A Total Ear Canal Ablation and Ventral Bulla Osteotomy may be warranted in animals with severe, chronic ear infections or patients that have a tumor of the ear canal.

Having the procedure performed by a skilled, experienced surgeon will minimize operative and post-operative complications.

Prognosis is very good, and typically hearing is not worsened by surgery.

What is it?

• The Total Ear Canal Ablation and Ventral Bulla Osteotomy (TECABO) is a surgery that is indicated in animals with long-term (chronic) ear infections that have failed to respond to medical management and/or are too difficult to treat medically. 

Pertinent Anatomy

• The ear is composed of 3 main parts (the photo to the right is a cross section through the components of the ear:
  
  1. The external ear which includes the external ear canal and visible pinna (ear flap).
  2. The middle ear which contains the tympanic cavity inside a bony chamber called the bulla which has an opening in its wall that connects to the throat.  The middle ear is separated from the external ear by the tympanic membrane (or eardrum).
  3. The inner ear which contains small bones and membranes that function in hearing and balance.

Clinical Signs

• Ear infections may affect the external ear (otitis externa), the middle ear (otitis media) and/or the inner ear (otitis interna).  Different clinical signs are present when the different areas of the ear are affected.
• Sharp pain response on palpation of the ears, malodorous ears, large amounts of debris in ears, head shaking, scratching, rubbing the ears, hearing loss, head tilt, loss of balance, odd circling behavior, lip droop and facial muscle spasms are all clinical signs that you may see with ear infections. 
• In extensively chronic ear infections, the ear canal may become irreversibly thickened and may calcify (turn to bone).  One or both ears may be affected.

Diagnosis

• It is important for your veterinarian to determine the severity of disease prior to treatment. 
• Physical examination will localize and determine the extent of disease.  If your pet is extremely painful, it may need to be sedated or put under anesthesia for a more thorough examination. 
• Your veterinarian may look into your pet’s ears with an instrument called an otoscope.  Otoscopic examination will determine if the eardrums are intact. 
• Further imaging techniques such as skull radiographs (using an x-ray), Computed Tomography (CT) scan, or Magnetic Resonance Imaging (MRI) may be performed to determine if there is concurrent middle ear disease or cancerous growths.

Treatment

• A Total Ear Canal Ablation and Ventral Bulla Osteotomy (TECABO) is a surgery in which the entire ear canal(s) is removed and the bulla is opened up to allow cleaning and drainage of the potentially infected middle ear.
                                                                                                

Potential Complications

• There are a few complications associated with surgery. 
• Anesthetic death is always a risk when any surgical procedure is performed under anesthesia.  Extensive training of the staff in anesthesia makes this risk very rare at a specialty facility. 
  
• Facial paralysis may occur and is usually temporary and resolves within 2 weeks, however a few cases may be permanent. 
• Swelling of the neck and throat may occur from bleeding the surgical site; this could cause breathing difficulties which may require treatment.
• Infection of the surgical wound, abscess formation, and damage to the ear flap’s blood supply may occur. 
• Most of these complications are prevented by having the surgery performed by an experienced, skilled surgeon. 

Aftercare

• After surgery, your pet may be prescribed a course of antibiotics and/or pain medications.  Be sure to give all medications as directed. 
• The incision site will need to be kept clean and dry until healing occurs.  Baths should not be given until you are instructed to do so. 
• There may or may not be sutures (stitches or staples) present that will need to be removed 10-14 days after the surgery. 
• Your pet will need to wear an E-collar (elizabethan collar) to prevent your pet from scratching its ears and causing damage.

Prognosis

• Prognosis after a TECABO procedure is very good. 
• If only one ear was operated on, the other ear may also be prone to severe infection and may need the procedure performed in the future. 
• Breeds with floppy ears have an excellent cosmetic result, however, breeds with erect ears may experience some drooping of the operated ear(s). 
• Ear disease may be caused by underlying medical problems dealing with your pet’s skin and/or endocrine system.  A further medical work-up for skin disease and/or endocrine disease should be performed if they were not investigated prior to surgery.
• Several studies have been performed to assess post-operative hearing quality.  Animals with severe chronic ear disease typically have a significant degree of hearing loss prior to surgery.  With the TECABO surgery, hearing does not improve nor worsen.  After the TECABO surgery, sound is passed in waves through the bones rather than through the air.  Some owners have reported that they feel their dog may hear better after surgery.  Most likely this is due to the elimination of the pain associated with severe ear infections.  When a pet is less painful, it is more likely to respond to sound stimuli. 

References

• Fossum, T.W. et al. Small Animal Surgery; 2nd edition. Mosby, St. Louis, MO.  2002. pp. 229-246
• Slatter, Douglas, et al.  Textbook of Small Animal Surgery; 3rd edition. Saunders. 1993. pp. 1746-1758

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