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.     

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.     

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.     

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.     

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).     

Breed variations in histopathologic features of chronic severe otitis externa in dogs: 80 cases (1995-2001)

OBJECTIVE: To compare pathologic changes of the horizontal ear canal associated with chronic severe otitis externa between Cocker Spaniels and dogs of other breeds. DESIGN: Retrospective study. ANIMALS: 80 dogs with severe otitis externa that required total ear canal ablation with lateral bulla osteotomy. PROCEDURE: Medical records were reviewed for breed, sex, and age at time of surgery. Histologic specimens from the horizontal ear canal were evaluated by a single examiner for overall tissue response pattern and scored for sebaceous gland hyperplasia, ceruminous gland hyperplasia, ceruminous gland ectasia, fibrosis, pigment-laden macrophages, and osseous metaplasia. RESULTS: 48 of 80 (60%) dogs were Cocker Spaniels. Thirty-five of 48 (72.9%) Cocker Spaniels had a predominately ceruminous tissue response pattern; only 9 of 32 (28.1 %) dogs of other breeds had the same pattern. Other breeds most commonly had a pattern dominated by fibrosis (n = 13 [40.6%]); fibrosis was the predominant pattern in only 4 of 48 (8.3%) Cocker Spaniels. Discriminant analysis and K-means clustering of 4 histopathologic criteria correctly classified 75% of the dogs as Cocker Spaniels or all other breeds. CONCLUSIONS AND CLINICAL RELEVANCE: Cocker Spaniels are at increased risk for chronic severe otitis externa requiring total ear canal ablation with lateral bulla osteotomy, indicating that earlier and more aggressive management of the primary otitis externa and secondary inflammation is warranted in this breed. Cocker Spaniels with chronic severe otitis externa have distinct differences in pathologic characteristics of the horizontal ear canal, compared with other breeds.     

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.     

Otitis media in a llama

A 7-month-old female llama was examined because of chronic otitis media and externa of 7 months' duration. Radiographically, the tympanic bullae appeared thicker than normal, and the ventral borders were poorly defined; the left external acoustic meatus (ear canal) appeared to be narrower than the right. The llama was treated with penicillin, and the ear canals were lavaged daily. Contrast radiography was performed on day 15 to determine the shape and size of the ear canals and evaluate the integrity of the tympanic membranes. Contrast medium was visible radiographically in the left tympanic bulla, indicating that the left tympanic membrane was ruptured, but the right tympanic membrane appeared to be intact. The left ear canal was narrower than the right, and the bony ear canals had a well-defined sigmoid shape. The right ear improved with medial treatment alone, but the left ear did not. Therefore, lateral ear canal resection was performed. After surgery, however, exudate was still evident in the left ear canal, and the llama became more lethargic and more reluctant to eat. Lateral bulla osteotomy was attempted, but no purulent material was obtained, and curettage of the bulla resulted in hemorrhage. Because of this and because of the llama's poor physical condition, a decision was made to euthanatize the llama. The sigmoid shape of the bony ear canal and the multicompartmental nature of the tympanic bulla make surgical treatment of otitis media and externa in llamas difficult. Further study of surgical treatments for otitis media in llamas is needed.     

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.     

Surgical management of chronic otitis secondary to craniomandibular osteopathy in three West Highland white terriers

Three West Highland white terriers were presented for investigation of left‐sided para‐aural abscessation. CT revealed chronic otitis media with extensive osseous proliferation surrounding the horizontal and vertical ear canals contiguous with the expanded temporal bone, consistent with a unilateral variant of craniomandibular osteopathy. A left total ear canal ablation with lateral bulla osteotomy was performed in all dogs. An ultrasonic bone curette (Sonopet; Stryker) proved useful when removing the osseous proliferation in two dogs. Histopathological examination of the ear canals was consistent with craniomandibular osteopathy and the treatment led to resolution of the presenting clinical signs in all dogs. To our knowledge, this is the first report of craniomandibular osteopathy engulfing the external ear canal, presumably leading to chronic otitis media and para‐aural abscess formation. This is also the first reported use of an ultrasonic bone curette in canine otic surgery.     

Comparison of Three Methods for Relief of Pain After Ear Canal Ablation in Dogs

This study compared three methods of pain relief in dogs that had total ear canal ablation with lateral bulla osteotomy. The hypothesis was that systemic opioids with preoperative local nerve blocks would provide superior pain relief. Thirty-one dogs with chronic otitis externa were included in the study. Dogs were randomly assigned to one of three protocols: systemic opioids alone (10 dogs, group 1), systemic opioids with bupivacaine splash block (11 dogs, group 2), and systemic opioids with preoperative local bupivacaine nerve blocks (10 dogs, group 3). Twenty-one dogs had bilateral ear ablation and 10 had unilateral ablation. Pain was assessed preoperatively, at extubation, 2 hours postextubation, and 1 day postoperatively by a single observer blinded to the analgesic protocol used. Pain scores were not significantly different within or between groups, nor did unilateral versus bilateral ablation have a significant effect on the score. Mean scores were less than 3 (scale 1 to 5) for all groups at all observation times. Rough recoveries were noted in 30% of group 1 dogs, 0% of group 2, and 20% of group 3 dogs. Ninety-four percent of dogs were moderately to heavily sedated at extubation. Sixty percent of group 3 dogs remained moderately to heavily sedated 2 hours postextubation. Rectal temperature, pulse rate, respiratory rate, and postoperative change in serum Cortisol levels were not significantly different between groups. Postoperative increase in blood glucose was significantly higher in groups 1 and 3 compared with preoperative levels. Twenty-three percent of the dogs required additional analgesia or tranquilization after surgery, as determined by the anesthetist; 1 dog in group 1, 2 in group 2, and 4 in group 3. Each of the three analgesic protocols provided similar pain relief in dogs undergoing total ear canal ablation.     

COMPARATIVE PERFORMANCE OF RADIOGRAPHY AND COMPUTED TOMOGRAPHY IN THE DIAGNOSIS OF MIDDLE EAR DISEASE IN 31 DOGS

The purpose of this study was to compare computed tomography (CT) and radiography for diagnosing the presence and severity of middle ear disease in dogs with a history of chronic otitis externa. Thirty-one dogs undergoing a total ear canal ablation and bulla osteotomy were studied. Three normal dogs served as controls. All dogs were examined using radiography and CT. Three radiologists independently evaluated imaging studies in random order. A visual analog scale method was used for scoring certainty and severity of middle ear disease. Surgical findings were recorded intra-operatively. Bulla lining samples were submitted for histopathologic evaluation and scored by a single pathologist who also used a visual analog scale system. Findings from both imaging modalities agreed more closely with surgical findings than with histopathologic findings. With either surgical or histopathologic findings as the gold standard, CT was more sensitive than and as specific as radiographs for predicting presence and severity of middle ear disease. Observer performance with CT was more consistent than the performance with radiographs in the detection of changes that occur with middle ear disease. Both radiography and CT were more accurate for predicting the severity of the disease than its presence. Findings indicate that CT is more accurate and reliable than radiography in diagnosing middle ear disease for dogs having concurrent otitis externa, but only when severity of disease is moderate or high. With low severity of disease, diagnostic certainty for both modalities becomes more variable.     

RADIOGRAPHIC APPEARANCE OF THE MIDDLE EAR AFTER VENTRALBULLA OSTEOTOMY IN FIVE DOGS WITH OTITIS MEDIA

Radiographs of the middle ear were made in five dogs 60 to 70 months after ventral bulla osteotomy was performed to treat otitis media. The clinical results of surgery were considered satisfactory in four dogs and unsatisfactory in one. In 4 dogs with satisfactory results, radiographs demonstratd complete reformation of the bulla in 3 operated middle ears (3 dogs), with partial bulla reformation in the three middle ears (3 dogs). Radiographs in one dog with unsatisfactory results showed complete bulla reformation with no increase in lumen opacity. The proliferative bony response obilerating the middle ear previously reported in normal dogs after ventral bulla osteotomy was not seen in any of these patients.     

Total Ear Canal Ablation Clinical Results in the Dog and Cat

The clinical results of 39 consecutive ear ablations (in 28 dogs and three cats) performed over a 15-year period were reviewed. Indications for ear canal ablation included hyperplastic tissue stenosis of the horizontal ear canal (23), failed lateral ear resections (13), and horizontal ear canal neoplasms (3). Ear ablation was successful in alleviating persistent signs of otitis in eight of 15 dogs with horizontal ear canal stenosis due to hyperplastic tissue, seven of 10 dogs with unsuccessful lateral ear resections, and two of five animals (three cats and two dogs) with horizontal ear canal neoplasms (follow-up time periods greater than 5 months). Surgical complications occurred following 82% of the ablations; wound infections (41%) and facial nerve damage (36%) were most common. Local wound and antibiotic therapy successfully treated prolonged drainage following ablation in five of nine dogs. Bulla osteotomy and drainage were successful in the treatment of three dogs (four ears) that were unresponsive to medical therapy with postoperative ear fistula following ablation, one of two dogs with prolonged ear drainage following ablation for failed lateral ear resection, and one dog with recurrence of signs of inner ear disease following ablation (follow-up period, 1 month to 4 years; mean, 3.4 years). Facial nerve damage caused by ablation was transient in nine of 14 ears, with most deficits returning to normal within 2 weeks.     

Chronic otitis externa/media with total ear canal ablation and bulla curettage in a North American bison (Bison bison).

An adult female North American bison (Bison bison) with a chronic otitis externa/media of the right ear was examined because of a 4-mo history of intermittent anorexia, apparent painful behavior, and auricular discharge from the right ear. Computerized tomography (CT) demonstrated osteolysis of the tympanic, petrous, and squamous aspects of the temporal bone with soft tissue replacement and sclerosis of the right bulla. A total ear canal ablation with bulla curettage was performed, and cefazolin-impregnated polymethacrylate beads were left within the right bulla and the remnant temporal bone. Six months after the surgery, the bison had no clinical signs of otitis media.     

Subtotal ear canal ablation in 18 dogs and one cat with minimal distal ear canal pathology

A modified technique for performing total ear canal ablations is described. This technique requires less dissection than the standard technique and maintains a portion of the distal vertical ear canal. Subtotal ear canal ablations were performed in 18 dogs and one cat for the treatment of otitis externa or masses of the horizontal ear canal. Animals with otitis externa had minimal involvement of the distal ear canal. Dermatological problems associated with the remaining ear canal and pinnae occurred in eight animals and resolved with medical management. Normal ear carriage was maintained in all animals with erect ears. Further investigation is required before the procedure can be recommended as a treatment for otitis externa not caused by masses or anatomical abnormalities of the horizontal ear canal in dogs with pendulous ears.     

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.     

Partial ear canal ablation and lateral bulla osteotomy in rabbits

Six lop rabbits were presented with clinical signs of otitis media or externa. The presence of disease was confirmed by computerized tomography examination, with two rabbits suffering from bilateral disease. The rabbits were anaesthetized and underwent surgery of the affected bulla. Rabbits with bilateral disease had a minimum of 2 weeks between procedures. A single vertical incision was made over the base of the vertical canal, which was bluntly dissected free from surrounding tissue. The ventral portion of the vertical canal was removed and a lateral bulla osteotomy was performed. The mucosa at the base of the dorsal vertical canal was apposed and the aural cartilage sutured to form a blind‐ending pouch open at the pretragic incisure. Histopathological samples taken from the dorsal margin of the vertical canal yielded subtle and non‐specific changes in the six samples submitted. All rabbits were discharged within 48 hours of surgery. The cosmetic outcome was excellent with animals retaining visually normal aural anatomy. The partial ear canal ablation/lateral bulla osteotomy procedure is quick and has a good cosmetic result when performed in rabbits.     

Ciprofloxacin as a representative of disk diffusion in vitro susceptibility of enrofloxacin for bacterial organisms from the middle-ear tissue of dogs with end-stage otitis externa

The purposes of this study were to determine whether ciprofloxacin disk diffusion susceptibility test (DDT) results could be used to assess the in vitro susceptibility of otic bacterial organisms to enrofloxacin and to determine the effect of concurrent enrofloxacin administration on the DDT results for enrofloxacin and ciprofloxacin. Thirty dogs with end-stage otitis externa undergoing unilateral total ear canal ablation were enrolled. The dogs were randomized to one of four enrofloxacin-treatment groups or to the control group. Each dog in the treatment groups received two intravenous doses of enrofloxacin prior to surgical removal of the middle-ear tissue while the control group did not receive any enrofloxacin. One dog was excluded from the study as no middle-ear tissue was removed during surgery. Twenty-four dogs were in the enrofloxacin-treatment groups and five dogs were in the control group. In 12 of 29 dogs (41.4%), 14 of 82 (17.1%) of bacteria had discrepancies in DDT results for enrofloxacin and ciprofloxacin. Discrepancies between the control group and treatment groups were not significantly different even though the percentage of discrepancies for the combined treatment group was 19.4% compared to 6.7% for the control group. In this study, ciprofloxacin DDT results were not an accurate indicator of the in vitro susceptibility of enrofloxacin for bacteria isolated from the middle-ear tissue of dogs with end-stage otitis.     

Plasma and ear tissue concentrations of enrofloxacin and its metabolite ciprofloxacin in dogs with chronic end-stage otitis externa after intravenous administration of enrofloxacin

The purpose of this study was to measure the concentrations of enrofloxacin and its metabolite ciprofloxacin following intravenous administration of enrofloxacin in the plasma and ear tissue of dogs with chronic end-stage otitis undergoing a total ear canal ablation and lateral bulla osteotomy. The goals were to determine the relationship between the dose of enrofloxacin and the concentrations of enrofloxacin and ciprofloxacin, and determine appropriate doses of enrofloxacin for treatment of chronic otitis externa and media. Thirty dogs were randomized to an enrofloxacin-treatment group (5, 10, 15 or 20 mg kg⁻¹) or control group (no enrofloxacin). After surgical removal, ear tissue samples (skin, vertical ear canal, horizontal ear canal, middle ear) and a blood sample were collected. Concentrations of enrofloxacin and ciprofloxacin in the plasma and ear tissue were measured by high performance liquid chromatography. Repeated measures models were applied to log-transformed data to assess dosing trends and Pearson correlations were calculated to assess concentration associations. Ear tissue concentrations of enrofloxacin and ciprofloxacin were significantly ( P  < 0.05) higher than plasma concentrations. Each 5 mg kg⁻¹ increase in the dose of enrofloxacin resulted in a 72% and 37% increase in enrofloxacin and ciprofloxacin concentrations, respectively. For bacteria with an minimal inhibitory concentration of 0.12–0.15 or less, 0.19–0.24, 0.31–0.39 and 0.51–0.64 µg mL⁻¹, enrofloxacin should be dosed at 5, 10, 15 and 20 mg kg⁻¹, respectively. Treatment with enrofloxacin would not be recommended for a bacterial organism intermediate or resistant in susceptibility to enrofloxacin since appropriate levels of enrofloxacin would not be attained.