What are 2 physical causes of an auricular hematoma?
head shaking, scratching
T/F: auricular hematomas can be immune mediated
TRUE- or inflammatory mechanism
Auricular hematoma hemorrhage comes from what artery?
from the great auricular artery within the cartilage plate
______ results in thickened, deformed ear = auricular hematoma
Fibrous reorginization in an auricular hematoma results in _____ contracture
-wrinkles up ear, cosmetic defect, can predispose to dermatitis
Conservative management options for auricular hematomas?
- oral prednisolone +/- aspiration
- needle aspiration and instillation of corticosteroid
- indwelling drains
Reason for auricular hematoma surgery?
larger, chronic hematomas
recurrence after conservative management
T/F: Indwelling drain for auricular hematoma shouldn't be placed with only local anesthesia
False: can be placed with sedation or local anesthesia
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
What is the name of the drain used for an indwelling drain for auricular hematoma?
Larson teat tube
Indwelling drain for auricular hematoma: 2 types of drain tube?
butterfly catheter tubing
How long do we leave an Indwelling drain in for auricular hematoma?
until cavity heals except for drain path
-about 2-3 weeks
What is the most common mistake with indwelling drain for auricular hematoma?
removing them too early
What is this picture showing?
Larson's teat tube- Indwelling drain for auricular hematoma
Describe a good prognostic factor for conservative tx of auricular hematoma?
case selection- recent hematomas that can be easily evacuated or are small
Prognosis of oral pred for auricular hematoma?
very good response
-recurrence rates unknown
Prognosis of aspiration and instillation of corticosteroid for auricular hematoma?
very good prognosis (>90%)
may need more than 1 treatment
Prognosis for Larson teat tube and indwelling drains for auricular hematomas?
recurrence of hematoma is common if removed too soon
T/F: indwelling drains are considered conservative treatment for auricular hematomas
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
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
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)
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
What is the most important aspect in the outcome for aural hematomas?
treat the underlying cause! (if it can be identified)
Partial amputation of the pinna is treatment for?
avulsion of portion of pinna
ear tip dermatitis
actinic (solar) dermatitis
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
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
What is the weak point between the vertical and horizontal part of the ear?
Can we do a lateral ear canal resection in a cocker spaniel?
shar pei, chows, bulldogs- narrow canals but do well
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
What procedure is depicted in the image?
lateral ear canal resection
Indications for a vertical ear canal ablation?
neoplasia affecting vertical ear canal only
Complications of TECA/LBO
facial nerve paralysis- low, half of cases resolve
chronic draining tract
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
What will diminish hearing?
fibrous tissue filling the bulla post op and the transmission of sound through the skin
T/F: chronic otitis does not cause deafness
False- can cause deafness due to ototoxicity caused by previous treatments
_____ forms due to incomplete removal of epithelium of external ear canal
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
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
List 4 issues associated with the middle ear
List 3 ways we can examine the middle ear
Surgical treatments for middle ear disease
Ventral bulla osteotomy
disease confined to or originating from middle ear
ear canal normal
Feline inflammatory polyps- nasopharyngeal polyps:
middle ear cavity or auditory tube
T/F: Most cats have nasopharyngeal polyps
Nasopharyngeal polyps may extend through ____ into the ear canal
Feline nasopharyngeal polyps:
young- median age around 2yr
DSH, maine coon, persian, abyssinian, ragdoll, sphynx, norwegian forest- true breed predisposition based on epidemiologic studies not proven
Feline nasopharyngeal polyps:
stertorous respiration, nasal discharge, sneezing, voice change, dyspnea and dysphagia
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
Nasopharyngeal polyps treatment
per-endoscopic trans-tympanic traction
ventral bulla osteotomy
Most common initial treatment for feline nasopharyngeal polyps?
- 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
How do we expose polyps for traction avulsion?
retract soft palate rostrally with spay hook or stay sutures
____% recurrence of felline inflam polyps with traction alone
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
What tx has a very low rate of recurrence for feline inflam polyps?
bulla osteotomy allows more complete resection of tissue origin
4 reasons for ventral bulla osteotomy
chronic, recurrent, recalcitrant otitis media
cholesteatoma (epidermoid cyst)
Complications of VBO?
Horner's syndrome from VBO is most frequent in which species? Why?
bc the sympathetic nerves run very superficially in the ventromedial compartment and are easily damaged
T/F: As a complication VBO, Horner's syndrome is usually transient- days to weeks