Total Ear Canal Ablation and Bulla Osteotomy


Key Points

Dogs that have had long-standing ear infections may develop irreversible damage to the ear canal

About 50% of the dogs that have chronic ear infections have a ruptured ear drum and infection in the middle ear

The diseased ear canal is removed entirely during the surgical procedure

Due to the delicate nature of this procedure, an experienced surgeon will have fewer complications during the surgery

Prognosis is very good following surgery

 

Indications for total ear canal ablation

  • Dogs that have had long-standing ear infections may develop irreversible damage to the ear canal. Due to chronic inflammation, the ear canal becomes very thickened and can turn into bone. As a result, the infection will not resolve with medication. The middle ear cavity (tympanic bulla) frequently is infected as the ear drum is commonly ruptured with chronic ear infections.
  • Cancer of the ear canal is another disease requiring this type of surgery. In dogs, surgery is usually curative for malignant cancer (adenocarcinoma) of the ear canal, if the tumor has not invaded through the cartilage or into the middle ear cavity. If your pet has an ear tumor, chest radiographs (x-rays) will be taken to help rule out the possibility of spread of the cancer to the lungs.
  • Congenital imperforate ear canal resulting in middle ear infection.

 

Benefits of surgery

  • Typically a dog that has chronic deep seated ear infections will be much less active than a normal dog because they do not feel well.
  • Most owners report that their dog is “a new dog” and act like a puppy again.
  • Many owners report that their dog can hear better than prior to surgery.  The reality is that the hearing likely is not improved, rather the dog is feeling better and is more willing to respond to auditory stimuli such as ringing of a doorbell etc.
  • If both ears receive surgery, ear infections generally will be permanently cured.
  • Considerable cost savings on ear medications and treatments after surgery is completed.

 

Surgical procedure

  • The diseased ear canal is removed entirely.
  • The bulla (middle ear) is opened up in order to remove the infected tissue from the middle ear. This is called a bulla osteotomy.
  • Drains are inserted into the surgical site if the infection is severe. About 98% of the cases that have a bulla osteotomy do not receive drains. If drains have been placed, antiseptic may be needed to be injected through the drains and the bandages changed twice daily for 6 to 7 days.
  • Your pet will stay in the hospital for 24 hours after the surgery providing that recovery is uncomplicated.
  • The photo of a cross-section of the ear canal; take note of the ear canal that starts at the base of the ear flap and is separated from the bulla by the ear drum (labeled D); The facial nerve that is in the black circle and labeled nerve, wraps around the ear canal; the inner ear is fairly close to the bulla and controls balance.

  • Below is an illustration demonstrating total ear canal ablation; the thatched area shows the part that is surgically removed; after the ear canal has been removed the area is sutured closed (see below after surgery)

 

Hearing and cosmetic appearance following surgery

  • Most pets that have chronic ear disease have a significant loss of hearing. The surgery may decrease hearing, however, many dogs still respond to the ringing of a door bell etc.
  • The cosmetics following surgery on a dog with floppy ears is very good. After the surgery is complete, there will be no opening into the ear canal. Cats and dogs that have erect ears may have some drooping of the ear flap, but generally the outcome is very cosmetic.

 

Other considerations following surgery

  • Chronic ear infections are usually not just a local disease. Frequently these pets have allergies or endocrine diseases that caused the ear infections. After your pet recovers from surgery, a dermatologist should be consulted to investigate and treat underlying skin disease.
  • If one of the ear canals is healthy at the time of surgery, it is common that chronic irreversible ear disease will develop and require total ear canal ablation in future.  Chronic medical therapy such as cleaning of the ears, controlling ear infections, and controlling allergies can help to prevent end-stage irreversible ear disease.

 

Potential complications

  • Even though rare, anesthetic death can occur. With the use of modern anesthetic protocols and extensive monitoring devices (blood pressure, EKG, pulse oxymetry, inspiratory and expiratory carbon dioxide levels, and respiration rate), the risk of problems with anesthesia is minimal.
  • Facial nerve paralysis, which is the most common complication of total ear canal ablation, occurs in about 5 to 10% of the patients. The more severe the ear disease, the greater the risk of this problem. The facial nerve wraps around the base of the ear canal and is important for function of facial muscles. If this nerve is bruised from the surgery your pet will not be able to close the eyelids, and the lips will appear droopy on the operated side. Eye drops may be required to prevent drying of the eye until the nerve palsy has resolved. In most cases, facial nerve paralysis is a temporary problem and resolves within 2 months.
  • Pain upon opening the mouth or difficulty chewing can occur if the joint of the jaw, which is located just in front of the middle ear, gets inflamed from middle ear infection or from surgery.  This problem typically resolves within 2 weeks.
  • Horner’s syndrome is where the pupil becomes constricted and third eyelid covers part of the eye. This syndrome is caused by damage or inflammation of the sympathetic nerve that runs through the middle ear. This is an unusual complication as the nerve is fairly well protected in dogs.
  • Vestibular syndrome (balance problems) can occur as the balance organ is located in the inner ear. Less than 2% of patients develop this problem, but it is more common in those patients that have had previous balance problems or a head tilt.
  • Swelling after surgery is may occur and be due to oozing of blood or accumulation of clear fluid at the level of the ear.  In some cases that swelling occurs shortly after surgery and results in swelling in the throat region which results in breathing difficulty.  If this occurs a breathing tube may need to be placed until the swelling goes down.  In severe cases, a temporary tracheostomy (tube placed through neck region) may be needed.  This is an uncommon complication occurring in about 5% of the patients and usually does not result in death.
  • Recurrent infection is an uncommon complication, usually due to unresolved infection at the level of the middle ear or ascending infection from via the auditory tube, and may require a second surgery to clean the bulla.

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