COMPUTED TOMOGRAPHIC ANATOMY OF THE CANINE INNER AND MIDDLE EAR

A series of high-resolution computed x-ray tomography (CT) images of the normal canine middle and inner ear are presented to serve as a reference for optimal interpretation of clinical CT images of animals with diseases affecting this region.     

VIRTUAL CT OTOSCOPY OF THE MIDDLE EAR AND OSSICLES IN DOGS

Virtual otoscopy enables noninvasive 3D endoluminal imaging of the middle ear through postprocessing of computed tompgraphy (CT) data. A standardized imaging approach for the middle ear was established in six normal dogs in an attempt to optimize the clinical application and student education. High‐resolution CT data were obtained. Virtual otoscopic images of the middle ear cavity and ossicles were generated using commercially available software. The views of the four different directions (the ear canal, tympanic bulla, eustachian tube, and ossicular chain) were made for virtual otoscopy. The promontory, cochlea window, tympanic bulla, septum bulla, and auditory tube were distinguished easily and clearly. One of the ossicles, the malleus, was visualized accurately. However, small structures such as the incus and stapes always could not be seen. The main advantage of virtual otoscopy is not only to provide diagnostic information but also to enhance the quality and efficiency of student education, because it contributes to an understanding of the anatomy of the middle ear. We describe the normal topographical 3Dimages of the middle ear of the dog using virtual otoscopy.     

Optimising magnetic resonance image quality of the ear in healthy dogs

The aim of this study was to develop an examination protocol for magnetic resonance imaging, in order to display diagnostically important information of the canine middle and inner ear. To ensure that this protocol could also be used as a basis for determining pathological changes, the anatomical structures of the ear were presented in detail. To minimise stress through anaesthesia in live animals, preliminary examinations were carried out on four dog cadavers. During these initial examinations, three-dimensional (3D) sequences proved to be superior to two-dimensional ones. Therefore, only 3D sequences were applied for the main examinations performed on six clinically healthy Beagles. The anonymised MR images were rated by three experienced reviewers using a five-point scale. The most valuable sequence was a T2-weighted CISS sequence (TR = 16.7 ms, TE = 8.08 ms). This sequence proved to be most suitable for illustrating the inner ear structures and enabled good tissue contrasts. The sequence ranked second best was also a T2-weighted DESS sequence (TR = 19 ms, TE = 6 ms), allowing the imaging of the tympanic cavity and enabling 3D reconstruction due to its isotropic voxels. Due to low contrast and strong noise, the other sequences (TSE, FISP, MP RAGE) were not suitable for anatomical illustration of the middle and inner ear.     

MAGNETIC RESONANCE IMAGING OF THE NORMAL AND DISEASED FELINE MIDDLE EAR

The magnetic resonance imaging appearance of the feline middle ear is described in three healthy cats and in five cats with middle ear disease. Owing to the good spatial resolution, multiplanar slice orientation as well as display high contrast resolution of soft tissue, in particular fluids, MR imaging was helpful prior to surgery. It is superior to radiography which failed to allow identification of the abnormality in two of our five cats. MR imaging for middle ear disease should include dorsal and transverse plane images using T1- and T2-weighted sequences. In the presence of a mass within the bulla or the external ear canal application of contrast medium is helpful.     

金毛犬耳痒螨病引发耳血肿的诊断和治疗

犬耳痒螨病是由犬耳痒螨（Otodecees cymotis）寄生于耳道内引起的皮肤寄生虫病。犬耳血肿是在外力作用下致使犬耳部血管破裂、出血,血液集聚在耳软骨与耳廓内侧皮肤之间形成的肿胀。耳痒螨病是引发耳血肿的重要病因,一旦发病需要及时治疗,严重者采用手术疗法。对一例犬耳痒螨病引发耳血肿进行了诊治,特将诊治过程和相关分析做具体介绍,以供临床参考。     

Congenital malformations of the external and middle ear accompanied by temporal bone anomaly in a calf

A 7-month-old female Holstein calf presented with bilateral microtia and absent external acoustic meatus. The real-time polymerase chain reaction test was negative for bovine viral diarrhea virus and bovine leukemia virus. The calf’s dam had a normal reproductive history. Computed tomography confirmed bilateral atresia of external auditory canals, aplasia of tympanic cavities and the ossicular chain, and temporomandibular joint abnormality. Necropsy revealed a severe malformation of the temporal bone. In the tympanic region, the external acoustic pore, tympanic bulla, and muscular process were absent bilaterally. The bilateral inner ear structure was normal. Based on these findings, we diagnosed the present case as congenital malformations of the external and middle ear accompanied by temporal bone anomaly.     

Inner ear fluid‐attenuated inversion recovery MRI signal intensity in dogs with vestibular disease

The inner ear contains endolymph and perilymph. The second is comparable and in continuity with the cerebrospinal fluid (CSF) so it is expected to suppress in fluid‐attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) if normal. Even though inner ear FLAIR abnormalities have been extensively described in humans with inner ear disease, its diagnostic value in dogs is yet to be proven. The goal of this retrospective cohort study was to investigate the diagnostic utility of FLAIR MRI in dogs with vestibular disease. A review of medical records identified 101 dogs that had brain MRI performed because of vestibular signs. Based on the final diagnosis, patients were allocated to three groups: otitis media/interna, idiopathic vestibular disease, and central vestibular disease. Additionally, a control group (n = 73) included dogs with normal MRI and without vestibular signs. Inner ears were delineated using a region of interest, and signal intensity was measured in FLAIR and T2‐weighted images. The percentages of suppression in FLAIR were calculated and compared between affected and unaffected sides of each individual and between groups using a general linear mixed model. Correlation between suppression and CSF cell count and protein concentration was assessed. Affected inner ears in dogs with otitis media/interna had decreased suppression in FLAIR compared to the unaffected side (P < .001), and all other groups (P < .01). No significant correlation was detected between CSF results and suppression. These results show the diagnostic value of FLAIR in otitis media/interna due to lack of suppression in the affected inner ear.     

Prevalence of clinical and subclinical middle ear disease in cats undergoing computed tomographic scans of the head

Three hundred and ten cats that had CT imaging of the head between January 2000 and December 2007 were evaluated retrospectively. Data that were recorded included signalment, presenting complaint, clinical signs, presence of upper respiratory tract disease, and CT findings. One hundred and one cats had evidence of middle ear disease on CT. Thirty-four of the 101 cats (34%) did not have a primary complaint of ear-related disease, clinical signs or physical findings consistent with ear disease, suggesting that the middle ear disease was subclinical. Twenty-seven of the 34 cats (79%) had concurrent nasal disease. Middle ear lesions were chronic in appearance. With the exception of tympanic bulla lysis, CT findings were similar in cats presenting with primary aural disease versus cats with presumptive subclinical middle ear disease. The majority of the cats did not return for treatment of the identified middle ear abnormalities. Subclinical middle ear disease is relatively frequent in cats undergoing CT imaging of the head. Few cats required subsequent treatment for ear disease although follow up was limited. Identification of subclinical middle ear abnormalities on CT should prompt acquisition of a detailed patient history and bilateral otoscopic examination.     

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.     

Differences between µCT‐imaging and conventional CT for the diagnosis of possible diseases of the middle and inner cat ear

The aim of this study was to check the relevance of using in‐vivo micro computed tomography (µCT) for the diagnosis of possible diseases of the middle and inner ear of the cat. Therefore, on the one hand, differences of the detail detectability between the two imaging methods conventional computed tomography (cCT) and in‐vivo µCT were analyzed. Six healthy cat ears were dissected and scanned several times and the obtained images were compared with each other. On the other hand, histological slices of all ears were prepared and pictures of defined anatomical structures were taken and compared with the identical sectional plane of the µCT‐images. This way it was possible to evaluate the quality and clinical limitations of the in‐vivo µCT. The results show that an in‐vivo µCT is suitable to analyze even the smallest osseous structures, such as the semicircular ducts, the spiral osseous lamina or the ossicles whereas with the help of cCT it is not possible to identify such small osseous structures because of their blurred and less detailed representation. Delicate soft tissue structures as the membranous labyrinth including hearing and vestibular organ cannot be differentiated with as well in‐vivo µCT‐ as with cCT‐images. In‐vivo µCT represent a good possibility for more detailed diagnosis of extremely fine structures which cannot be detected with cCT. Histological slices can nonetheless not be replaced by in‐vivo µCT due to a too low spatial resolution and the limitations of the in‐vivo µCT with regard to the evaluation of soft tissue dense structures.     

COMPARISON BETWEEN COMPUTED TOMOGRAPHIC CHARACTERISTICS OF THE MIDDLE EAR IN NONBRACHYCEPHALIC AND BRACHYCEPHALIC DOGS WITH OBSTRUCTIVE AIRWAY SYNDROME

Prevalence of subclinical middle ear lesions in dogs that undergo computed tomography (CT) and magnetic resonance imaging of the head has been reported up to 41%. A predisposition in brachycephalics has been suggested, however evidence‐based studies are lacking. Aims of this retrospective cross‐sectional study were to compare CT characteristics of the middle ear in groups of nonbrachycephalic and brachycephalic dogs that underwent CT of the head for conditions unrelated to ear disease, and test associations between thickness of the soft palate and presence of subclinical middle ear lesions. One observer recorded CT findings for each dog without knowledge of group status. A total of 65 dogs met inclusion criteria (25 brachycephalic, 40 nonbrachycephalic). Brachycephalic dogs had a significantly thicker bulla wall (P = 2.38 × 10^?26) and smaller luminal volume (P = 5.74 × 10^?20), when compared to nonbrachycephalic dogs. Soft palate thickness was significantly greater in the brachycephalic group (P = 2.76 × 10^?9). Nine of 25 brachycephalic dogs had material in the lumen of the tympanic cavity, compared to zero of 45 of nonbrachycephalics. Within the brachycephalic group, a significant difference in mean soft palate thickness was identified for dogs with material in the middle ear (12.2 mm) vs. air‐filled bullae (9 mm; P = 0.016). Findings from the current study supported previous theories that brachycephalic dogs have a greater prevalence of subclinical middle ear effusion and smaller bulla luminal size than nonbrachycephalic dogs. Authors recommend that the bulla lumen volume formula previously developed for mesaticephalic dogs, (?0.612 + 0.757 [lnBW]) be adjusted to 1/3(?0.612 + 0.757 [lnBW]) for brachycephalic breeds.     

REVIEW OF DIAGNOSTIC IMAGING OF EAR DISEASES IN THE DOG AND CAT

Diagnostic imaging techniques (conventional radiography, computed tomography and magnetic resonance imaging) are an essential tool in the diagnostic work-up of ear diseases. Conventional radiography is commonly used, but often lacks sensitivity. Computed tomography (CT) and magnetic resonance (MR) are complementary imaging studies of the middle ear, labyrinth, internal auditory canal and their contents. CT provides excellent images of bony structures and is indicated where osseous changes are of greatest diagnostic importance. MR is superior in imaging soft tissue components including intralabyrinthine fluid. Therefore, more than one of these imaging techniques may be required in order to make a diagnosis.     

Ear cleaning: the UK and US perspective

Ear cleaning helps maintain the normal otic environment and is important in the treatment of otitis. Over cleaning, however, may trigger otitis through maceration of the epidermal lining. Simple manual cleaning is useful for routine cleansing but doesn't remove tightly adherent debris. Bulb syringes are more vigorous but may damage the ear in inexperienced hands. Devices using mains water pressure or dental machines are also available. Thorough cleaning of the ear canals and middle ear cavity can only be achieved by retrograde flushing using specially adapted catheters, feeding tubes or video otoscopes under anaesthesia. Myringotomy, inspection and cleaning of the middle should be performed if the tympanic membrane appears abnormal. There are a wide variety of cleaning fluids available. Ceruminolytics soften and dissolve cerumen to facilitate cleaning. Surfactants emulsify debris, breaking it up and keeping it in solution. Astringents dry the ear canal surface, preventing maceration. Maintaining a low pH and incorporating antimicrobial agents can inhibit microbial proliferation and glucocorticoids can be used to reduce inflammation. Adverse effects and contraindications following ear cleaning can include maceration, contact reactions, otitis media, ear canal avulsion, vestibular syndrome, Horner's syndrome, facial nerve paralysis and deafness. Care should be exercised in selecting cleaning fluids if the tympanic membranes are ruptured.     

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.     

Neurologic evaluation of the ear.

Diseases of the ear often cause signs of neurologic dysfunction because of damage of peripheral nervous system structures associated with the middle and inner ear. Vestibular dysfunction, facial paralysis, Horner's syndrome, and hearing deficits are the most common neurologic deficits that accompany middle and inner ear disease. Differentiating these signs from disease of the central nervous system is crucial for an accurate diagnosis and prognosis but can be difficult. Understanding the normal anatomy of the ear and its association with the brain is crucial to interpretation of the neurologic examination. This article reviews neurologic dysfunction commonly associated with diseases of the ear and differentiating these signs from central disease.     

Computed tomographic anatomy of the temporomandibular joint in the young horse

Reasons for performing study: The equine temporomandibular joint (TMJ) and its surrounding structures can be difficult to investigate in cases with a clinical problem related to the region. Little previous attention has been given either to a computed tomographic (CT) imaging protocol for the joint or an interpretation of the structures displayed in CT images of the normal joint. Objectives: To provide a CT atlas of the normal cross‐sectional anatomy of the equine TMJ using frozen and plastinated sections as anatomical reference. Methods: Eight TMJs from 4 immature pure‐bred Spanish horses were examined by helical CT. Scans were processed with a detailed algorithm to enhance bony and soft tissue. Transverse CT images were reformatted into sagittal and dorsal planes. Transverse, sagittal and dorsal cryosections were then obtained, photographed and plastinated. Relevant anatomic structures were identified in the CT images and corresponding anatomical sections. Results: In the CT images, a bone window provided excellent bone detail, however, the soft tissue components of the TMJ were not as well visualised using a soft tissue window. The articular cartilage was observed as a hyperattenuating stripe over the low attenuated subchondral bone and good delineation was obtained between cortex and medulla. The tympanic and petrous part of the temporal bone (middle and inner ear) and the temporohyoid joint were seen in close proximity to the TMJ. Conclusions: Helical CT provided excellent images of the TMJ bone components to characterise the CT anatomy of the normal joint. Potential relevance: Detailed information is provided that may be used as a reference by equine veterinarians for the CT investigation of the equine TMJ and serve to assist them in the diagnosis of disorders of the TMJ and related structures (middle and inner ear). The study was performed at an immature stage and further studies of mature individuals are required in order to confirm that the clinical interpretation is not affected by changes occurring with age.     

Anatomy of the ear.

This review of the anatomy is meant to serve as a quick reference to provide the reader with a concise yet thorough overview of the anatomy of the inner, middle, and external ear as well as the physiology of hearing. Additional information is also presented regarding structures located adjacent to the ear that may be important with respect to surgical anatomy.     

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.