Ear surgery in dogs and cats at ABvet clinic
The ear consists of three parts: the outer ear, the middle ear and the inner ears. The inner ear contains the vestibular apparatus (center of balance) and the middle ear, the small bones of hearing. The middle ear or tympanic bulla is a large resonance chamber. The outer ear consists of the pinna and the external auditory canal. In dogs and cats, the ear canal is initially vertical and then becomes horizontal to the eardrum. The ear in our pets is the site of many diseases and some breeds with floppy ears or a naturally narrow ear canal are more prone to ear diseases such as otitis externa or otitis media. In the most severe cases, local treatment is not sufficient and surgery may be the only treatment option.
Photo 1 bis: view of the auricle of an ear affected by chronic otitis with obstruction of the external auditory canal
How can I tell if my pet has an ear infection or other ear diseases?Otitis is a painful disease. Your pet will have pain when handling the ears or difficulty swallowing because the mandibles are close to the ear canals. In addition, the pinna of the ear will show redness and sometimes a more or less purulent discharge or even a foul smell. In the terminal phase, the ear canal may be completely obstructed.
Photo 1 bis : vue du pavillon d’une oreille atteinte d'une otite chronique avec obstruction du conduit auditif externe
How are otitis or other ear diseases diagnosed at the ABVET specialist clinic in Neuilly sur Seine?
The diagnosis of otitis is based on clinical, otoscopic, endoscopic, cytological and possibly CT (computed tomography) examinations. The clinical examination reveals the signs mentioned above. Cytological examination of the earwax or secretions present allows the identification of bacterial or fungal proliferation. Otoscopic or endoscopic examinations provide direct visualization of abnormalities. In the most chronic cases, the middle ear or even the inner ear may be affected. It is common to observe neurological disorders characterized by loss of balance, head tilt and disorientation, indicating a vestibular syndrome. It is therefore essential to carry out a CT scan of the ears in order to identify the damage to the tympanic bullae and choose the appropriate treatment.
Photo 2: CT scan of tympanic bullae in a cat with chronic right otitis. Note the filling of the right tympanic bulla and the corresponding ear canal
Otitis represents most ear disorders in dogs. However, they are often associated with dermatological problems (food allergies, atopy), parasites, polyps, benign and malignant (cancerous) tumours, foreign bodies, or general diseases such as hypothyroidism, Cushing's disease and autoimmune diseases. Examination of the ear by otoscopy or endoscopy can often clarify the cause. Further tests are often necessary.
Why do chronic ear diseases lead to stenosis (occlusion) of the external auditory canal and often to purulent otitis media?
Chronic ear disease and especially chronic otitis cause irritation of the inner lining of the external auditory canal which proliferates. Over time, the overgrowth is such that the ear canal is blocked by the proliferations (photo 3 otitis externa). Chronic inflammation of the external auditory canal and its obstruction are most often associated with perforation of the eardrum and contamination of the middle ear. Failure to recognize and treat these two types of otitis occasionally leads to internal otitis
Photo 3: diagram showing the three possible types of ear infection: external, medium and internal
How are ear diseases treated at the ABVET specialist clinic in Neuilly sur Seine?
The first line of treatment for otitis externa is local with antibiotic and/or antifungal solutions combined with a meticulous cleansing of the external auditory canal. In some cases, local treatment is not sufficient and it is necessary to resort to otoscopy and endoscopy of the ear and cleaning of the external canal. Even better, ear endoscopy and endoscopically guided treatment improve the quality of visualization, diagnosis and treatment of ear diseases. Nevertheless, some cases require further management with ear canal surgery, especially when otitis becomes chronic with obstruction of the external ear canal and middle ear involvement.
Removal of the vertical part of the external auditory canal:
Often, chronic infections of the external auditory canal are difficult to recognize and become impossible to treat medically because the chronic inflammation leads to obstruction of the canal lumen. In some cases, otitis externa is associated with obstruction of the vertical part of the ear canal alone. In this case, removal of the vertical part of the ear canal allows the preservation of the horizontal portion of the ear canal. It is a surgery performed under general anesthesia. The animal retains its hearing. However, this treatment may not be sufficient in the most severe cases of ear canal damage, and a total removal of the ear canal may be necessary.
Photo 4: The different stages of removal of the vertical part of the external auditory canal with preservation of the horizontal canal (photo 4F).
Total removal of the external auditory canal and trepanning of the tympanic bulla under endoscopic guidance:
This treatment is considered when the external auditory canal is stenotic or totally obstructed by a tumor or in the terminal stage of unresolved chronic otitis and associated with tympanic bulla involvement. This surgery is performed under general anesthesia. The ear canal is dissected and removed along its entire length.
Photo 6: Removal of the external auditory canal and trepanation of the tympanic bulla
The tympanic bulla is then visualized, opened and curetted under endoscopic guidance. The animals are hospitalized to treat the associated pain. After this surgery, hearing is not regained. This procedure is a last resort but unfortunately often necessary due to the severity of the damage to the external auditory canal and associated problems.
Photo 7: After trepanation, the tympanic bulla is cured under endoscopic guidance
Photo 8: Endoscopic view of the tympanic bulla after evacuation of an abscess
Ventral trepanation of the tympanic bulla:
Ventral trepanation of the tympanic bulla is a surgical procedure for the treatment of otitis media when the cause is located in the middle ear and there is little or no external involvement. This technique is performed under general anesthesia and allows the preservation of the external ear in comparison with trepanation of the tympanic bulla after total removal of the external auditory canal. Although this treatment has fewer disadvantages, it is only feasible if the external auditory canal is not affected. In cats, this surgery is indicated in the case of an inflammatory polyp of the middle ear, for example. In dogs, otitis media is very often a complication of chronic otitis externa and a total removal of the external auditory canal is often the most recommended technique for a complete remission of the pathology.
What other ear surgeries are performed at the ABVET clinic in Neuilly-sur-Seine?
Many other interventions are performed on the pina and are not voluntarily described in this presentation. We routinely treat othematoma (subcutaneous hematoma of the ear), removal of tumors, surgical correction of ear carriage (plastic surgery for drooping ears in dogs with straight ears such as German Shepherds, Yorkies, Fox Terriers, etc.) and surgical removal of the pinna in the presence of large and aggressive tumors.
What is the prognosis after treatment of ear diseases?
When the vertical portion of the external auditory canal is removed, recurrence may occur and total removal is recommended. This last technique ensures that there is no recurrence of the otitis. In addition, curettage of the tympanic bulla under endoscopic guidance ensures that it is properly cleaned. Antibiotic therapy will be administered to your pet to completely eradicate the infection present in the ear tissue. In the case of total removal of the external auditory canal and the associated tympanic bulla trepanation, even if your pet has lost its hearing, it will regain remarkable comfort with the disappearance of the pain associated with ear infections.
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