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Total Ear Canal Ablation (TECA)

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INTRODUCTION

A total ear canal ablation (TECA) means removal of the ear canals. Many times it is performed on both ears at once. It is an operation that is performed when an animal has severe inflammatory disease of the external ear canal or when a growth, such as cancer, is present within the ear canal or middle ear cavity.

To understand why this procedure might be necessary, it’s important to first understand the anatomy of your pet’s ear and the surrounding area.

Under your pet’s earflap is the ear canal, which extends internally to the eardrum and forms the outer ear. The middle ear is a hollow cavity within the skull that is separated from the outer or external ear by the eardrum and contains three delicate bones that transmit sound to the inner ear. The inner ear receives the vibrations from the bones of the middle ear and transfers it into an electrical signal, which is then interpreted by the brain as sound. The inner ear is also responsible for your pet’s sense of balance. The facial nerve, which controls muscles of facial expression and the eyelids, wraps around the ear canal.

Dogs with long-standing ear infections may develop irreversible disease of the ear canal in which chronic inflammation causes the ear canal to thicken to the point that it turns to bone and becomes impervious to medication that might be used to treat the infection. In about 50% of pets where the ear canal is damaged, the eardrum is ruptured and the infection extends to the middle ear.

It is important to note that dogs with chronic ear infections often also have skin allergies. If this is the case for your pet, you should have a dermatologist evaluate him once the ear problem is addressed.

Cancer can also affect the ear canal. Of the tumors that affect the ear canal in dogs, 85% of them are malignant tumors (adenocarcinoma). Surgery usually cures these tumors if they do not extend beyond the cartilage layer of the ear canal or into the middle ear cavity.

Whenever your pet is showing signs of a health issue your first step is to contact your primary care veterinarian. If it is indicated that your pet may suffer from chronic ear infections or another serious condition, a veterinary specialist is available at an ExpertVet certified hospital.

CLINICAL SIGNS & DIAGNOSIS

Symptoms of an ear infection or an ear canal tumor include shaking of the head, ear scratching and rubbing, crying out in pain, sensitivity when the ear is touched, thickened ear canals, foul odor from the ear, and/or a bloody or yellow-green discharge in the ear canal.

If the infection extends into the inner ear, your pet may keep her head in a tilted position, may have continual shifting of the eyes, or might walk in circles. Unfortunately, dogs with end-stage ear disease do not respond to medical treatment.

If your pet is experiencing symptoms of ear disease, your veterinarian will examine the ear to see if a tumor is in the canal or if there is chronic irreversible infection. A complete blood count (CBC), chemistry profile, and urine testing are performed prior to surgery to allow your veterinarian to select the best anesthetic for your pet. Remember to ask about potential risks, including clotting factors, which exist in every surgery no matter how healthy your pet may be.

X-rays of the chest will made if a tumor is in the ear canal to check for spread of the cancer to the lungs. The results of this test would affect treatment options. ACT (computed tomography) scan of the head can also be used to evaluate the extent of a chronic ear infection or tumor.

TREATMENT

A total ear canal ablation (TECA) involves the complete removal of the ear canal and is frequently recommended for patients that have a tumor or end-stage ear infections. In addition, a bulla osteotomy is performed, which involves removal of the outer wall of the middle ear chamber in order to extract infected or cancerous tissue from this region.

After the incision has been closed, there will be no visible opening into the ear canal. However, in most cases the pinna, or external ear "flap," remains intact. As a result, you may only notice an absence of a hole where you would normally see the opening of the ear canal.

A drain may be placed into the middle ear during surgery. If this is necessary, your pet will stay in the hospital for a few days until it is removed. While the drain is in place, your pet will have a light bandage applied to the head to prevent her from "playing" with the drain.

The anesthesia and surgical team working on your pet’s case will prescribe a pain management program both during and after surgery that will keep your pet comfortable. This will include a combination of general anesthesia, injectable analgesics, analgesics delivered through the skin and oral analgesics. After surgery, you will continue to give your pet a prescribed pain reliever to minimize discomfort.

POSTOPERATIVE CARE

In most cases, a non-steroidal anti-inflammatory drug (NSAID) will be recommended for pain control. This class of drugs is often helpful in relieving postoperative inflammation, pain, and swelling, helping your pet be more comfortable and return to normal function sooner. Do not give your pet any other medication without consulting your veterinarian: Many other NSAIDs available for people, like ibuprofen, are often toxic to pets.

Antibiotics given by mouth will be prescribed after surgery in most cases. This is because the ear canal and middle ear cavity are often contaminated with numerous bacteria and yeast organisms. A culture will be taken at the time of surgery to make certain that the antibiotic chosen is appropriate for your pet's specific infection. Even if the culture result is negative, your pet should remain on antibiotics for a minimum of three weeks. This means you will be responsible for keeping your pet on antibiotics once he goes home, according to your veterinarian’s prescription.

A bandage and an Elizabethan collar (E-collar or cone) will be used prevent your pet from scratching the surgical site. It’s also important to limit your pet’s activity for two weeks after surgery.

The healing process will be monitored by the surgeon with follow-up exams at two weeks and eight weeks after the surgery. By two weeks after surgery, the incision should be healed and your companion should be feeling well again.

External skin sutures will be placed to close the incision. These sutures should be removed by your veterinarian at the two-week recheck appointment. You should look at the incision daily and alert your veterinarian if you notice swelling, redness, or discharge.

PROGNOSIS

All surgeries have risks and the potential for complications, and about 10% of the dogs that have a total ear canal ablation surgery will develop facial nerve paralysis. Signs to watch for include drooping of the face and the inability to close eyelids. Facial nerve paralysis is usually temporary and resolves within three months.

Less common complications include pain when opening the mouth, bleeding into the tissues of the neck (which causes breathing difficulty), Horner’s syndrome (pupil constricts and third eyelid covers part of the eye), vestibular syndrome (balance problems), and recurrent infection. Although these complications are serious, they are seen in less than 5% of the patients and usually resolve with time. Infection that is unresponsive to antibiotics will require a second surgery.

The most common question asked about ear canal ablation is, "Will my pet be deaf?" The ear canal is only a conduit for sound waves to travel to the inner ear where sound is actually perceived. The inner ear is not affected by this procedure, therefore the ability to perceive sound should not be changed, although perhaps the precision of sound may be muffled.

Although it is difficult to predict, most people report that their pet's hearing is about the same after surgery as it was before the surgery. This means the surgery could rid your pet of constant pain without diminishing his or her hearing abilities. In general, most pet owners usually report that their dog “is acting like a puppy again” after healing takes place.

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