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Surgical Treatment of Ear Disease

Background
Infections and other diseases of the ear are some of the most common ailments  treated  by veterinarians.  Most of the time, they are able to be treated and controlled with medication.  However, when medication becomes ineffective, surgery must be considered.
Anatomy
The ear has four main parts; 
  • pinna or (ear flap)
  • canal (vertical and horizontal)
  • tympanic cavity (or bulla)
  • inner ear (not pictured)

Ear Canal Disease

Moisture in the ear canal promotes yeast and bacterial  growth leading to infection, foul odor, and pain.  Hanging ear flaps, canal hair, skin allergies, parasites, tumors and birth defects can contribute to infection. Over time, even with the most  fastidious ear care, many dogs develop chronic changes which  medication cannot resolve. 
Chronic Changes
Long standing and recurrent ear infections results in three important changes;
  • thickening of the ear canal (which blocks the opening) 
  • deep infection of the tympanic cavity
  • resistance to many common antibiotics
As a result of these changes, medical treatment becomes ineffective.

Surgery of the Ear Canal

When medical treatment fails, surgery becomes the only hope for resolution of ear disease.  Success with surgery of the ear canal is as high as 92% depending on the type of procedure, skill of the surgeon, concurrent disease, severity of ear disease, prior ear surgery and overall health of the pet.
Four surgical procedures are available for the treatment of ear disease; 
  • Lateral Ear Canal Resection
  • Vertical Ear Canal Resection
  • Ventral Bulla Osteotomy
  • Total Ear Canal Ablation with Lateral Bulla Osteotomy (TECA) 
The appropriate procedure is chosen based upon the severity and nature of ear disease.  TECA is the most commonly performed procedure in the case of long standing disease.  When TECA is performed, the entire ear canal is removed and the tympanic cavity is opened and cleansed.  TECA is described in further detail below.

As with any surgical procedure, general anesthesia is required.  Fortunately, risk of anesthetic complications is rare in otherwise healthy pets, regardless of age. 

Total Ear Canal Ablation with Lateral Bulla Osteotomy (TECA)


Typical appearance of the surgical site
several weeks following TECA
in a cocker spaniel.
  • The likelihood of curing ear disease with TECA is as much as 92%.
  • TECA involves removing the entire ear canal from the skull, opening and cleansing the tympanic cavity.
  • The appearance of the surgical site when completely healed is quite cosmetic.  The skin heals with a faint scar which cannot be seen if the ear flap hangs down.
  • General anesthesia is utilized for the procedure.
  • An overnight stay in the hospital is required so that post-operative discomfort can be controlled with injectable pain medication.
  • Hearing is typically no worse or better after surgery. 
  • Chronic ear changes and presence of vital structures (e.g., nerves and blood vessels) near the surgical field make complications a real possibility (see below). 
Benefits:
  • Typically, after a recuperative period of 2-4 weeks, no further medication of the ear is required.
  • Pets are relieved of discomfort and often feel “like young pets again”.
  • Pets often lose their “head shyness” which had resulted from constant treatment and pain.
  • Hearing is generally unaffected.
  • In the case of tumors, cancer can be treated more effectively.
Complications and Risks:
Pets may experience the following problems after TECA:
  • infection and/or breakdown of the incision site
  • temporary facial nerve paralysis causing loss of blink and a drooping lip
  • persistent skin disease at the surgical site
Rarely, pets experience:
  • reoccurrence of bulla infection, draining wounds or abscess formation 
  • partial or complete loss of ear flap due to disrupted circulation
  • vertigo; which manifests as head tilt, incoordination and loss of appetite
  • permanent facial nerve paralysis causing loss of blink and a drooping lip
  • massive intra-operative bleeding resulting in death
  • complications (including death) arising from anesthesia
Permanent facial nerve
paralysis following TECA.

Fortunately, most of the above complications are preventable with meticulous surgical technique or are temporary and can be resolved with post-operative care.  Rarely, additional surgery is necessary.





Post-Operative Care:

  • Pain medication is administered orally for several days following the procedure.
  • Antibiotics are administered for several weeks based on deep bacterial culture results.
  • A collar is worn to prevent scratching until sutures are removed 10-14 days after surgery.
  • The incision is monitored for signs of swelling, redness or discharge and kept clean with a moist cloth if necessary.
  • Soft food is fed for several days to ease pressure on the TMJ joint near the surgical site.
  • Activity is restricted to short leash walks.
  • If blink is diminished, the eye is kept lubricated until normal function returns (typically 2-4 weeks).
Cost of the Procedure:
  • This typically includes examination, pre-anesthetic bloodwork, anesthesia, surgery, hospital care, post-operative medications, and two follow-up examinations.
  • Please ask your veterinarian for a detailed surgical estimate for your pet.


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