Karteikarten
SA Ear Surgery
Karten in diesem Stapel (32)
- 1What are the Indications for Ear Surgery?- Auricular hematoma
- Neoplasia
- Otitis externa- media
- Trauma/ avulsion
- Para-aural abscess -infection - 2What causes Auricular Haematoma?- usually secondary to ear scratching or shaking
- Warm fluctuant non painful swelling on inner surface of the ear
- will not 'die' from it but if left untreated the haematoma will slowly resorb and fibrose leading to potential disfigurement and irritation - 3What types of Neoplasia Affect the Ear?- Squamous cell carcinoma, on the pinna or ear canal
- Haemangioma/ hemangiosarcoma
- Basal cell tumour
- Mast cell tumour
- Histiocytoma/ adenoma (benign)
- Ceruminous adenocarcinoma (external ear canal) - 4Is Ceruminous gland hyperplasia Neoplastic?- No!
- needs biopsy to confirm but very typical appearance and normally more than one lesion is present - 5What is Otitis externa-media?- very common condition
- primary causes perpetuated by secondary factors
- tympanic membrane perforation can lead to the progression to an otitis media
- Surgery is indicated when medical tx fails - 6What happens to the ear during trauma/avulsion which may mean surgery is indicated?Causes: - fights, road traffic accident & sadistic acts
- Avulsion between the auricular and annular cartilage or at the level of the external acoustic meatus:
+ fluid , cerumen and debris will accumulate in the proximal portion of the ear canal
+ will potentially get infected leading to pain, head tilt and irritation - 7What is para-aural abscess- infection?- extension of ear infection
- Caused by incomplete removal of the epithelial lining of the external ear canal/ bulla during a TECA-LBO (<10%) - 8What surgical procedures are done on the Pinna?- Tx of pinna lacerations: using vertical mattress, figure of 8 sutures that include the cartilage if damaged
- Total or Partial Resection of the pinna
- Local skin flaps: can be used to repair defect of the lateral aspect of the pinna - 9What surgical procedure is done on an Aural Haematoma?1. haematoma is drained via an elliptical / sigmoid incision made in the centre of the concave aspect of the pinna
2. Alternative: use haemostatic sponges as mattress and suture them on the concave aspect of the ear
3. Sutures (full or partial thickness) are placed parallel (vertically) to the long axis of the pinna in the areas where haematoma has caused gap between skin and cartiladge
4. Placement of bandage to maintain the ear in place - 10When is the Lateral Wall Resection (Zepp procedure) Indicated?- tx of benign or malignant mass lesions located near or at the level of the lateral part of the vertical portion of the ear canal
- NOT an indication for treatment of otitis externa - 11What is the Technique for performing a Lateral Wall Resection?- Lateral portion of the vertical ear canal is resected w/ scissors
- Horizontal canal opening identified and simple interrupted sutures between cartilage and skin are placed - 12When is performing a Lateral Wall Resection ineffective??- If otitis externa is already established
- 13What Breed may have a lateral wall resection done prophylactically?Shar Pei's
Due to congenitally narrow canals - 14What does TECA stand for?Total Ear Canal Ablation
- 15When is a TECA performed and What is it?- commonly performed to treat chronic ear disease not amenable to medical treatment in dogs
- Always ass. w/ an ostectomy of the tympanic ostium ( and/or bulla depending on the degree of involvement) - 16When is a LBO performed and What is it?Lateral Ostectomy of the Tympanic Bulla
- is a procedure that follows a TECA if bulla is affected (most commonly in dogs)
- Never performed as a lone procedure in dogs
- preferred approach to the bulla in dogs. In cats can use ventral approach as they in cats just an LBO - 17What are the complications that can occur as a result of TECA/LBO procedures?- Facial nerve (CN VII) injury
- Haemorrhage from the retroarticular vien
- Vestibular signs: inadvertent damage to the round window
- Wound dehiscence
- Chronic sinus tract development (para-aural abscess)
- Ear carriage (pinna may fold over)
- Deafness? - generally aggravation of deafness, and only major issue if both ears - 18What are the Clinical signs of a Para-aural abscess/ fistula?- Pain around head
- Pain on opening mouth/ reluctance to eat
- Head tilt
- Lethargy
- Swelling/ draining sinus over surgical site
- Usually 3 to 9 months post-op (but up to 3 yrs) - 19What is the Pathophysiology of Para-aural abscess/ fistula?- Inadequate debridement of middle ear (epithelium)
- Failure to remove all ear canal cartilage
- Osteomyelitis (ossicles, tympanic bulla)
- Parotid gland damage
- Can happen with cholesteatoma - 20What are the DDx for Para-aural abscess/ fistula?- Migrating FB
- Neoplasms (TMJ, salivary glands, tonsils) - 21How is Para-aural abscess/ fistula diagnosed?- Advanced imaging:
+ plain radiographs
+ contrast fistulogram
+ CT + contrast - 22What are the Treatment options for Para-aural abscess/ fistula?- Medical: AB therapy
- Surgical:
+Lateral approach if remnant of ear canal, lesion lateral to bulla
+ Ventral approach if confined to bulla or ventral to it - 23What is the Outcome of Tx of Para-aural abscess/ fistula?medical tx: successful in 10-20%, may need to be repeated
Surgical tx: successful in ~70% but potential complications incl. facial nerve paralysis, otitis interna & head tilt - 24What is the Prognosis following a TECA/LBO?- Good to excellent for chronic OE or trauma
- If Ceruminous gland adenocarcinoma: then good local control & long-term remission
- If squamous cell carcinoma: guarded prognosis as very poorly responsive to radiation therapy - 25What is Cholesteatoma?- Epidemic cyst of keratinizing squamous cells growing in tympanic bulla
- Primary or secondary to otitis externa/media
- Expansive lesion at the level of the bulla which may cause neurological signs - 26How can Cholesteatoma be treated?Surgical: wide resection
Medical: AB long term tx - 27What is an VBO and when is it performed?Ventral bulla oestotomy
- is performed to remove ear polyps in cats
- Indication of VBO in dogs are limited as the approach in dogs is sig. more complicated than in cats
- Should use radiographs and CT scan to aid - 28How is a VBO performed?1. Dorsal recumbency with the neck extended and a sandbag placed under the neck
2. Ventral incision made in upper neck region
3. Open both chambers of the bulla in cats
4. Clean and flush
Note: if both ears affected then will need to do a staged procedure - 29What are the complications that can occur due to VBO procedures?- horner syndrome
- vestibular disturbances
- polyp regrowth (in cats) not common if removed from both chambers
- haemorrhage
- wound drainage
- damage to auditory ossicles
- hypoglossal nerve/ facial nerve paralysis or damage
- Facial and hypoglossal nerve paralyses are uncommon complications of VBO! - 30What does PSOM or 'Glue Ear' stand for?Primary Secretory Otitis media
- 31What is PSOM and what are the clinical signs?- some dogs e.g. CKC, have fluid in their middle ear incidentally
- causes moderate to severe pain localised to the head or cervical area
- is an emerging diagnosis due to advanced imaging techniques
- may be due to poor venting of ET orifice in naso-pharynx - 32What is the best treatment for PSOM?Since VBO or TECA do not treat the cause best method may be Tympanostomy tube (grommet) placement as in people
- Is too early to know if is long-term solution or if animals will grow out of it like humans do
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- 2 Clinical Veterinary Science Karteikarten am SA Ear Surgery, erstellt von Rebecca Hitchman am 04/02/2019.
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- Rebecca Hitchman
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