Exam 3: Lecture 16 - Surgery of the ear Flashcards
(108 cards)
1
Q
what is the definition of otitis media
A
inflammation of the tympanic cavity and membrane
1
Q
what is the definition of otitis externa
A
inflammations of the vertical or horizontal ear canal or both
2
Q
what is the definition of otitis interna
A
inflammation of the inner ear that typically causes vestibular disease in dogs and is nearly always caused by extension of infection into petrosal bone from otitis media
3
Q
what is the definition of presbycusis
A
term used to describe age-related hearing loss
4
Q
what should we always ask owners prior to doing surgery on the ear
A
ask about their perception of the dogs hearing before sx!!
5
Q
T/F: total ear canal ablation (TECA) may diminish hearing and may be unacceptable
A
true!
6
Q
how can we decrease owner dissatisfaction after ear sx
A
be sure to tell owner / make sure they are aware of the dogs hearing deficits prior to sx
7
Q
T/F: Most owners of dogs with severe chronic otitis externa or media do not report substantial changes in their pets hearing after a TECA
A
true!
8
Q
T/F: pain management should be fully integrated into every phase of diagnosis, treatment, and recovery because ear disease and surgical intervention is VERY painful
A
true!!!
9
Q
how can we control pain for ear surgery
A
- local anesthetics (splash blocks)
- postoperative analgesia via the constant-rate delivery catheter
10
Q
what is important to remember for a vet picking a pain scale
A
must find one that the staff may be able to utilize quickly, easily, and consistently
11
Q
T/F: sicker patients may need additional monitoring of oxygen saturation, pulse, and BP once we give sedatives
A
true!
12
Q
what are the 3 parts of the ear
A
inner ear, middle ear, external ear
13
Q
what makes up the inner ear
A
a membranous and bony labyrinth and functions for healing and balance
14
Q
what makes up the middle ear
A
it is formed by the tympanic cavity and connects to the pharynx via the auditory tube (eustachian tube)
15
Q
what makes up the external ear
A
formed by the auditory meatus and a short canal
16
Q
what separates the middle and external ear
A
tympanic membrane
17
Q
what is the opening of the horizontal canal into the middle ear called
A
external acoustic meatus
18
Q
how does the middle ear connect to the nasopharynx
A
the auditory tube (eustachian tube)
19
Q
T/F: nasopharyngeal polyps may extend from the nasopharynx into tympanic cavity and can extrude into the external ear canal
A
true!!
20
Q
how is the feline tympanic cavity divided
A
it is divided into 2 compartments by a thin bony septum
21
Q
T/F: for complete drainage of the middle ear in cats, the bony septum often needs to be perforated
A
TRUE!!
22
Q
what is the promontory of the ear
A
there are post-ganglionic sympathetic nerves that form a plexus
23
Q
T/F: The nerves in the promontory are often traumatized during surgical curettage of the feline middle ear, causing horner’s syndrome
A
TRUE
24
what are the clinical signs of Horner's syndrome
1. drooping of the eyelid on the affected side (ptosis)
2. pupil of the eye affected will be constricted (miosis)
3. affected eye often appears sunken (enophthalmos)
4. prominent third eyelid
25
what are the 8 clinical signs associated with facial nerve paralysis
1. diminished palpebral reflex
2. widened palpebral fissure
3. drooping of the ear and lip
4. excessive drooling
5. blepharospasm
6. elevation and wrinkling of the lip
7. caudal displacement of the labial commissure
8. elevation of the ear on the affected side
26
T/F: facial nerve paralysis and horner's syndrome may be caused by otitis interna, otitis media, or surgery
very true!
27
what are the 4 important landmarks of the base of the ear that we should know for surgery
1. tragus
2. lateral crus of the helix
3. pretragic incisure
4. intertragic incisure
28
what are the 3 surgical techniques for surgery on the ear
1. lateral ear canal resection
2. vertical ear canal ablation
3. total ear canal ablation-lateral bulla osteotomy (TECA-LBO)
29
what are the characteristics of a lateral ear canal resection
1. increases drainage
2. improves ventilation of ear canal
3. facilitates placement of topical medications
30
when is a lateral ear canal ablation indicated
when there is minimal hyperplasia of the ear canal epithelium or small neoplastic lesions of the lateral aspect of the vertical canal
31
when is a lateral ear canal resection contraindicated
1. obstruction or stenosis of the horizontal ear canal
2. concurrent otitis media
3. severe epithelial hyperplasia
32
dogs with what underlying diseases often respond poorly to a lateral ear canal resection
hypothyroidism and primary idiopathic seborrhea
33
T/F: most studies have shown owner satisfaction to be low when lateral ear canal resection is performed for chronic otitis externa
TRUE!!!
34
what is a zep procedure
modification of the original lateral ear canal resection technique which forms a drain board to restrict hair growth at the horizontal canal opening
35
what procedure is this a picture of
zep procedure
36
what procedure is shown in the picture
lateral ear canal resection
37
what is VERY important to talk to the client about when performing a lateral ear canal resection
make sure the owner understands that lateral ear canal resection is not a cure and that medical management of the ear probably will be necessary for the remainder of the animals life
38
when do we perform a vertical ear canal ablation
when the entire vertical canal is diseases but the horizontal canal is normal
39
in what patients is a vertical ear canal ablation used
neoplasia is confined to the vertical canal or in some animals with chronic otitis externa
40
what are benefits of the vertical ear canal ablation compared to a lateral ear canal ablation
1. may result in less postoperative exudation and pain
2. may provide a better cosmetic appearance of the ear
41
what procedure is this a picture of
vertical ear canal ablation
42
what are 3 complications of the lateral ear canal resection or vertical ear canal ablation
1. inadequate drainage and continues otitis external
2. clinical signs may not be relieved in dogs with underlying dermatologic disease that cannot be effectively managed
3. if drainage is insufficient, the result is persistent or recurrent signs of otitis externa
43
T/F: facial nerve palsy is a rare complication of vertical ear canal ablation
TRUE!!
44
Why do we ALWAYS have to perform a bulla osteotomy in conjunction with a TECA for otitis externa and media?
Because when we remove the avenue for drainage by performing a TECA and dont treat the otitis media it is a disaster
45
what are the 6 indications for TECA-LBO
1. chronic otitis externa, unresponsive to medical management
2. severe calcification and ossification of ear cartilage
3. severe epithelial hyperplasia extending beyond the pinna or vertical canal
4. when lateral ear resection has failed
5. severely stenotic ear canals
6. neoplasia of horizontal ear canal
46
T/F: Because of the potential for serious complications a TECA-LBO should not be performed on animals with mild disease or by surgeons unfamiliar with anatomy of the ear
very very true!!
47
Explain the 6 basics steps of performing a TECA-LBO
1. make a t-shaped incision
2. retract skin flaps and reflect loose connective tissue and expose the lateral aspect of the vertical canal
3. dissect around the proximal and medial aspects of the vertical canal
4. continue the dissection to the level of the external acoustic meatus
5. excise the horizontal canal attachment to the external acoustic meatus with a scalpel blade
6. use a curette to carefully remove secretory tissue that is adherent to the rim of external acoustic meatus
48
what does a lateral bulla osteotomy do
exposes the tympanic cavity so that exudate and secretory epithelium can be removed
49
what does a ventral bulla osteotomy do
allows increased exposure of the tympanic cavity and allows both bullae to be opened without the need to reposition the animal
50
when is a ventral bulla osteotomy used
when middle ear neoplasia is suspected in cats that have nasopharyngeal polyps
51
what procedure is this
ventral bulla osteotomy
52
what procedure is this
modified TECA-LBO in a cat
53
what procedure is this
TECA-LBO
54
why is it important to monitor patients very closely after a VBO (ventral bulla osteotomy)
bandages or excessive swelling, particularly after bilat TECA and lateral bulla osteotomy may impair patient respiration
55
T/F: Facial paralysis, vestibular dysfunction and horners syndrome are not usually caused by otitis media, otitis interna, or by surgery
FALSE! they all may be caused by otitis media, otitis interna, or surgery
56
why is it important to note any abnormalities prior to sx
to avoid having them considered as surgical complications
57
What do we warn cat owners about when doing a VBO
that horners syndrome and facial nerve paralysis are common after the procedure
58
what are the 7 complications of TECA-LBO
1. superficial wound infection
2. facial nerve paralysis
3. vestibular function
4. deafness
5. avascular necrosis of the skin of the pinna
6. chronic fistulation or abscessation
7. intraoperative arterial hemorrhage that may be life-threatening
59
what are the characteristics of facial nerve paralysis
1. usually resolves within a few weeks of sx
2. caused by stretching or retraction of the nerve
3. permanent damage may occur if the nerve is transected or is severely stretched
4. occurs in 56% of cats after TECA
5. can be permanent in approx 1/4 of patients
60
T/F: aural hematomas are a primary problem
FALSE! Secondary problem
61
what is an aural hematoma
a collection of blood within the cartilage plate of the ear which is usually a fluctuant, fluid-filled swelling on all or some of the concave surface of the pinna
62
what are 5 causes of aural hematomas
1. secondary to head shaking or scratching
2. in cats usually secondary to otodectes cynotis
3. originates from branches of the great auricular artery within fractured articular cartilage
4. trauma
5. increase capillary fragility as with cushings disease
63
what is the common signalment/history of aural hematomas
1. more common in floppy-eared dogs
2. history of violent head shaking
3. history of acute or chronic otitis externa +/- otitis media
64
T/F: The underlying disease must be ID and treated to reduce likelihood of recurrence of aural hematoma
TRUE!
65
what are the 3 goals of surgery for an aural hematoma
1. remove the hematoma
2. prevent recurrence
3. retain the natural appearance of the ear
66
what are the 3 most common treatments for aural hematoma
1. incising the tissue overlying the hematoma
2. evacuating blood clots and fibrin
3. holding the cartilage in apposition until scar tissue can form
67
what are the alternative methods to treat aural hematoma
placement of a drain or cannula or lasers
68
T/F: the incision of an aural hematoma is left open to drain
true!
69
what are the 6 important things to remember about aural hematomas
1. S-shaped incision made on the concave surface
2. incision extends from end-to-end of the hematoma
3. sutures are parallel to the majors vessels
4. leave no pockets to collect fluid
5. do NOT ligate visible branches of the great auricular artery
6. do NOT suture the incision closed
70
T/F: alternatively the ear can be secured using an aural hematoma pad
true!
71
what are the characteristics of aural hematoma pads
1. pad is secured to the ear using additional horizontal mattress sutures
2. hematoma pads are available commercially
3. can also be made using simple materials found in most vet hospitals
72
how do we place an aural hematoma pad
1. remove sponge from scrub brush and split it in half to decrease the thickness of the sponge
2. trace the outline of the pinna on the piece of radiographic film
3. glue the sponges to the radiographic film to completely cover the outline of the pinna
4. once glue dies, cut along the trace of the pinna outline
5. attach aural hematoma pad to concave aspect of the pinna with 3 to 4 full thickness mattress sutures
6. pad is removed in 3 days
73
what technique is this
aural hematoma pad
74
what technique is shown in this picture
aural hematoma pad
75
what are the characteristics of neoplasia of the pinna and external ear canal
1. relatively uncommon in dogs and cats
2. benign or malignant
3. most common are from the ceruminous glands
4. more aggressive in cats than dogs
5. often associated with otitis externa, media, interna
76
what are the 7 types of malignant neoplasia of the pinna and external ear canal
1. ceruminous gland adenocarcinomas
2. Squamous cell carcinomas
3. MCT
4. basal cell tumors
5. melanomas
6. fibrosarcomas
7. lymphomas
77
what are the 8 types of benign neoplasia of the pinna and external ear canal
1. inflammatory polyps
2. cholesteatomas (epidermoid cysts)
3. basal cell tumors
4. papillomas
5. histiocytomas
6. fibromas
7. ceruminous gland carcinomas
8. fibromas
78
what are the surgical techniques we can use for neoplasia in the ear
1. lateral ear resection
2. TECA-LBO
3. pinnectomy
4. pinnectomy with vertical ear canal ablation
79
how can we treat small superficial tumors
cryotherapy or chemotherapy
80
T/F: the most important aspect of sx for ear neoplasms is achieving wide margins to prevent local recurrence
TRUE
81
T/F: if aggressive surgical therapy cannot provide clean margins, we do not need to use any other type of therapy
false, we should consider adjunctive therapy
82
_______ ear tumors must be excised with wide margins or normal tissue and the owner should be made aware
malignant ear tumors
83
what is the surgical technique for small tumors on the central portion of the convex surface of the pinna
1. resect the neoplasm and mobilize the skin around the defect by undermining between the cartilage and the skin
2. suture the skin margins or if needed leave the defect open to heal by secondary intention under a light bandage
84
T/F: for malignant ceruminous gland tumors of the external ear, ablation is seldom curative
true!
85
T/F: local recurrence of squamous cell carcinoma is common if wide margins are not obtained
true!!
86
prognosis is _____ with squamous cell carcinoma of the middle and inner ear
poor
87
_____ tumors of the pinnae tend to be very aggressive
mast cell tumors
88
T/F: early surgical treatment of aural cholesteatoma in the bullae may be curative but recurrence after sx is seen with advanced disease
TRUE
89
what are the 7 characteristics of SCC of the pinna in cats
1. most common tumor of pinna in cats
2. usually in older cats
3. more common in white cats or cats with lack of protective pigmentation
4. solar radiation is a causative factor
5. highly invasive
6. metastasis is uncommon
7. may be noted on nares and eyelids
90
what condition does this cat have
SCC (squamous cell carcinoma)
91
T/F: Inflammatory polyps are benign, fibrous, pedunculated masses that can be found in oropharynx, middle ear, or external ear canal
true!
92
where are inflammatory polyps presumed to originate
epithelial lining of the tympanic bulla or eustachian tube
93
inflammatory polyps are the _____ most common cause of nasopharyngeal disease in cats
second most common
94
T/F: Inflammatory polyps can not occur in dogs
FALSE! They can but are more common in cats
95
do we know the cause of inflammatory polyps
no we do not!
96
what is the usual signalment of inflammatory polyps
1. tend to occur in younger cats that are <2 yrs old
2. no breed or sex disposition
3. dogs that get them are typically male and middle aged
97
what is the usual history seen with an inflammatory polyp
1. most cats present for eval of dysphagia or upper respiratory signs
2. they may present for signs of otitis external
3. may be presented for acute onset of a head tilt, nystagmus, and or vestibular imbalance
4. clinical signs may be present for months before evaluation
98
what is the usual PE findings for inflammatory polyps
1. most are unilateral
2. may have concurrent otic or nasopharyngeal polyps
3. usually pink and pedunculated
4. often covered with mucus or blood
5. usually have upper respiratory obstructive signs
6. may have secondary infections
99
T/F: Lateral rads of the pharyngeal region are most useful for diagnosing nasopharyngeal polyps
true!!
100
what is CT good for when talking about polyps
it is the gold standard for determining the extent of involvement and whether the condition is unilateral or bilat
101
T/F: Medical management is successful for polyps
false! Surgery is usually indicated
102
what are the 4 ways to surgical treat polyps
1. traction-avulsion of the mass (rip it out...lol)
2. VBO
3. lateral ear canal resection
4. TECA with a LBO and myringotomy
103
what is the BEST surgical treatment of polyps
VBO (recurrence is less than 2%)
104
T/F: VBO should always be performed if middle ear disease is evident on rads or CT
true!!
105
what is the prognosis for polyps
1. excellent with complete removal of the polyp
2. nasopharyngeal polyps may be less likely to recur than aural ones
3. horners syndrome typically resolves within a few weeks
4. rarely, temporarily, or permanent vestibular signs
5. transient facial nerve paralysis is uncommon
106
Do polyps affect hearing
unlikely due to BAER testing
107
T/F: polyp recurrence and long-term adverse effects are rare
true!
