TOTAL EAR CANAL ABLATION SURGERY
Total ear canal ablation (TECA) is a surgical option for cats, dogs and other pets with ear disease. The indications for the surgery are chronic, severe ear infections or inflammations that will not respond adequately to medical treatment, and ear tumors.
The primary goals of the procedure are to relieve the pain, inflammation and infection associated with the pet's condition, and/or to remove the tumor. Secondary goals are to eliminate malodorous ear discharge and eliminate the need to regularly medicate the pet.
TECA is removal of the entire ear canal, from its opening at the base of the flap of the ear down to and including the ear drum. The flap of the ear is not removed. We usually perform TECA in combination with a lateral bulla osteotomy (LBO). The middle ear is surrounded by a pouch of bone called a bulla; LBO is removal of a section of this bone, to allow inspection of the middle ear and removal of abnormal discharge, inflammatory tissue, or tumor tissue in this space.
There are risks, some of them very serious, with every surgery, no matter how minor or how common the procedure. When we perform a TECA / LBO we are manipulating very inflamed, infected tissues. We are operating in a body region where very large, important blood vessels and nerves, and many sensitive, delicate structures, such as the tiny bones of the inner ear, the eustachian tube, and the parotid salivary gland, are in contact with each other and with the tissues we are removing. As a result, in addition to the standard risks of surgery, there are risks for numerous other complications with TECA / LBO.
Complications are the exception and not the rule; most pets have minimal or no problems recovering from TECA / LBO. Also, most complications are less severe than the problem that led to the surgery. But because the risks are somewhat greater in number and severity with this procedure compared to many other surgical procedures, and because TECA is an elective procedure, we want our clients aware of these risks when they are making their decision whether or not to choose this surgery for their pet.
- Floppy-eared dogs look no different after TECA. The ears of cats and erect-eared dogs might flop to some degree after surgery; we have plastic surgery techniques we use to try to prevent this, but, even so, it may still happen.
- Many of the pets for whom owners are considering TECA are all ready deaf or have significantly decreased hearing. Permanent deafness is a possible complication of TECA.
- Infection in the tissue just under the skin, and dehiscense (opening of the surgical incision) can usually be managed medically and resolve within two weeks after surgery.
- We can encounter excessive bleeding during surgery. We sometimes manage this with a gauze placed deep in the incision and exiting the skin near the incision. We remove this gauze within a couple of days of the surgery.
- Hematoma is a pocket of blood in the flap of the ear. This usually resolves within two to four weeks after surgery with minimal treatment.
- Necrosis, or skin death, of the skin along the margins of the ear flaps may occur. This usually takes more than a week or two to appear: it can take several weeks to manage, and some pets might require surgical removal of part of the ear flap.
- The facial nerve is a large nerve that normally lies tightly against part of the ear canal that we are removing with TECA. Sometimes the inflammation of the ear disease secondarily involves the facial nerve, binding it closely to the ear canal with scar tissue, making it very difficult to safely retract. If the facial nerve is injured, the ability to blink may be lost and tear production is decreased. This condition necessitates application of eye medication two to four times a day until it resolves, which can take six weeks or more. In rare cases when the facial nerve is permanently damaged it might not be possible to treat the eye medically, and ultimately the eye has to be surgically removed.
- Balance may be affected due to trauma to the inner ear. This typically resolves within two days to two weeks. Sometimes this problem is serious enough that the pet requires hospitalization for nursing care until adequate balance returns.
- Persistence of infection deep within the surgery site is probably the most problematic complication. It can be difficult to diagnose, it can create a fistulous tract, which is a small tunnel with a persistently draining opening; it can create an abscess, which can be painful; it usually requires repeat surgery (not as extensive as the initial surgery); it can be difficult or impossible to get resolved.
At YVC, patients are usually admitted to the hospital on the morning of the day of their surgery. Our TECA patients remain hospitalized for 2 or 3 days following surgery, to allow repeated bandage changes and exams. (This hospitalization is included in the price of the surgery.)
Medical and surgical treatments for complications that arise from the initial surgery are not covered in the price of the initial surgery; they are charged for at regular YVC rates.