Ear surgery

Question 1

What should be done with different laceration of the pinna?

Answer 1

• One skin layer affected = Clean, debride and suture
  -Allow to heal by second intention if small
• Skin and cartilage = Suture with vertical mattress sutures in dogs - Superficial bite engaging skin, deep in cartilage
  -Suture second skin layer with simple interrupted if required
  -Start suturing at ear margin
• Suture skin only in cats - concave surface first
  -bandage ear post-op until suture removal

Question 2

How do aural haematoma form? What happens if untreated?

Answer 2

• Haematoma within pinna due to trauma, head shaking or scratching]
• If untreated can fibrose, contract + distort pinna

Question 3

How are aural haematomas treated? What can medical treatment lead to?

Answer 3

• Medical Tx = needle drainage + injection of methylprednisolone
• usually needs 2-3 treatments
• can lead to abscess formation
• Surgical Tx =
• Acute haematomas - treat immediately in dogs / after 5-6d in cats - stab incision, lavage, drain placement + bandage ear to head
• Chronic haematomas - surgical drainage + suturing of pinna

Question 4

What are different tumours of the pinna?

Answer 4

• Actinic keratoses
• Squamous cell carcinoma
• Haemangioma / haemangiosarcoma
• Basal cell tumour
• Mast cell tumour
• Histiocytoma
• Sebaceous adenoma

Question 5

How would you perform a pinnectomy?

Answer 5

• Incise pinna with scalpel or scissors >1-2cm from lesion
• Curve incision if required to improve cosmesis
• Cautery for haemostasis
• Pull skin of convex surface over cut edge and suture to skin of concave surface
• Simple continuous monofilament suture

Question 6

What are indications for surgical treatment of otitis externa?

Answer 6

• Failure of medical treatment
• Irreversible change in ear canal
• Cutaneous fistula
• Para-aural abscess
• Otitis media or interna

Question 7

What are different procedures for surgical tx of otitis externa?

Answer 7

• Lateral wall resection
  -Improving ventilation of the ear canal to reduce humidity and temperature and allow easier administration of topical medication in cases where ear canal changes are thought to be reversible with medical treatment
• Vertical canal ablation
  -Treatment of severe disease of the vertical canal where the horizontal canal is unaffected e.g. severe hyperplastic otitis, trauma, neoplasia
• Total ear canal ablation + lateral bulla osteotomy
  -Ceruminous gland adenocarcinoma of the ear canal.
  -Extensive irreversible hyperplastic otitis.
  -Presence of otitis media / interna.
  -Failed lateral wall resection

Question 8

What are Complications of lateral wall resection and vertical canal ablation?

Answer 8

• Infection / dehiscence
• Stricture
• Self-trauma

Question 9

What are complications of Total ear canal ablation + lateral bulla osteotomy? (TECA/LBO)

Answer 9

• Horner’s syndrome
• Facial paresis / paralysis
• Haemorrhage from retroglenoid vein or internal carotid
• Infection / dehiscence
• Para-aural abscess
• Reduced hearing

Question 10

What is seen in septic otitis media?

Answer 10

• Almost exclusively seen in dogs
• Pain, altered head carriage, jaw pain, purulent discharge
• Neurological signs =
  -Facial paresis / paralysis
  -Horner’s syndrome
  -Peripheral vestibular disease

Question 11

How is septic otitis media diagnosed?

Answer 11

• History and clinical signs
• Otoscopy - Bulging, loss of translucency, changed colour or perforation of tympanic membrane
• Radiography / CT / MRI - Loss of air density, thickening or lysis of bulla
• Myringotomy if tympanic membrane intact - Cytology and culture

Question 12

What is treatment of septic otitis media?

Answer 12

• medical treatment
• Not in cases with =
  -End-stage irreversible changes of ear canal
  -Extensive changes in middle / inner ear (Osteomyelitis of bulla, Neurological signs)
• Myringotomy / lavage of bulla
• Topical and systemic antibacterials - 4-6 week course
• Surgery if treatment fails (TECA/LBO)

Question 13

What are inflammatory polyps? What do they cause?

Answer 13

• Almost exclusively occur in cats
• Non-neoplastic proliferation of bulla epithelium
• URT viral infection blocks Eustachian tube
• Secretions build up in bulla
• Epithelium becomes inflamed and proliferates
• Can extend to nasopharynx = Dysphagia, stertor, nasal discharge
• Can extend to external ear = Otitis externa
• Pressure in bulla causes neurological signs = Horner’s syndrome, peripheral vestibular disease

Question 14

What is treatment of inflammatory polyps?

Answer 14

• Conservative management =
• Remove polyp by traction
• Oral prednisolone
• Surgery = if medical Tx fails or neuro signs present
• In dogs = TECA / LBO
• In cats = ventral bulla osteotomy (bulla = 2 compartments in cats)

Question 15

What are complications of ventral bulla osteotomy?

Answer 15

• Horner’s syndrome
• Facial paresis / paralysis
• Peripheral vestibular disease
• Haemorrhage from lingual artery
• Damage to hypoglossal nerve