Aural surgery

Question 1

Main Surgical Diseases

Answer 1

• Aural Hematoma
• Surgery of the Pinna
• Feline Inflammatory Polyps
• Otitis

Question 2

Aural Hematoma cuase

Answer 2

• Violent head shaking or scratching
• Usually due to otitis externa
• Cartilage fractures
• Branches of the great auricular artery rupture and create a hematoma within the cartilage

Question 3

Aural Hematoma treatment optoins

Answer 3

Needle Drainage
vs Surgical Tx

Question 4

Surgery of the Pinna can involve what structures

Answer 4

Can involve skin on concave, convex side or cartilage or all three

Question 5

Pinnal neoplasias that could require surgery:

Answer 5

▸ Actinic keratoses➝Dysplasia➝Squamous
cell carcinoma
▸ Hemangiosarcoma
▸ Mast cell tumor
▸ Basal cell carcinoma
▸ Histiocytomas

Question 6

Otitis Externa

Answer 6

• inflammation of the vertical and horizontal ear canal

Question 7

Otitis Media

Answer 7

• inflammation of the tympanic cavity and membrane

Question 8

Otitis Interna

Answer 8

• inflammation of the inner ear; caused by extension of infection into the petrosal bone from otitis media

Question 9

Otitis Externa - Treatment

Answer 9

Medical Management
* Underlying cause?
* Cleaning/flushing the ear
* Drying agents
* Topical medications

Surgical Management
* When Medical Management Fails
* Cases with neoplastic cause or stenotic canals
* Need to evaluate for concurrent Otitis Media

Question 10

Otitis Media and Interna
- cause in dogs and cats

Answer 10

Dogs:
Extension of Otitis Externa
Bacterial infection
()
Cats:
Extension of Otitis Externa Nasopharyngeal Polyp

Question 11

Otitis Interna - History/Clinical Signs

Answer 11

• Similar to Otitis Media
• Peripheral Vestibular Disease
  > Head Tilt
  > Circling/Rolling/Falling to one side
  > Nystagmus (Fast phase away from lesion)

Question 12

Otitis Media and Interna - Treatment options

Answer 12

medical or surgery

Question 13

Otitis Media and Interna - Medical Treatment

Answer 13

• Underlying cause?
• Remove infected tissue/exudate
• Myringotomy?
• Systemic Antibiotics
  Most cases will require surgery

Question 14

Otitis Media and Interna - surgical Treatment

Answer 14

• Bulla osteotomy (with total ear canal ablation in dogs / ventral bulla osteotomy cats)
• Remove affected tissue
• Culture
• Antibiotics

Question 15

Lateral Ear Canal Resection purpose

Answer 15

• Increased drainage and ventilation
• Facilitates administration of topical agents

Question 16

Lateral Ear Canal Resection indications? contraindications? owner satisfaction?

Answer 16

Indications:
- Minimal hyperplasia
- Small neoplastic lesion on lateral canal

Contraindications:
- Otitis Media

Owner satisfaction is low

Question 17

Vertical Canal Ablation indications? contraindications?

Answer 17

Indications:
- Vertical canal diseased, horizontal canal is normal (rare)
- Benign tumor of vertical canal

Contraindications:
- Otitis Media

Question 18

BOTH, lateral and vertical canal ablations will fail if …

Answer 18

if the underlying dermatologic disease is not addressed

Question 19

Total Ear Canal Ablation (TECA) and Lateral Bulla Osteotomy (BO) indications
(TECA-BO)

Answer 19

• Severe end-stage otitis externa
• Cockers!!
• Neoplasia confined to the external canal

Question 20

(TECA-BO) Post-operative Care

Answer 20

• Multimodal analgesia required!
• +/- Head bandage
• Eye lubricants
• Empirical antimicrobial therapy
• Monitor airway

Question 21

TECA-BO Complications

Answer 21

Facial Nerve Paralysis
Horner’s Syndrome
Incisional infection
Chronic draining tract – etiology??

Question 22

Nasopharyngeal Polyps in Cats - what is it, what can it cause?

Answer 22

• Benign mass of the nasopharynx, auditory tube and/or tympanic cavity
• Cause of otitis media in cats
• Pedunculated, smooth, shiny pink mass

Question 23

Nasopharyngeal Polyps in Cats - locations

Answer 23

1) Behind soft palate
2) Protruding from ear canal

Question 24

Nasopharyngeal Polyps in Cats cause?

Answer 24

Cause unknown – Infectious?? vs Congential??

Question 25

Nasopharyngeal Polyps in Cats - signalment - history - PE

Answer 25

Signalment: - <2years of age most commonly History: - Upper respiratory obstruction (Stertor) - Dysphagia/Gagging - Signs of otitis externa/media PE: - Mass in ear canal or dorsal to soft palate

Question 26

Conservative Management of Nasopharyngeal polyps? recurrence rate?

Answer 26

Traction + prednisolone: 10% recurrence

Question 27

Conservative Management of external ear polyps? recurrence?

Answer 27

Traction + prednisolone: 50% recurrence

Question 28

Ventral Bulla Osteotomy (VBO) should be considered for polyps when:

Answer 28

Neurologic signs High risk of recurrence (Aural location?) Recurrent case!! Recurrence with VBO is <2%

Question 29

VBO Complications

Answer 29

Horners syndrome! – Most cases resolve but can be permanent