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CFT II > Exam 2 - Surgical Management of Ear Disease > Flashcards

Exam 2 - Surgical Management of Ear Disease Flashcards

1
Q

what are the important anatomic structures that make up the external ear?

A

pinna

auditory meatus

vertical canal

horizontal canal

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2
Q

where does the external ear terminate & the middle ear begins?

A

terminates the the level of the tympanic membrane

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3
Q

what are the important anatomic structures that make up the middle ear?

A

tympanic membrane

tympanic cavity within the bulla

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4
Q

where does the middle ear connect to the pharynx?

A

connects to the pharynx via the auditory tube

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5
Q

what are the major functions of the inner ear?

A

sound perception & balance

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6
Q

what are the important anatomic structures that make up the inner ear?

A

bony labyrinth

membranous labyrinth - vestibule, cochlea, & semicircular canals

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7
Q

in the cat, which compartment of the tympanic cavity is larger?

A

ventromedial compartment

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8
Q

what separates the tympanic cavity in cats?

A

bony septum - that is patent dorsally & has the sympathetic plexus more exposed

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9
Q

what is the importance of the dorsolateral compartment of the tympanic cavity in cats?

A

contains the ossicles & communicates with the tympanic membrane

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10
Q

where does the facial nerve lie in regards to the ear canals?

A

caudoventral to the canal at the level of the terminal horizontal canal

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11
Q

what is the main concern regarding vasculature around the ears of dogs & cats when considering surgery?

A

there are a lot of very large vessels in your surgical field

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12
Q

what are the 2 broad categories that indicate the need for ear surgery in companion animals?

A
  1. primary disease - either space occupying lesions or trauma
  2. secondary diseases - dermatological stuff
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13
Q

what is the most common neoplasia of the ear canal?

A

adenocarcinoma

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14
Q

what are some neoplasias that commonly occur on the pinna that are a primary disease?

A

SCC, mast cell tumors

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15
Q

what are some primary non-neoplastic growths that occur on the ears that require surgical intervention?

A

aural polyps & epithelial hyperplasia

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16
Q

what are some examples of how trauma indicates the need for surgical intervention regarding the ear?

A

pinna lacerations

separation of the vertical & horizontal ear canals

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17
Q

for otitis externa/media, when should you consider the need for surgery for correcting this secondary disease?

A

ear canal is calcified

ear canal is too stenotic to medicate

patient will not tolerate medications

poor client compliance

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18
Q

T/F: after surgical correction for otitis externa/media, you still need to address the underlying cause of disease

A

true

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19
Q

what is the minimum database for working up a patient for ear surgery?

A

otoscopic exam

advanced imaging - especially with neoplasia, CT

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20
Q

what is another name for the Zepp procedure?

A

lateral ear canal resection

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21
Q

when should you not do a lateral ear canal resection surgery?

A

in cases where the horizontal ear canal is obstructed!!!

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22
Q

T/F: there is an 86% unacceptable outcome in a lateral ear canal resection surgery in cocker spaniels

A

true

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23
Q

why is success variable in lateral ear canal resection surgeries?

A

lifelong medications are still necessary in most cases - need to educate owners on this

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24
Q

what is the purpose of a lateral ear canal resection procedure? what must be addressed?

A

aids in the managemnet of mild cases of non-proliferative otitis externa

facilitates cleaning & medicine application, increases ventilation

must address otitis media!!!!

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25
Q

the picture shows the approach used for what procedure?

A

lateral ear canal resection

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26
Q

when is a vertical ear canal resection used? what is the advantage of this compared to TECA?

A

used when the vertical canal is DISEASED but the horizontal canal is NORMAL

preservation of anatomy!!!

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27
Q

what are the specific indications for a vertical ear canal resection?

A

neoplasia of the vertical canal ONLY - rare (think about margins)

traumatic separation of the vertical & horizontal ear canal!!!

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28
Q

the picture shows the approach used for what procedure?

A

vertical ear canal resection

29
Q

what procedure is required alongside a TECA? why?

A

concurrent bulla osteotomy - need to remove exudate & secretory epithelium

30
Q

what are the indications for performing a TECA-LBA?

A

irreversible chronic otitis - with calcification of the ear canal & epithelial hyperplasia

neoplasia

owner or patient compliance issues

31
Q

what does TECA-LBO stand for?

A

total ear canal ablation & lateral bulla osteotomy

32
Q

the picture shows the approach used for what procedure?

A

TECA-LBO

33
Q

T/F: in a TECA-LBO surgery, you should always submit the ear canal for histopathology once it is removed

A

true

34
Q

what must you do with the cuff of tissue around the osseous meatus when doing a TECA-LBO surgery? why?

A

remove the cuff of tissue - risk of causing a draining tract

35
Q

what should you avoid doing around the tympanic cavity when doing a TECA-LBO surgery?

A

avoid aggressive curettage of the dorsal & medial aspect of the tympanic cavity

36
Q

what should you do prior to closure of a TECA-LBO surgery?

A

lavage the site thoroughly & then obtain a culture of the surgical site

37
Q

if a drain is placed after a TECA-LBO surgery, how long is it left in? what is very important to do alongside drain placement?

A

3-5 days (penrose) - bandaging!!!

38
Q

T/F: there is no significant difference in complications following TECA-LBO surgeries with primary closure vs. drain placement

A

true

39
Q

what happens if you bandage a dog too tight after TECA-LBO surgery?

A

they can’t breath

40
Q

is this correct for bandaging? why?

A

yes - doesn’t close off the ear

41
Q

what are the indications for ventral bullae osteotomies?

A

indicated for middle ear disease - inflammatory polyps in cats & otitis media with mild otitis externa issues

42
Q

what is the difference between a nasopharyngeal polyps & aural polyps?

A

nasopharyngeal - originate at the auditory tube & passively grow into the nasopharynx or nose

aural - extend from the middle ear through the tympanic membrane into the ear canal

43
Q

what is the etiology for inflammatory polyps in cats?

A

not too sure - we think chronic inflammation/viral causes

44
Q

what is the common signalment of cats affected by inflammatory polyps?

A

young cats - 1.5-3 years old

45
Q

what type of exam should you always do if you think a young cat may have an inflammatory polyp? why?

A

pharyngeal exam - may be hiding behind the soft palate

46
Q

what are the clinical signs of nasopharyngeal inflammatory polyps in cats?

A

stertorous breathing, upper airway obstruction, & nasal discharge

47
Q

what are the clinical signs of aural inflammatory polyps in cats?

A

otitis externa/media/interna signs (discharge from ear, painful ear, head tilt, nystagmus, horner’s syndrome)

48
Q

why will you never do a bilateral vertical bulla osteotomy in a cat with aural inflammatory polyps?

A

significant risk for airway obstruction & death!!!!!!!

49
Q

what treatment is used for nasopharyngeal inflammatory polyps in cats?

A

traction removal followed by prednisolone for 2-4 weeks - 33-57% recurrence rate

50
Q

what treatment is used for aural inflammatory polyps in cats?

A

traction assisted by video endoscopy - recurrence 13.5%

vertical bulla osteotomy for surgical correction - 0-33% recurrence

51
Q

what should you consider when choosing a surgery for ear disease?

A
  1. overall systemic health - consider a biopsy if cancer is a concern
  2. owner compliance & goals - communication & education
  3. consider advanced imaging & know what you’re getting yourself into
52
Q

what is the surgical approach used for a ventral bulla osteotomy?

A

cat is placed in dorsal recumbency with cervical support to extend the neck to maximize surgical access

skin incision is made over the ventral aspect of the bulla & dissection of muscles is done, mandibular salivary gland & bifurcation of the linguofacial & maxillary veins are retracted from the surgical field - avoid manipulation of the hypoglossal nerve which is close to the lingual artery

after the bulla is located, the periosteal covering is stripped & osteotomy is done with removal of mucus & dismantling of the bony septum separating the two compartments of the tympanic cavity of the cat & the polyp is removed & any residual debris is removed with gentle irrigation

53
Q

how is antimicrobial therapy used for surgical correction of ear diseases?

A

empirical treatment to start until you get culture results for at least 4 weeks!!!!

large variation of isolates between external ear & middle ear - need to base choice off of culture & sensitivity

54
Q

T/F: otitis media impairs hearing without surgery

A

true

55
Q

clients usually are concerned about their pet’s ability to hear after ear surgery - how do you respond to this?

A

otitis media impairs hearing without surgery

TECA-LBO surgery dogs still respond to loud and/or high pitched voices/noises

cats can still hear after VBO

bottom line - if the disease is already severe, owners are unlikely to notice a difference

56
Q

how is incisional dehiscence +/- infection treated as a complication following ear surgery?

A

need to treat the underlying disease - often leave it open to granulate

57
Q

how are draining tracts treated as a complication following ear surgery?

A

these can occur up to several months after surgery due to the incomplete removal of secretory epithelium & debris which causes the formation of a fistula!

go back in & get it out

58
Q

T/F: nerve damage as a complication of ear surgery is not always permanent

A

true

59
Q

what are some signs of facial nerve damage following ear surgery?

A

damage in up to 40% of dogs & 60% of cats

loss of palpebral reflex & lip droop

60
Q

what are the signs of horner’s in cats? what causes this following ear surgery?

A

damage to the sympathetic trunk during surgery - way more common in cats, up to 42%

miosis, ptosis, enophthalmos, & protrusion of the 3rd eyelid

61
Q

why is a pre-op exam before surgery important to perform in regards to nerve damage?

A

pre-existing nerve dysfunction is unlikely to resolve after surgery - need to see if it is present to start with

62
Q

what are signs of damage to the cochlea/semicircular canals following ear surgery?

A

vestibular signs - nystagmus, ataxia, circling, head tilt

63
Q

what animals have a higher risk of airway obstruction during ear surgery? what do you do if there is bilateral disease present?

A

cats & brachycephalic dogs!!!!

need to stage sides in at risk animals

64
Q

what animals are at risk of the collapse of the ear carriage following ear surgery?

A

cats & dogs with erect ears

65
Q

what complication are you concerned about following lateral or vertical resection of the ear canals?

A

collapse of remaining external ear canal or stenosis of the opening created (lateral & vertical resection)

66
Q

T/F: after a lateral ear canal resection, medical therapy is done

A

false

67
Q

should you perform lateral ear canal resections if the vertical & horizontal canals are significantly affected by disease?

A

NOPE

68
Q

these animals are displaying neurological signs after ear surgery - what is this condition called? why is it happening?

A

horner’s syndrome - damage occurred on the sympathetic trunk

CFT II (28 decks)

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