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.     

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 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 treatment of middle ear cholesteatoma using an oral approach in 2 dogs

Middle ear cholesteatoma is caused by the formation of epidermoid cysts that result in distention and enlargement of the tympanic bulla with subsequent destruction of surrounding tissues. We report treatment of middle ear cholesteatoma in 2 dogs, via an oral surgical approach. Abnormal tympanic bulla contents and the wall compressing the pharynx were successfully removed in both cases. Computed tomography imaging, surgical findings, and histopathology results were consistent with middle ear cholesteatoma in both cases. The outcomes in both cases suggest that an oral surgical approach may be an alternative treatment for middle ear cholesteatoma in dogs.Key clinical message:Despite the limited number of cases described herein, our report indicates that the direct oral approach for canine cholesteatoma may be and alternative approach.     

Effect of tympanic cavity evacuation and flushing on microbial isolates during total ear canal ablation with lateral bulla osteotomy in dogs

OBJECTIVE: To evaluate differences in bacterial numbers, identity, and susceptibility in samples obtained from the tympanic cavity on entry (preflush) and after evacuation and lavage (postflush) and assess perioperative and empiric antimicrobial selection in dogs that underwent total ear canal ablation (TECA) with lateral bulla osteotomy (LBO) or reoperation LBO. DESIGN: Prospective clinical study. ANIMALS: 34 dogs. PROCEDURE: TECA with LBO or reoperation LBO was performed on 47 ears. Pre- and postflush aerobic and anaerobic samples were obtained from the tympanic cavity. Isolates and antimicrobial susceptibility patterns were compared. RESULTS: Different isolates (31/44 [70%] ears) and susceptibility patterns of isolate pairs (6/44 [14%] ears) were detected in pre- and postflush samples from 84% of ears. Evacuation and lavage of the tympanic cavity decreased the number of bacterial isolates by 33%. In 26% of ears, bacteria were isolated from post-flush samples but not preflush samples. Only 26% of isolates tested were susceptible to cefazolin. At least 1 isolate from 53% of dogs that received empirically chosen antimicrobials postoperatively was resistant to the selected drugs. Anaerobic bacteria were recovered from 6 ears. CONCLUSIONS AND CLINICAL RELEVANCE: Accurate microbiologic assessment of the tympanic cavity should be the basis for selection of antimicrobials in dogs undergoing TECA with LBO. Bacteria remain in the tympanic cavity after evacuation and lavage. Cefazolin was a poor choice for dogs that underwent TECA with LBO, as judged on the basis of culture and susceptibility testing results.     

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.     

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.     

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.     

COMPUTED TOMOGRAPHY FEATURES OF MIDDLE EAR CHOLESTEATOMA IN DOGS

We describe the computed tomography (CT) findings in 11 dogs with middle ear cholesteatoma. The cholesteatoma appeared as an expansile tympanic cavity mass with a mean attenuation value of 55.8±4.2 Hounsfield units. There was no appreciable contrast enhancement of the tympanic bulla contense but ring enhancement was seen in four dogs. Due to the slow progressive growth, the lesion causes severe bone changes at the contour of the tympanic bulla, including osteolysis, osteoproliferation and osteosclerosis, expansion of the tympanic cavity, and sclerosis or osteoproliferation of the ipsilateral temporomandibular joint and paracondylar process. Cholesteatoma can cause lysis of the petrosal part of the temporal bone, leading to intracranial complications. Although not definitive, CT provides useful information for distinguishing a middle ear cholesteatoma from otitis media and neoplasia. In otitis media, enlargement of the tympanic cavity is not routinely observed. In tumors that primarily affect the middle or inner ear, the predominant signs are lysis of the contour of the tympanic bulla or the petrosal part of the temporal bone, soft tissue swelling around the middle ear and marked contrast enhancement. In tumors that arise from the external ear, a soft tissue mass is visible within the external acusticus meatus, and the middle ear is only involved secondarily.     

Thoracolumbar spinal arachnoid diverticula in 5 pug dogs

Clinical features, myelography, and computed tomography imaging findings as well as neurological outcome with and without surgery in 5 pug dogs with thoracolumbar arachnoid diverticula are described. Short-term prognosis after surgical therapy may not be as good as reported for other canine breeds, since immediate postsurgical deterioration is possible. Improvement of neurological deficits beyond the presurgical status may take several months.     

Cosmetic results of a ventrally based advancement flap for closure of total ear canal ablations in 6 cats: 2002-2003

OBJECTIVE: To report the outcome of a modified total ear canal ablation (TECA) technique to maintain normal ear carriage in cats. STUDY DESIGN: Case series. ANIMALS: Six cats with external ear canal disease. METHODS: Medical records were reviewed to identify cats in which a modified TECA using a single pedicle advancement flap was used to maintain normal ear carriage. Signalment, histopathologic diagnosis, complications, and outcome were retrieved. Owners were contacted to document long-term outcome. RESULTS: Modified TECA procedures (7) were performed in 6 cats. Normal ear carriage was present immediately after surgery and was preserved at follow-up interview. Owners were satisfied with cosmetic appearance. Histopathologic diagnosis of excised ear masses included ceruminous gland adenocarcinoma (2 cats), ceruminous gland adenoma (2 cats, 3 ears), and inflammatory polyp (2 cats). CONCLUSIONS: Modification of the TECA skin incision preserved normal ear carriage in all cats. Owners were satisfied with overall outcome and with cosmetic result. Rate and nature of complications were similar to previously published data. CLINICAL RELEVANCE: A simple modification of the TECA skin incision to create a single pedicle advancement flap maintains normal ear carriage in cats.     

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.     

MRI findings of a middle ear cholesteatoma in a dog

This article describes the MRI features of a middle ear cholesteatoma in an 8 yr old flat-coated retriever. Physical examination revealed pain on opening the jaw, and otoscopic examination showed tympanic membrane rupture associated with hyperplastic tissue at the entrance of the middle ear. Standard MRI sequences allowed for the identification of a severely expanded bulla containing material that was isointense to brain tissue on T1-weighted images and of mixed intensity on T2-weighted and fluid-attenuated inversion recovery sequences. No postcontrast enhancement of the content was present, but the lining of the bulla was partially enhanced. The images allowed evaluation of the surgical margins and the secondary changes due to the expansion of the mass. Surgery was performed and histopathology confirmed the presumptive diagnosis of cholesteatoma. In the present case, MRI appeared to serve as a good alternative to computed tomography for the diagnosis of cholesteatoma.     

Middle ear cholesteatoma in 11 dogs

Middle ear cholesteatoma is a rare condition in dogs with chronic otitis. Otorrhea, otodinia, and pain on temporomandibular joint palpation are the most common clinical signs. Neurological abnormalities are often detectable. Computed tomography reveals the presence of an expansive and invasive unvascularized lesion involving the tympanic cavity and the bulla, with little or no contrast enhancement after administration of contrast mediu. Video-otoscopy may detect pearly growth or white/yellowish scales in the middle ear cavity. Surgery is the only therapy but is associated with a high risk of recurrence.     

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.     

Results of surgical correction of abnormalities associated with brachycephalic airway obstruction syndrome in dogs in Australia

OBJECTIVES: To describe clinical features of brachycephalic airway obstructive disease in dogs, the incidence of laryngeal collapse in dogs presenting for surgery and the outcome after surgery in dogs with laryngeal collapse. METHODS: Basic clinical details were reviewed retrospectively in 73 dogs. Presence of laryngeal collapse and short-term outcomes after surgery were determined for 64 dogs with complete medical records. Long-term outcomes were reviewed for 46 dogs by telephone survey between 19 and 77 months following surgery. RESULTS: Stenotic nares were present in 31 dogs (42.5 per cent), elongated soft palate in 63 (86.3 per cent) and everted laryngeal saccules in 43 (58.9 per cent). The most common breeds were the pug (19 dogs, 26 per cent), Cavalier King Charles spaniel (15 dogs, 20.5 per cent), British bulldog (14 dogs, 19.2 per cent) and Staffordshire bull terrier (4 dogs, 5.5 per cent). Laryngeal collapse was present in 34 of 64 (53 per cent) dogs. No dogs died perioperatively and only one dog was euthanased as a result of its respiratory disease three years after surgery. Telephone interviews indicated that 26 dogs (56.5 per cent) were much improved after surgery, 15 (32.6 per cent) had some improvement and 5 (10.9 per cent) showed no improvement. Signs that persisted after surgery were snoring during sleep (34 dogs, 73.9 per cent), stertor/stridor while conscious (23 dogs, 50 per cent), excessive panting (13 dogs, 28.3 per cent) and dyspnoea (10 dogs, 21.7 per cent). Long-term outcome was considered good, even in dogs with laryngeal collapse. CLINICAL SIGNIFICANCE: Laryngeal collapse is relatively common in dogs presented for surgical correction of brachycephalic airway obstructive disease. Dogs with severe laryngeal collapse often respond well to surgery. Clinical signs rarely resolve completely following surgery.     

Bilateral ear canal neoplasia in three dogs

Bilateral ear canal infections are common in dogs. Ear canal neoplasia is usually associated with unilateral problems, and is uncommon in dogs. To the best of the author's knowledge, bilateral aural neoplasia has not been reported in dogs, and only four case reports were found in the human literature. This report presents three dogs that had bilateral tumours in their ear canals. They were presented with bilateral otitis externa. All three dogs exhibited tissue proliferation of both ear canals that did not respond to glucocorticoids. Treatment consisted of total ear canal ablation, and tissues were submitted for histopathological evaluation. Case # 1 (a 10-year-old, male cocker spaniel) was diagnosed as ceruminious gland carcinoma. Cases # 2 and 3 were diagnosed as squamous cell carcinoma. Case # 1 was diagnosed 4 years earlier as having keratinization disorder, which was causing its chronic ear problems. Case # 2 (a 5-year-old, female French bulldog) was diagnosed 4 years earlier as having atopic dermatitis, which did not respond to hyposensitization, and only partially responded to glucocorticoids therapy. Case # 3 (a 9-year-old, male German shepherd) was diagnosed by the referring veterinarian as having unilateral ear canal proliferation 2 months prior to presentation. However, otoscopic examination showed bilateral proliferation that obstructed both canals. In summary, bilateral ear canal neoplasia should be considered in cases of nonresponsive, proliferative aural pathology.     

Diagnostic imaging of the canine and feline ear.

Radiographic evaluation of the tympanic bulla is limited. Improper obliquity or angulation of the skull for radiographs or malpositioning of the tongue can result in an inadequate study [4]. Additionally, because of the complex anatomy of the canine and feline skull, with superimposition of multiple osseous structures, radiography can result in false-negative examinations or understimation of the disease present [2]. When compared with surgical findings of 19 clinical cases of presumptive middle ear disease, false-negative radiographic findings were found in 25% of the surgically confirmed cases of otitis media [4]. Therefore, radiographs are not considered to be a highly sensitive mode of diagnosing otitis media. Radiographs may be helpful in determining lysis associated with neoplasia; however, the extent of involvement is still underestimated. In a study comparing CT and radiographic evaluation of otitis media, CT was determined to be more sensitive but less specific than radiography [11]. CT is the preferred modality for the evaluation of the tympanic bulla at our institution. This opinion may be biased by the fact that most cases are presented for recurrent or chronic otitis. Although radiography is more accessible, the availability of CT in local referral settings is increasing as opposed to being limited to university settings. After the cost (i.e., anesthesia, radiographs) and amount of time necessary to make optimum radiographic studies are taken into account, a CT study may actually be faster and more informative. Given our preference for the CT examination, the cost of the examination has been adjusted to make it more appealing to the owner and clinician. For example, a bulla CT study is only 1.3 times the cost of a radiographic bulla study. In conclusion, imaging of the ear canal can provide important information about ear disease, including unilateral or bilateral ear disease, the degree of middle or inner ear involvement, peripheral versus central vestibular disease, an infectious or inflammatory versus neoplastic process, the chronicity of the disease process, involvement of adjacent structures, and postsurgical complications.