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Flashcards in Ear Deck (53):
1

Blood supply to the pinna is by these 3 vessels

  • Caudal auricular vein
  • Caudal auricular artery branches
  • Cranial auricular vein

2

What's going on here?

Q image thumb

Auricular (Aural) Hematoma

3

What are the 3 proposed pathogenesis of auricular hematoma?

  • Physical injury
    • Head shaking, scratching
    • Rarely documented
  • Immune-mediated or inflammatory mechanism
  • Hemorrhage
    • From great auricular artery within cartilage plate

4

Natural course of auricular hematoma, ______ is deposited and rsults ina thickened _____ ear

  • fibrin
  • deformed

5

Fibrous reorganization results in “_______” contracture.

Q image thumb

“cauliflower”

6

Treatment of Auricular Hematoma

• Conservative Management options? (3)

  • Oral prednisolone +/- aspiration
     
  • Needle aspiration and instillation of corticosteroid

 

  • Indwelling Drains

 

7

Treatment of Auricular Hematoma

• Surgical Management is done for these 2 reasons?

  • For larger chronic heamtomas
  • OR if they reoccur after conservative management fails

8

For an indwelling drain for hematomas this can be done with sedation or local, make sure to Evacuate and ____ with sterile_____ to remove as much _____ material as possible

flush; saline; fibrinous

9

For indwelling drain we often use the ____ ____ tube, it's left in until ____ heals besides drain path (__-__weeks)

  • Larson teat tibe
  • cavity
  • 2-3 weeks

10

If the larson teat tube or indwelling drain is removed too soon what can take place

reoccurance

11

What treatment yieds this:

 

• Verygoodprognosis(>90%successreported)

• But May need more than one treatment

Aspiration and instillation of corticosteroid

12

What options are there surgery of hematomas for incision (2)

• Straight

• S-Shaped

13

What other surgical option creates fenstrations on _____ side of the ear

Dermal punch

  • concave

14

What surgical option for hematoma provides multiple sites for drainage avodiing suture placement?

Laser fenestrations

15

Where are the sutures placed after surgical incision of the hematoma?

Sutures placed parallel to long axis of pinna

 

Blood supply to the pinna can be compromised if sutures are placed perpendicular to vessels convex side

16

We want to make sure we irrigate or remove fibrinous exudate, _____ the dead space for surgical incision of the aural hematoma and place multiple _____ sutures

  • obliterate
  • mattress

17

For aural hematoma Postoperative management: 

 

Bandages typically used to ______ ear until sutures are removed, especially in patients that continue to shake their head postoperatively. may be difficult to maintain and keep clean

immobilize

18

What technique is best for aural hematoma surgery and what must be addressed

No single best technique

Underlying cause must be identified

 

 

19

What are the advantages/disadvantages for placing suture in cartilage?

  • Advantages: more support, better alignment
  • Disadvantage: may get thickening around sutures

20

Partial Amputation of the Pinna is the treatment for:

  • _____ of portion of pinna
  • Ear ______
  • Ear tip _____
  • _____(____) dermatitis
  • Frostbite injury
  • ______

  • Avulsion o fportion of pinna

  • Ear fissures
  • Eartipdermatitis
  • Actinic(Solar)dermatitis
  • Cold/frostbiteinjury
  • Neoplasia

21

For Partial Amputation of the Pinna

 

Suture _____ and _____ surface skin edges with _____ _____pattern making sure cartilage is covered

  • concave and convex
  • simple continuous

22

Otitis externa can be caused by:

  • _____ infection or secondary to _____
  • Generalized skin disease
  • Predisposing factors (breed)

 

primary; inflamation

23

Trauma to the external canal can be caused by:

  • ______wounds
  • Avulsion of the ______ ear canal at the ______ liganment between vertical and horizontal canal

  • Penetrating
  • vertical
  • annular ligament

24

Neoplasia to the external canal can be caused by:

  • ______ gland tumors
  • ______ cell carcinoma

  • Sebaceous
  • Squamous

25

The la croix and modifed la croix zepp are examples of this type of resection

  • Lateral ear canal resection

26

Select procedure based on condition of epithelium:

  • No permanent changes – ________ resection may be indicated
  • Permanent epithelial changes – _____tissue

  • No permanent changes – lateral ear canal resection may be indicated
  • Permanent epithelial changes – resect tissue

27

State the type of surgical procedure:

 

  • Facilitates medical treatmentof otitis externa
  • Alters local environment

Lateral Ear Canal Resection

28

Lateral Ear Canal Resection cannot be peformed on what breed?

cocker spanials

29

Lateral Ear Canal Resection can be performed on ____, ____, and ____ breeds despite them having narrow canals

Shar Pei, Chow, Bulldogs

30

What are the other indications for Lateral Ear Canal Resection:

  • Access to _____ _____
  • Select cases with ______

• Access to horizontal canal

• Select cases with masses

31

What is the most common cause of failure from lateral ear canal resection

improper case selection

32

What are the main 2 indications for vertical ear canal ablation

  • Otitis externa
  • Neoplasia affecting vertical canal only

33

What are some TECA/LBO complications?

 

  • Facial nerve _______
  • _______ signs
  • Hearing
  • Wound ______
  • Chronic _____ _____

  • Facial nerve paralysis
    • Incidence as low as 4%; at least half of cases resolve
    • Evaluate tear production pre-op
  • Vestibular signs
    • Usuallytransient
  • Hearing
  • Wound infection
  • Chronic draining tract

34

In terms of hearing being diminished from TECA/LBO procedures, Most already have diminished hearing due to loss of ___ ______ of sound down ear canal to ______

  • air transmission
  • tympanum

35

In terms of hearing being diminished from TECA/LBO procedures, ______ tissue filling the bulla post op and the transmission of ____ through the skin will diminish hearing if otherwise normal

  • Fibrous
  • sound

36

Chronic otitis cases may be deaf due to ______caused by previous treatments

ototoxicity

37

Draining tracts are usually due to incomplete _____ of the _______ in the external ear canal. Which can start arising ____ after the incision was healed!

  • removal
  • epithelium
  • months

38

What do we use to examine the middle ear?

  • ______
  • ____ ______
  • ____

• Otoscopy

• Bulla radiography

• CT

39

What can you do surgically for middle ear disease?

  • _______
  • ____ _____
    • Vental
      • disease confined to or orginating from ____ ear
      • Ear canal is _____
    • Lateral
      • In conjunction with ______

  • Myringotomy
  • Bulla osteotomy
    • Ventral
      • Disease confined to or originating from middle ear
      • Ear canal normal
  • Lateral
    • In In conjunction with TECA

40

Name the polyps that plague the middle ear often in _____?

Feline Inflammatory Polyps

  • Nasopharyngeal Polyps

41

Feline Inflammatory Polyps (Nasopharyngeal Polyps) arise from the _____ ear cavity or _____ _____

  • middle
  • auditory tube

42

Most cats have _______ ______

nasopharyngeal polyps

43

Nasopharyngeal polyps may extend through _____ into the ear canal

tympanum

44

What is the signalment for nasopharyngeal polyps? Is breed predispostion proven, what breeds if so?

  • Young – median age around 2 years (range 0.5 -15 yrs)

  • DSH, Maine Coon, Persian, Abyssinian, Ragdoll, Sphynx, Norwegian Forest

    • true breed predisposition (not proven)

45

What clinical signs do you see with nasopharyngeal polyps?

  • stertorous respiration

  • nasal discharge

  • sneezing

  • voice change

  • dyspnea

  • dysphagia.

46

What do you often see with ear canal polyps? (3)

  • Otorrhea (dark brown ceruminous or purulent exudate)
  • head shaking
  • +/-mass in the ear canal.
  • Otitis media or interna

    • head tilt

    • nystagmus

    • dysequilibrium

47

What is the most common initial treatment of nasopharyngeal polyps?

  • Traction–Avulsion

48

What type of surgical treatment do we perform for nasopharyngeal polyps if there's significant middle ear disease and failed traction-avulsion?

Ventral bulla osteotomy

49

Recurrence of feline inflammatory polyps of middle ear and nasopharynx = ___% recurrence with traction alone

50

50

Recurrence of feline inflammatory polyps of middle ear and nasopharynx:

  • Results of traction significantly improved by administering ________ postop

corticosteroids

51

Recurrence of feline inflammatory polyps of middle ear and nasopharynx:

 

______ ______allows more complete resection of tissue of origin and has a very low rate recurrence.

Bulla osteotomy

52

Name the sirgical procedure we would perform on the ear for these indications: 

• Chronic, recurrent, recalcitrant otitis media

• Inflammatory polyps
• Cholesteatoma ( Epidermoid Cyst)
• Neoplasia

Ventral Bulla Osteotomy

53

What is one of the number one complications of ventral bulla osteotomy in cats and why is that?

Horner’s syndrome

 

  • because the sympathetic nerves run very superficially in the ventromedial compartment and are easily damaged