Sometimes chronic ear problems are simply hopeless, or what we refer to as ‘end stage’. Organisms causing infection in the ear may be too resistant for treatment, the ear canal may have become hard and mineralised from chronic irritation, or the ear canal may be so scarred and narrowed that cleaning is futile. This degree of irreversible disease requires surgical treatment. Total Ear Canal Ablation (TECA) and Bulla Osteotomy (BO), often referred as TECA for short, involves removal of the diseased ear canal along with the lining and bones of the middle ear, whilst leaving the outer part of the ear (the ear flap or ‘pinna’) and inner ear (the hearing organ itself) in place. This ends what has generally been a long-standing tribulation of pain, odour, ear cleaning, and expensive veterinary medications and reexaminations
The ear comprises three main parts:
- The outer ear includes the pinna (or ear flap), which picks up the sound, and the ear canal which funnels the sound down to the ear drum.
- The middle ear is a bony air-filled cavity in the skull (tympanic bulla), lined with a secretory layer of cells. Three tiny bones (called ossicles) pass the sound vibrations from an outer membrane (the ear drum) across to an inner membrane.
- The inner ear lies on the other side of this inner membrane. The cochlea and auditory nerves of the inner ear are the part of the brain which makes up the hearing organ itself.
Canine ear disease usually occurs due to inflammation of the skin that lines the ear canal (otitis externa) which can lead to secondary infection of the middle ear chamber (otitis media).
In the majority of cases, inflammation of the skin within the ears is part of a more generalised skin condition; pets suffering from ear problems often experience irritation elsewhere. More severely affected pets can suffer from clear evidence of skin allergy over other parts of their body, in addition to the ear disease.
The reason that the ears are often more severely affected by this generalised skin irritation than other areas of the body, is because of the environment within the ear canal. Initially the hypersensitivity or skin allergy causes a low level of inflammation which allows bacteria and yeast organisms that normally live on skin to increase in numbers. In mildly affected dogs, most areas of the skin can avoid significant organism overgrowth, but the moist and warm environment within the ear canal provides the ideal environment for these organisms to grow and therefore cause further inflammation. As the organisms increase in numbers, their presence causes further inflammation and damage to the skin, leading to a vicious cycle of deterioration. As the infection and inflammation progress, the ear canal becomes irreversibly narrowed, and the middle ear chamber can become filled with infected material.
The key to successful management of ear disease lies in control of the bacteria and yeast organisms within the ear canal and soothing the inflammation, at the same time as addressing the initial cause of the irritation. Initial treatment aims to break this vicious cycle; ear cleaning and flushing, ear preparations containing antibiotics, antifungals and anti-inflammatories and systemic (oral) antibiotics and /or anti-inflammatory medications all form part of our medical arsenal to treat ear disease. However, treating the initial or underlying cause will usually involve recognition and correction of predisposing factors that may be present in the patient. This may require allergy testing or dietary management to reduce the level of allergic inflammation in the skin.
TECA surgery is an ‘end stage’ or salvage procedure and is reserved for those cases that cannot be managed satisfactorily by medical means. The operation involves the removal of the entire ear canal. The pinna (ear flap) and inner ear (hearing organ) are left in position. Following removal of the diseased ear canal, part of the bony wall of the tympanic bulla (middle ear) is also removed (Bulla Osteotomy) to facilitate removal of the secretory lining and infected material from the middle ear chamber. Once the wound is closed there is no longer an ‘ear hole’.
For more information or to discuss this surgery in more detail with one of our veterinary surgeons please contact us on 015394 88555 or visit the referrals section of our website at www.oakhillvetgroup.co.uk