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.     

Surgical management of otitis externa

The surgical management of otitis externa is discussed in conjunction with failed medical management, primary causes, and proper case selection. The techniques of lateral ear canal resection and vertical ear canal ablation are described in detail.     

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.     

Potential factors affecting the outcome of dogs with a resection of the lateral wall of the vertical ear canal.

The records of 60 dogs that had a resection of the lateral wall of the vertical ear canal (Zepp) were examined. The surgical outcomes were evaluated in association with the following variables: breed, sex, age of onset of the otitis externa, duration of the disease before the surgery was performed, treatment received for the otitis externa, the status of the ear and tympanic membrane at the time of the surgery, the culture results, and concurrent medical problems. The outcome of surgery was acceptable in 45% and unacceptable in 55% of the cases. Breed was the only factor that could be correlated with the outcome. The procedure failed in 86.5% of the cocker spaniels. When surgical outcomes in breeds other than cocker spaniels were evaluated, 63% were acceptable and 37% were unacceptable. Sharpeis were found to have an ear canal of small diameter compared with that of other breeds and a tendency to have better outcomes.     

Resection of a ceruminous adenocarcinoma in a horse by a modified vertical ear canal ablation

A 13‐year‐old Swedish Warmblood mare was presented for evaluation of a mass on the medial aspect of the left vertical ear canal. The mass was initially resected using monopolar loop diathermy. Histopathological diagnosis of the excisional biopsy was a low‐grade malignant ceruminous adenocarcinoma. The clinical and histopathological features of this previously unreported neoplasm in the horse are described. A modified vertical ear canal ablation was performed in order to remove the base of the neoplasm with adequate free margins. The surgical technique is described. No recurrence was noted 2 years after surgery and the appearance and function of the pinna were retained.     

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.     

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.     

BAER testing in a dog with bilateral external ear canal atresia

A 3 yr old male castrated Labrador retriever presented for evaluation and treatment of bilateral atresia of the external ear canals. The owners reported that the dog could hear only loud and high-pitched noises. Computed tomography of the head revealed intact vertical and horizontal ear canals filled with debris and a debris-filled right tympanic bulla. Air- and bone-conducted brainstem auditory evoked response (BAER) testing revealed an elevated response threshold to air-conducted stimuli and greater amplitude waveforms evoked by bone-conducted stimuli. The ear canals were surgically corrected via lateral ear canal resection. BAER testing postoperatively revealed a decrease in the air-conducted BAER threshold. This case is an example of the use of bone-conducted BAER testing to aid in the diagnosis of conductive deafness, and in determining prognosis for normal hearing after surgical treatment of external ear canal atresia.     

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.     

Surgical management of acute ear canal separation in a cat

A 5-year-old cat presented with haemorrhagic left aural discharge, 2 days following a road traffic accident. Otoscopic examination identified disruption of the external ear canal at the auricular/annular cartilage junction. This was managed by total ear canal ablation and lateral bulla osteotomy. Left sided facial nerve deficits were present following surgery. Eighteen months postoperatively there were no auricular problems, however facial nerve deficits persisted. There are no previous reports describing management of acute separation at the auricular/annular cartilage junction of the external ear in the cat or dog. This case report describes the presentation, diagnosis and surgical management of an acute ear canal separation at the auricular/annular junction of the external ear canal in a cat.     

Pathologic changes in otitis externa

Otitic lesions must be evaluated in the context of the whole animal. Accurate historical and clinical assessments are important aids to the pathologist attempting to reach an accurate diagnosis. Primary lesions of the pinna, with or without involvement of the external ear canal, may be an extension of a more generalized dermatologic problem or may specifically involve the ear because of its unique gross and histologic characteristics.     

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.     

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.     

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.     

Cholesterol granuloma as long-term complication of total ear canal ablation in a dog

A 13-year-old cocker spaniel presented with pain on opening the mouth. History of a previous left total ear canal ablation with lateral bulla osteotomy, left intermittent facial palsy and left intermittent head tilt suggested progression of a total ear canal ablation with lateral bulla osteotomy complication. Magnetic resonance imaging revealed a large mass arising from the tympanic bulla. Cytology of aspirates revealed a chronic suppurative inflammatory reaction and numerous cholesterol crystals. The mass was removed by surgical excision and an active drainage system was placed for a few days. The head tilt, facial palsy and apparent pain were resolved by the surgery. Physical examination was unremarkable nine months postoperatively. Bacterial cultures of the collected fluid were negative and histological examination confirmed the diagnosis of a cholesterol granuloma.     

A chondropathy of the pinna in rabbits associated with rabbit haemorrhagic disease

AIMS: To investigate the relationship between loss of parts of the pinna in rabbits and rabbit haemorrhagic disease (MD). METHODS: A case-control study design was employed. Rabbits with ear lesions were shot on farms in various locations in the South Island of New Zealand. For each case, an attempt was made to obtain a sex and size-matched control rabbit from the same farm on the same day. Serum samples were collected immediately after shooting. The serum samples were tested for RHD titres from 1:lO to 1:640. A selection of affected ears was examined histologically. Odds ratios and their 95% confidence intervals were calculated to assess the relationship between ear loss and RHD antibody status at various serological cut-off levels. RESULTS: Affected ears were characterised by firm cartilaginous nodules and ridges, folding of the ear or loss of pinna to form a notch or complete loss of the outer pinna from about 052.0 cm above the intertragic notch. Histological changes in affected ears consisted mostly of focal mineralisation in the auricular cartilage, proliferation of cartilaginous tissue and loss of cartilage. The serological findings showed a significant association between rabbits with ear lesions and elevated RHD titres. CONCLUSION: The loss of the outer pinna in the rabbits under study was due to degenerative and hyperplastic changes in the auricular cartilage with distortion of the pinna, withering and loss of the outer pinna. The serological findings suggests that RHD is a likely factor in the development of the ear lesions.     

Bulla curettage for chronic otitis media and interna in dogs.

In a series of 10 clinically affected and 6 clinically normal dogs, the technique of bulla curettage via the external ear canal, after lateral ear resection, was evaluated. In 5 of the 10 dogs with chronic otitis media and interna, the head carriage became normal 2 to 8 weeks after surgery and remained so for at least 18 months; 4 other dogs improved, but the improvement was either temporary or incomplete. In the clinically normal dogs, postsurgical complications were minimal; the tympanic membrane healed completely in 4 of the 6 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.     

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.     

Separation of the Auricular and Annular Ear Cartilages: Surgical Repair Technique and Clinical Use in Dogs and Cats

Objective— To report a surgical technique for primary repair of separation of the annular and auricular cartilages of the ear and long-term outcome.
Study Design— Case series.
Animals— Cats (3) and dogs (2) with ear canal separation.
Methods— Medical records (1998–2007) of dogs and cats with ear canal separation were reviewed. Long-term outcome was obtained by telephone interview of owners or referring veterinarians.
Results— Three cats and 1 dog had ear canal separation after being hit by a car; there was no history of trauma in 1 dog. Successful repair was achieved by a caudal approach to the ear canal, identifying and debriding separated cartilage edges and using primary repair. A patent ear canal was confirmed in all animals by otoscopy 4–12 weeks later and by ear canalography in 3 animals. Long-term outcome was excellent with no reported complications 10–90 months later (median 24 months).
Conclusions— Both acute and chronic separation between the annular and auricular cartilages, in the absence of middle ear disease, can be successfully treated using primary repair via a caudal approach to the ear canal, with excellent long-term outcome.
Clinical Relevance— Primary repair should be considered in animals with separation of the annular and auricular cartilages.