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Total Ear Canal Ablation and Ventral Bulla Osteotomy

                            The TECA Procedure

 

Sometimes an ear infection is so severe that surgery is the only option. The organism growing might be too resistant for treatment, the ear canal might have mineralized due to chronic irritation, or the ear canal might be so scarred and narrowed that external cleaning is impossible. The bottom line is that this degree of irreversible disease requires surgical treatment. In such cases, all the diseased tissue: the entire ear canal, bones of the middle ear etc. are removed, the middle ear is drained, and the healthy tissue around the ear is closed. This ends what has generally been a long ordeal of pain, odour, ear cleaning, and expensive veterinary medications and rechecks.

It is important to understand the surgical procedure and its associated risks. This surgery requires advanced skill and is a procedure that not all veterinarians are comfortable performing. The surgery essentially removes the ear structures but leaves the ear flap unchanged. The round bone behind the ear, called the tympanic bulla (reach behind your own ear and feel yours if you are not sure what the bullae are), is opened and flushed. A normal bulla is hollow and air-filled. After years of otitis, the bulla is usually packed with pus, slime, or cheesy infectious material that must be scooped or rinsed out. Many important nerves travel through this area of the ear and these are exposed to potential damage during surgery.

 

Preparing for the TECA

Radiographs or, even better, a CT scan (at the Tunstall branch), to assess the tympanic bullae are helpful because it is useful to know before surgery how bad the bullae look, how narrowed the ear canals are and if they are mineralized, and if there is an obvious tumor growing. These images help confirm that the surgery is appropriate for the patient.

The ear may be cultured. This helps get the patient on an effective antibiotic right from the beginning. Further cultures may still be required once the bullae are opened.

It is important to assess the patient's cranial nerve function prior to surgery. If these nerves are diseased prior to surgery, it is unlikely that they will regain function after surgery. Nerve disease that results from surgery is usually temporary so it is important to know if the nerve problems exist prior to surgery.

The facial nerve runs just near the base of the ear. This nerve controls facial expression. A facial paralysis is not uncommon after long-standing ear disease. This means that the patient is slack-jawed, usually on one side of the face, and may not be able to blink. After a time, the eye usually retracts into the eye socket to facilitate tear lubrication so that the loss of blinking does not lead to eye damage. Initially, though, lubricating gels are helpful.

Hearing is usually diminished after long-term ear infections so further hearing loss after ear ablation may not represent a dramatic change for the patient. Most owners have a good sense of whether or not their pet can hear, so it is rarely necessary to formally test hearing. After the ear canals are ablated, in many patients some hearing remains as sound waves can still be transmitted through the tissues.

 

What Happens in Surgery

The ears and head are shaved and the ear canal is flushed one last time to remove as much infected material as possible. This is done to minimize bacterial contamination of the normal tissue.

Both the vertical and horizontal portions of the ear canal are removed as one long intact curved cylinder. The bones of the middle ear and the ear-drum are removed as well. The bone of the tympanic bulla is exposed and opened. Any material is flushed out and the cellular lining of the bone is scraped away. Any material left inside after closure will lead to chronic drainage of liquid from the incision. Sometimes an external drain is left in place during the healing period.

Oral antibiotics and pain medication can be expected after surgery as can an Elizabethan collar to protect the delicate incisions from scratching.

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