Middle Ear Polyp Removal: A Lateral Approach
Jonathan Miller, DVM, MS, DACVS, Oradell Animal Hospital, Paramus, New Jersey
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What Is The Prognosis For Cats With Polyps
Cats that have been diagnosed with polyps often enjoy a rapid resolution of their signs after appropriate removal. In some cases, the entire stalk of tissue cannot be completely removed and some gets left behind. This can mean that the polyp regrows and causes the signs to recur in the future, requiring another procedure. It is more common for those that originate in the middle ear.
In such cases, or where a polyp is causing a middle ear infection, a further operation called a ventral bulla osteotomy can be done to help prevent a recurrence. However, this is a much more invasive procedure not without its own risks and it often requires a specialist. Both VBO and removal by traction can cause some negative side effects such as nerve damage, but, in most cases, this resolves with time.
Generally speaking, cats go on to live normal lives when the polyp has been addressed.
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Reasons For Cat Ear Surgery
Lucy has 30+ years of technical and marketing writing experience, as well as many years of experience writing articles on an array of subjects for several digital publications.
If your cat suffers from polyps, recurring infections, or some types of tumors, ear surgery may help. Knowing why the surgery is required and how it may benefit your cat long term can help you make the best choices for your kitty’s health.
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What Is The Brown Stuff In My Cat’s Ears
When the lining of the ear canal is irritated, it reacts by producing increased levels of secretions which include wax. As this accumulates, it condenses and dries out as a dark brown, thick substance which can be seen from the outside. Its important to find out the cause of the irritation which has prompted this increased wax production so that it can be effectively treated.
Assessing And Diagnosing The Condition
Veterinarians will use a lighted, magnifying tool to look into theinner ear of a cat whenever any type of infection of the ear issuspected. With the use of this tool, a veterinarian will actually beable to see the presence of the polyps on the inner wall of the ear.Once the polyps have been physically seen, the diagnosis is complete.
However, the next step in the diagnosis is to make sure that thepolyps are not cancerous. Because polyps are actually small lumps madeup of the growth of cells, they have the ability to be cancerous intheir nature. In order to determine if this is the case, a biopsy ofthe polyps will be performed.
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Treatment For Ear Discharge In Cats
Regardless of the discharges underlying cause, ear cleaning is generally recommended to remove discharge.
Treatment options for ear discharge depend on the underlying cause. As examples:
- Mite infections may require an anti-mite ointment to be applied regularly for up to three weeks.
- Bacterial infections of the external ear canal so-called otitis externa may need antibacterial and anti-yeast ointment to be applied, as well as some investigation of the underlying cause in the first place, especially in chronic ear infections.
- Polyps or growths inside the ear canal may need complex surgery to remove the polyps or growths.
- In all cases, ear cleaning may be recommended, to remove any discharge so that this does not further complicate the underlying primary problem. Ear drops can be used to soften the wax, and cotton buds or a cotton ball can be used carefully to wipe away accumulated wax, as long as care is taken not to push wax deeper down into the ear canal. Care needs to be taken when selecting and using ear drops: deafness is a possible consequence if the wrong drops are used, especially if your veterinarian has not examined the ear to rule out a ruptured eardrum.
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Lateral Ear Canal Resection
LECR eliminates the lateral wall of the vertical canal. It is only successfulsuccess being defined as patients in which recurrent otitis does not occurin approximately 50% of patients. Clients should be warned of the relatively high failure rate. In one study, the failure rate was as high as 62.5%.1 This study utilized strict criteria for post surgical evaluation to determine success.3
When this procedure is performed early in the disease processbefore development of otitis media or chronic proliferative changes to the horizontal canalit is much more successful. In one study, lateral resection failed in 86.5% of the cocker spaniels but other breeds, especially Chinese shar-peis, had a better outcome, especially when LECR was performed early in the disease process.4 Cocker spaniels often have more proliferative and mineralizing changes that affect the entire ear canal and bullae, likely accounting for the higher failure rate seen in this breed .
FIGURE 8. Cocker spaniel with severe chronic proliferative and mineralizing otitis externa and media.
LECR is indicated in patients with stenotic vertical ear canals or those in which this procedure can improve medical management by allowing better drainage and ease of topical application. It is not indicated in dogs with stenotic horizontal ear canals, otitis media, and severe proliferative disease or mineralization of the auricular cartilage. In these patients, the success of LECR is very poor.
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Total Ear Canal Ablation With Lateral Bulla Osteotomy
TECA/LBO is indicated in patients with visible masses that cannot be removed by alternative methods, neoplasia of the ear canal/bullae, and severe end-stage otitis externa/media that has not responded to medical therapy .
FIGURE 10. TECA/LBO in a golden retriever with a chronic nonresponsive medical otitis externa/media due to an obstructive mass at the level of the horizontal ear canal.
FIGURE 11. Marked canal stenosis and mass from dog in Figure 10 are seen during ear canal resection.
TECA should always be performed with LBO, which allows for removal of infected tissue, exudate, or bone that may be trapped in the middle ear. If LBO is not performed, this trapped material can result in persistent infection and granulation tissue in the bulla and create postoperative abscesses and drainage.6,8
This procedure still requires that underlying skin disease be managed or controlled or higher failure rates are seen.9 A large percentage of dogs, ranging from 46% to 80%, that have undergone TECA/LBO also have generalized skin disease.1,10,11 In one study, ongoing disease persisted in the medial aspect of the pinnae, creating ongoing problems in 6 of 8 patients.1
When performed properly, the overall success of this procedure is high. In one series, 27 of 29 dogs undergoing TECA/LBOin which follow-up results were obtainedhad an excellent or improved outcome following surgery,1 with other reports in the literature showing ranges of 76% to 95%.10,13
What Are The Signs Of Nasopharyngeal Polyps
Nasopharyngeal polyps impact your cat’s breathing. The polyps obstruct the passage of air so affected cats usually develop a distinctive snorting sound as they breathe. Secondary bacterial infections can develop due to the blockage and accumulation of secretions. If this occurs, the cat develops nasal discharge and sneezing. The discharge may be clear or have some blood in it.
If the polyp has extended into the ear, signs may include pawing at the ear, head shaking, head tilt, or discharge from the ear. Rarely cats can experience loss of balance and different pupil sizes.
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Growth Removal $175 To $875
GROWTH REMOVAL- EXTRA LARGE $875
GROWTH REMOVAL LARGE $655
GROWTH REMOVAL MEDIUM $425
GROWTH REMOVAL SMALL $175
MAMMARY CHAIN REMOVAL $ 1095 Requires spay in addition
Growths can appear anywhere on your pets body and can grow from many different cell types. Some are slow growing and some can grow quite quickly. Either way, any abnormal lump or bump should be checked by your veterinarian. A needle biopsy can help determine the type of growth and if removal is indicated. This will be done by your regular full service veterinarian. If a larger sample is needed, or you simply want the growth removed, we can remove the growth and send the entire piece of tissue to the lab with the results sent to your full service veterinarian for review and follow up care. If the cell type is unknown prior to surgery or if the growth is suspicious for cancer, we will make every effort to achieve clean margins of skin around the growth. Therefore the incision will appear larger than the actual growth was. There are some areas of the body where the skin will not allow for clean margins and only a debulking of the mass can be achieved. Drainage tubes and bandages may be used post- op depending on the location and size of the growth. Instructions for care will be sent home with you.
Reduce Proliferative Canal Changes
Glucocorticoid therapy is indicated in markedly inflamed edematous otitis and when chronic pathologic changes cause marked stenosis of the canal lumen. Some patients with allergic otitis may be treated with systemic glucocorticoids, which allow the initial topical therapy to be a low potency glucocorticoid product.
Injectable dexamethasone is useful when only 2 to 3 days of action are required. For more severely inflamed ears, especially when other systemic signs are present, anti-inflammatory dosages of prednisone or prednisolone or triamcinolone can be used initially then tapered to the minimum alternate day dosage that controls clinical signs. In some cases, low-dose, alternate day therapy can be used to avoid the need for surgery.
For the patient with severe stenosis, primarily of the vertical canal, intra-otic/intralesional triamcinolone acetonide may be helpful.
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How Much Does It Cost To Treat A Cat With Ear Discharge
It is impossible to estimate this cost, as there are so many possible issues that can cause ear discharge. You should ask your veterinarian for a detailed estimate before agreeing to proceed with treatment.
The cost could be less than $100 to treat a simple case of ear mites, or over $1000 in severe cases e.g. if your cat has an ear polyp requiring complex surgery and follow-up treatment.
Diagnosis Of Ear Discharge
The diagnosis of the presence of an ear discharge is easy to make, as it is a visual observation. However it is important that an accurate diagnosis of the cause of the ear discharge is made by your DVM veterinarian, and a series of steps may be needed to do this.
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Ear Polyps In Pets: What Pet Owners Need To Hear
Most times an ear infection is a pretty easy problem to solve. Sometimes, though, we will run into an infection that wont clear or that keeps on coming back. In this instance, it is likely that there is something going on that is predisposing that ear to have problems.
One of the more common diagnoses in complicated ear infections in pets are ear polyps. Find out what you need to know about ear polyps in pets and how they affect your animal.
How Do Cats Get Ear Discharge
Cats develop ear discharge for a number of reasons, primarily irritation of the ear lining.
Ear discharge develops as a consequence of a number of different ear problems. If the lining of the ear is irritated , the ear canal produces extra secretions.
This is part of the immune systems response e.g. to bacteria, as the secretions have an anti-microbial effect. As these secretions build up, they can be seen by the owner as a waxy build-up, and sometimes they move upwards so that they gather around the opening of the ear.
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What Is An Ear Polyp
An ear polyp is a variation of a tumor. All tumors are cells that grow outside of normal control in an abnormal place. Ear polyps, obviously, are an abnormal growth within the ear canal.
Most growths in the ear are little polyps attached to the lining of the ear canal by a stalk. These little tumors are often one of two kinds:
- Ceruminous gland adenomas
- Squamous cell carcinomas
Just like most forms of cancer, we dont always understand why pets develop ear polyps. We do know, however, that chronic inflammation within the ear canal can lead to overgrowth and polyp development.
Most ear polyps can be diagnosed with an otoscopic examination. Many of them are deep within the ear canal, though, and some may require sedation to be visualized. Occasionally advanced imaging such as a CT scan or MRI is required.
Ear polyps are fairly common in cats and dogs with frequent ear infections such as Cocker Spaniels.
Treating Cat Ear Polyps
Cat ear polyps are not the type of condition that can be treatedwith conventional medications. In order to completely rid a cat of hisear polyps, he will have to have surgery on his ears. The process ofremoving the polyps includes removing the stalk on which they grow andtheir masses. When the stalk is not completely removed, there remains a75% chance that the polyps will grow back.
In some cases, a cat owner may opt to have a procedure known as aventral bulla osteotomy done to ensure that the polyps do not growback. While this procedure is quite expensive, it involves removingpart of the bone which surrounds the ear. When this portion of the boneis removed, it is almost a sure thing that polyps will not be able togrow back.
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How Are Polyps Treated
Generally, polyps are fast and uncomplicated to treat. Easy-to-reach nasopharyngeal and ear polyps can be removed using gentle, steady traction on the mass of tissue, with the cat under general anaesthetic. Its normally a very short procedure and the cat recovers quickly. There is often a rapid improvement in the signs it showed before the surgery.
Total Ear Canal Ablation Procedure In Cats
Your cat will be treated with antibiotics prior to surgery if ear infection is present. Prior to surgery your veterinarian will ensure that systemic infection is not present in your cat. Your cat will be sedated, administered intravenous anesthetic and an intubation tube inserted and anesthesia maintained by gas during this procedure.
Incisions in the external ear canal are made to remove the diseased ear canal entirely.
If bulla osteotomy is being performed in conjunction with total ear canal ablation in your cat, the bulla or ear is opened surgically and infected and damaged tissues around the hearing apparatus is removed.
Infected tissue may be biopsied and sent for analysis to identify bacterial organisms present and adapt antibiotic treatment as required.
Drains may be placed in the ear to allow drainage, especially if a bulla osteotomy is not performed.
Hospitalization for 24 hours occurs after surgery to monitor your pet’s condition for complications.
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Causes & Factors Of Otitis
Predisposing factorsalone do not cause otitis, but increase risk of development and persistence of chronic infection. These factors work in conjunction with primary or secondary causes, allowing otitis to become a significant problem.
Primary causes of otitis are the inciting agents or etiology that directly damages the ear canals epithelium, resulting in subsequent inflammation. To prevent recurrent episodes of otitis, it is critical that the primary cause be diagnosed and managed.
Secondary causes of otitis do not create pathology in a healthy ear instead, they incite disease in ears affected by a primary cause or predisposing factor. If the inciting cause or factor is inadequately controlled, secondary causes, such as bacterial or yeast overgrowth, typically become chronic issues.
Perpetuating factors are changes in anatomy and physiology of the ear that occur in response to otitis. They are most commonly seen in chronic cases and are not disease specific. These factors can accentuate development of secondary infections by providing environments and microscopic niches that favor their persistence.
In severe cases, perpetuating factors can ultimately prevent the resolution of otitis by leading to irreversible changes of the ear canal. They are the most common reason that otitis fails to respond to medical therapy and, ultimately, requires surgical intervention.
Symptoms Of Ear Discharge In Cats
Ear discharge may be brown, green, or yellow. This type of discharge is commonly referred to as ear wax.
When an owner examines their cats ears, there should normally be a clean, dry skin surface, and when the ear canal itself is checked, the lining should be clean and empty, with no liquid or solid material in sight.
If ear discharge is present, these may be seen as brown, yellow, or even green coloured material around the opening of the ear. If the ear is examined closely, sometimes this type of discharge may just be seen inside the ear canal.
This type of discharge is commonly referred to as ear wax.
Often affected cats may be head shaking, or pawing at their ears, because of the ongoing ear disease. Most often, the outer ear is the only affected area, but if there is also disease of the middle ear or inner ear , they may be other signs, such as a head tilt, or loss of balance. There may also be hearing loss.
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