteotomy (TECA/LBO), have led to resolution of the clinical signs. This report adds a further case to the literature in which TECA/LBO was employed successfully.     

Atresia of the external acoustic meatus in a dog

Summary: A 3 year old, female great Dane with atresia of the right external ear canal had recurrent episodes of ear pain. Radiography revealed absence of air in the right external acoustic meatus, thickened bone of the right tympanic bulla and increased radiodensity of the chamber of the bulla. Total ear canal ablation and lateral bulla osteotomy were performed. The superficial portion of the external ear canal was absent and the deeper segment of the vertical ear canal began as a blunt ended cartilage tube. A patent lumen in the existent portion of the external ear canal and the tympanic bulla contained wax, hair and exfoliated squames. The tympanic membrane was not intact. No bacteria were cultured from the contents of the external and middle ear. The dog responded well to surgery and was free of pain 11 months later. Failure to surgically correct atresia of the ear canal in young dogs may allow the accumulation of cellular and sebaceous debris with subsequent involvement of the middle ear in an inflammatory response.     

Total ear canal ablation combined with lateral bulla osteotorny in J the cat

Eighteen total ear canal ablations combined with lateral bulla osteotomy (TECA/LBO) procedures were performed in 15 cats over a period of 30 months. The indications for surgery included neoplastic disease, ceruminous gland adenocarcinoma of the horizontal canal or middle ear (10 ears), squamous cell carcinoma extending from the pinna (four), polyps emanating from the middle ear (three), and chronic unremitting middle ear disease (one). Complications associated with surgery included facial paralysis (seven cases), facial neuropraxia (four), Horner's syndrome (three), and wound dehiscion (one). Eleven cats were alive and disease-free six months after the surgery. The results indicate that the major indication for TECA/LBO in the cat is neoplastic disease involving the ear. Unlike the procedure in the dog, for which the usual indication is benign end-stage ear disease, neurological complications are common despite meticulous surgical dissections. In addition, the postoperative prognosis is guarded because of malignant disease in many cases.     

Total ear canal ablation combining bulla osteotomy and curettage in dogs with chronic otitis externa and media

Ear canal ablation combining bulla osteotomy and curettage was performed on 44 dogs (n = 72 ears). Indications for the procedure included one or more of the following: chronic nonresponsive otitis externa and/or media (n = 71), tumor in the horizontal portion of the ear canal (n = 1), failed lateral ear resection (n = 11), ossified auricular cartilages secondary to chronic otitis externa (n = 22), failed previous total ear canal ablation (n = 1), and otitis interna (n = 1). In 40 dogs, the surgery was successful in alleviating all clinical signs of otitis externa and media. During the immediate postoperative period, 2 dogs died of causes unrelated to otitis. Complications related to the surgery developed in 9 of the surviving 42 dogs. Ultimately, 95% (40 of the surviving 42) of the dogs were cured by use of this procedure. Surgery successfully resolved the original problems in 97% (66 of 68) of the surgically treated ears of these dogs.     

Wound contamination and antimicrobial susceptibility of bacteria cultured during total ear canal ablation and lateral bulla osteotomy in dogs.

OBJECTIVE: To detect contamination of wound sites from surgical handling of excised tissues during total ear canal ablation and lateral bulla osteotomy in dogs, and to compare susceptibility of bacterial isolates to cefazolin with susceptibility to other antimicrobial agents. DESIGN: Prospective clinical study. ANIMALS: 13 dogs. PROCEDURE: Dogs were treated surgically for otitis externa and media via total ear canal ablation and lateral bulla osteotomy. Specimens for aerobic bacterial culture were obtained from SC tissue immediately following skin incision, tissues excised from the osseous bulla (after transection of the horizontal ear canal and lateral bulla osteotomy), and from SC tissue prior to skin closure. Antimicrobial susceptibility of bacterial isolates to various antibiotics was determined by use of a broth dilution assay. RESULTS: There was a significant association between isolation of Streptococcus canis and Escherichia coli from specimens from the osseous bulla and specimens from the SC tissues prior to skin closure, indicating contamination of the SC tissues during surgery. Seventy percent of bacterial isolates were susceptible to cefazolin. CLINICAL IMPLICATIONS: Measures to limit bacterial contamination resulting from tissue handling during total ear canal ablation and lateral bulla osteotomy are necessary. Bacteriologic culture of tissue of the osseous bulla and determination of antimicrobial susceptibility are recommended. Administration of cefazolin alone may not be efficacious for antimicrobial prophylaxis.     

Ultrasound imaging of the canine tympanic bulla

A procedure for imaging the canine tympanic bulla, external ear canal and adjacent structures using currently available ultrasound equipment was established. Lateral and ventral transducer positions were identified for this purpose and a 6.5 MHz curvilinear transducer was considered to be optimal. The sonographic appearance of these structures in cadavers and live dogs unaffected by ear disease is documented. Fluid was introduced into the tympanic bullae of the cadavers and its presence could be identified through the bony wall of the bulla. The ability of ultrasound to differentiate between gas and fluid within the bulla has important clinical implications as this is a common occurrence in dogs with middle ear disease. Ultrasound has several advantages over other imaging modalities and the examination procedure was well tolerated by unsedated dogs.     

Total ear canal ablation and lateral bulla osteotomy in the dog

One hundred total ear canal ablation/lateral bulla osteotomy procedures were performed in 71 dogs over a four year period. The main indication for surgery was advanced disease of the aural canal or middle ear resulting from prolonged inflammatory disease of the outer ear. Complications of surgery included facial nerve injury, inner ear injury, retroglenoid vein haemorrhage and wound dehiscion. The incidence of complications (29 per cent) was, however, substantially lower than has previously been recorded following this procedure. Meticulous dissection technique and increasing familiarity with the procedure were thought to be responsible for lower complication rates than have previously been recorded. Surgery was considered to have resolved the original aural condition in 92 per cent of cases and only infrequently resulted in complete loss of hearing function.     

Surgical Management of Rabbit Ear Disease

Clinical signs associated with otic disease in rabbits (Oryctolagus cuniculus) are very similar to those demonstrated in dogs and cats. The surgical treatment options to resolve diseases involving the rabbit ear are also comparable with those used for canine and feline species. However, there are key anatomic and physiologic differences that must be accounted for to perform proper surgical treatment on a rabbit that has been diagnosed with ear disease. This article describes the diagnostic and treatment options for otitis externa, otitis media, and otitis interna, with an emphasis on surgical procedures and the important distinctive otic features of the rabbit patient. The ventral bulla osteotomy procedure is recommended for management of otitis media in rabbits without otitis externa. In rabbits with pathology in the external ear canal and the middle ear, total ear canal ablation and lateral bulla osteotomy should be performed. This combined procedure will allow the surgeon to address pathology in both sites, with the ultimate goal of resolution of the underlying disease etiology. Lateral ear canal resection is only appropriate in rabbits with otitis externa without otitis media; however, this surgical procedure may not resolve the otitis externa. If this is a concern, a total ear canal ablation should be done because it offers a greater chance of success.     

Material in the middle ear of dogs having magnetic resonance imaging for investigation of neurologic signs

The aim of this study was to determine the prevalence and potential significance of finding material in the middle ear of dogs having magnetic resonance (MR) imaging. Of 466 MR studies reviewed, an increased signal was identified in the tympanic bulla in 32 (7%) dogs. Cavalier King Charles spaniels, Cocker spaniels, Bulldogs, and Boxers were over-represented compared to the population of dogs having MR imaging. Five (16%) dogs had definite otitis media and one (3%) had a meningioma invading the middle ear. Of the remaining dogs, 13 (41%) had possible otitis media and 13 (41%) had neurologic conditions apparently unrelated to otitis media. The most common appearance of material in the middle ear was isointense in T1-weighted images and hyperintense in T2-weighted images. There was no apparent correlation between the signal characteristics of the material and the diagnosis. Enhanced signal after gadolinium administration was observed affecting the lining of the bulla in dogs with otitis media and in dogs with unrelated neurologic conditions. In dogs without clinical signs of otitis media, finding an increased signal in the middle ear during MR imaging may reflect subclinical otitis media or fluid accumulation unrelated to inflammation. Brachycephalic dogs may be predisposed to this condition.     

Virtual otoscopy for evaluating the inner ear with a fluid-filled tympanic cavity in dogs

The feasibility of virtual otoscopy (VO) imaging was evaluated in five dogs with experimentally induced otitis media, two control dogs, and two canine patients with otitis media. VO images of the tympanic cavity and ossicles were generated with commercially available software using raw computed tomography (CT) data. Eight out of 10 ears inoculated with pathogen exhibited obvious clinical signs associated with otitis externa. CT images revealed soft tissue density material occupying the tympanic bulla compatible with otitis media in three dogs with experimentally induced otitis media and two patients. No remarkable features were observed on the radiographs. Four different VO views (ear canal, tympanic bulla, eustachian tube, and ossicular chain) were created. Promontory, cochlea window, tympanic, and septum bulla as well as ossicles were easily and clearly distinguished except for the incus and stapes of the clinical patients. VO images were not more suitable than images created with conventional CT for accurately diagnosing otitis media in this study. However, it appears that VO could be more feasible for assessing the complex structure of the inner ear in dogs with fluid-filled tympanic cavities since fluid accumulation within the tympanic bulla did not affect the evaluation of bony tissue in the middle ear on VO images.