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Flashcards in Sx of ear Deck (59):
1

What are 2 physical causes of an auricular hematoma?

head shaking, scratching

-rarely documented

2

T/F: auricular hematomas can be immune mediated

TRUE- or inflammatory mechanism

3

Auricular hematoma hemorrhage comes from what artery?

from the great auricular artery within the cartilage plate

4

______ results in thickened, deformed ear = auricular hematoma

fibrin deposition

5

Fibrous reorginization in an auricular hematoma results in _____ contracture

cauliflower

-wrinkles up ear, cosmetic defect, can predispose to dermatitis

6

Conservative management options for auricular hematomas?

  • oral prednisolone +/- aspiration
  • needle aspiration and instillation of corticosteroid
  • indwelling drains

7

Reason for auricular hematoma surgery?

larger, chronic hematomas

recurrence after conservative management

clinician preference 

8

T/F: Indwelling drain for auricular hematoma shouldn't be placed with only local anesthesia

False: can be placed with sedation or local anesthesia

9

What can we do to remove as much fibrinous material as possible when using an indwelling drain for auricular hematoma?

evacuate and flush with sterile saline

10

What is the name of the drain used for an indwelling drain for auricular hematoma?

Larson teat tube

11

Indwelling drain for auricular hematoma: 2 types of drain tube?

silastic tubing

butterfly catheter tubing

12

How long do we leave an Indwelling drain in for auricular hematoma?

until cavity heals except for drain path

-about 2-3 weeks

 

13

What is the most common mistake with indwelling drain for auricular hematoma?

removing them too early

14

What is this picture showing?

Q image thumb

Larson's teat tube- Indwelling drain for auricular hematoma

15

Describe a good prognostic factor for conservative tx of auricular hematoma?

case selection- recent hematomas that can be easily evacuated or are small

16

Prognosis of oral pred for auricular hematoma?

very good response

-recurrence rates unknown 

17

Prognosis of aspiration and instillation of corticosteroid for auricular hematoma?

very good prognosis (>90%)

may need more than 1 treatment

18

Prognosis for Larson teat tube and indwelling drains for auricular hematomas?

recurrence of hematoma is common if removed too soon

19

T/F: indwelling drains are considered conservative treatment for auricular hematomas

True

20

What surgical options do we have for auricular hematomas?

incision- straight or S-shaped

dermal punch- create fenestrations on concave side of ear

laser fenestrations- provide multiple sites for drainage avoiding suture placement

21

Surgical incision method for auricular hematomas?

incise from one end of hematoma to other on concave side

remove clot/fibrinous exudate and irrigate

obliterate dead space: pressure bandage or multiple matress sutures

22

For surgical incision when fixing an aural hematoma, what is important to remember when suturing?

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

sutures need to be placed parallel to long axis of pinna (as seen in pic)

A image thumb
23

Describe the post op management of surgical incision for aural hematoma

bandages typically used to immobilze ear until sutures removed, esp in patients that continue to shake their head

may be difficult to maintain and keep clean- change bandages

24

What is the most important aspect in the outcome for aural hematomas?

treat the underlying cause! (if it can be identified) 

 

25

Partial amputation of the pinna is treatment for?

avulsion of portion of pinna

ear fissures

ear tip dermatitis

actinic (solar) dermatitis

cold/frostbite injury

neoplasia

26

How so we suture a partial amputation of the pinna?

suture convex and concave surface skin edges w/ simple continuous pattern making sure cartilage is covered

-skin on inside doesnt move, so suture outside skin so it rolls in on margin

A image thumb
27

Reasons for surgery of the external ear canal? (3)

otitis externa- inflam, skin dz, breed predisposition

trauma- avulsion of vertical ear canal at annular ligament b/t

neoplasia- sebaceous gland tumors, squamous cell carcinoma

28

What is the weak point between the vertical and horizontal part of the ear?

annular ligament

 

29

Can we do a lateral ear canal resection in a cocker spaniel?

NOOOOOOOO

shar pei, chows, bulldogs- narrow canals but do well

30

How do we decide if a dog is a good case selection for a lateral ear canal resection?

ear must be "anatomically" normal or will be normal with treatment

31

What procedure is depicted in the image?

Q image thumb

lateral ear canal resection

32

Indications for a vertical ear canal ablation?

otitis externa

neoplasia affecting vertical ear canal only 

33

Complications of TECA/LBO

facial nerve paralysis- low, half of cases resolve

vestibular signs

hearing

wound infection

chronic draining tract

34

T/F most animals getting a TECA already have diminished hearing 

True: due to loss of air transmission of sound down ear canal to tympanum

35

What will diminish hearing?

fibrous tissue filling the bulla post op and the transmission of sound through the skin

36

T/F: chronic otitis does not cause deafness

False- can cause deafness due to ototoxicity caused by previous treatments

37

_____ forms due to incomplete removal of epithelium of external ear canal

draining tracts

38

T/F: you can expect to see draining tracts form for up to 3 weeks after ear canal surgery

False- up to months after incision has healed 

39

What do we do if a draining tract forms after ear canal surgery?

explore and remove residual disease

**make sure you remove all the lining of ear canal the first time or they will come back with draining tracts*** its very difficult to find the little bit of tissue you missed

40

List 4 issues associated with the middle ear

otitis media

cholesteatoma

nasopharyngeal polyps

neoplasia

41

List 3 ways we can examine the middle ear

otoscopy

bulla radiography

computed tomography

42

Surgical treatments for middle ear disease

myringotomy

bulla osteotomy

43

Ventral bulla osteotomy

disease confined to or originating from middle ear

ear canal normal

44

Feline inflammatory polyps- nasopharyngeal polyps:

arise from?

middle ear cavity or auditory tube

45

T/F: Most cats have nasopharyngeal polyps

True

46

Nasopharyngeal polyps may extend through ____ into the ear canal

tympanum

47

Feline nasopharyngeal polyps:

signalment

young- median age around 2yr

DSH, maine coon, persian, abyssinian, ragdoll, sphynx, norwegian forest- true breed predisposition based on epidemiologic studies not proven

48

Feline nasopharyngeal polyps:

Clinical signs

stertorous respiration, nasal discharge, sneezing, voice change, dyspnea and dysphagia 

49

Ear canal polyps clinical signs

otorrhea (dark brown ceruminous or purulent exudate), head shaking and a mass in the ear canal

otitis media or interna- head tilt, nystagmus and dysequilibrium

50

Nasopharyngeal polyps treatment

traction-avulsion

per-endoscopic trans-tympanic traction

ventral bulla osteotomy

51

Most common initial treatment for feline nasopharyngeal polyps?

traction-avulsion

  • nasopharyngeal polyps via oropharyngeal approach
    • grasp around base w/ hemostats or right angle forceps and slowly pull
  • aural lesions- may need lateral ear canal resection or remove "piece-meal"
  • lateral approach to ear canal

52

How do we expose polyps for traction avulsion?

retract soft palate rostrally with spay hook or stay sutures

53

____% recurrence of felline inflam polyps with traction alone

50%

54

What significantly improves the outcome of feline inflam polyps that are removed by traction?

administering corticosteroids postop

pred 1-2 mg/kg for 2 weeks then taper

55

What tx has a very low rate of recurrence for feline inflam polyps?

bulla osteotomy allows more complete resection of tissue origin 

56

4 reasons for ventral bulla osteotomy

chronic, recurrent, recalcitrant otitis media

inflam polyps

cholesteatoma (epidermoid cyst)

neoplasia

57

Complications of VBO?

vestibular signs

horner's syndrome

 

58

Horner's syndrome from VBO is most frequent in which species? Why?

cats

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

 

59

T/F: As a complication VBO, Horner's syndrome is usually transient- days to weeks

true