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Surgical Management of Chronic Otitis Media by Total Ear Canal Ablation and Tympanic Bulla Osteoctomy in a Bullock.

Abstract

An adult bullock was presented with foul smelling wound in his right ear. On close examination, necrosis of wound with foully discharge was observed. Animal is unable to chew food properly from past 10 days. Total ear canal ablation (TECA) was done to remove the necrotic tissues lining ear canal and Tympanic bulla osteoctomy (TBO) done to remove damage part of tympanic membrane and epithelium or middle ear that undergone metaplasia with new bone proliferation of tympanic bulla which was serving as resistant nidus of infection. Post-operative wound care with suitable antimicrobial therapy and pain management was done for 10 days till wound healed.

Keywords: Otitis media; otitis, total ear canal ablation (TECA); tympanic bulla osteoctomy (TBO); tympanic membrane

Introduction

Otitis is uncommon pathological condition of ears in large animals. Otitis when left untreated started ascending toward middle ear. Accumulated bacteria and debris in horizontal ear canal can eventually access tympanic cavity. As the infection establishes, tympanic membrane and ear canal epithelium become thickened and hyperplastic. Dystrophic calcification often occurs in cartilage. In end-stage middle ear infection, epithelium undergoes metaplasia with new bone proliferation of tympanic bulla which serves as a nidus of infection. Total ear canal ablation (TECA) combined with Tympanic bulla osteotomy (TBO) is the most common procedure for accessing the tympanic cavity. This combined approach allows complete removal of debris and inflamed epithelium from chronically diseased ear canal tissues and permits exposure of tympanic cavity thus minimizes occurrence of post infections on surgical wound.

History and Diagnosis

A bullock was presented with wound showing discharge from right ear. On close examination, the fluid from wound was thick reddish brown and foul smelling. External cleaning of wound by Potassium permagnate solution and Tincture iodine shows necrosed epithelial lining of ear canal. No maggots infestation was observed. External condition of the bullock were normal. History indicated presence of ear infection from past one month with purulent discharge. Detailed clinical examination revealed that ruminal motility was normal, rectal temperature was 100.4 (0)F, respiration rate was 32 per minute, anorexia and defecation was normal with normal fecal consistency at time of presentation. Hematological examination shows decreased neutrophills (30%) and increased lymphocytes (68%) Serum biochemistry is normal except for mild increase in PCV value of 42.6 percentage which attributes dehydration. Condition of wound required surgical intervention for healing.

Treatment

Animal was given Inj. Ceftriaxone +Tazobactam 4gm iv, Inj. Rigers lactate 6000 ml I.V., inj. Melonex (a) 6 ml I.V. and Inj. Neuroxin (b) 5 ml I.V. on the day of presentation and surgery was planned on 2nd day. The animal was kept off-fed for 24 hour prior surgery. At the day of surgery - surgical site prepared by shaving hairs around site of incision and antiseptic wash of the wound. Standard surgical instruments, along with orthopedic instrument as muscle retracter, bone Nebular and oliver bone curator and suction pump were used in surgery. Inj. DNS 4000 ml I.V., Melonex (a) 5ml I.V., 5ml s/c, inj. Ceftriaxone +Tazobactam 4 gm and Neuroxin (b) 5ml I.V. were given during surgery.

Surgical Procedure

Total Ear Canal Ablation (TECA)- A T-shaped incision was made in the skin at the opening of ear canal. Surrounding muscles and fascia were separated. Blunt incision was proceeded and facial nerve trunk laying adjacent to ear canal was separated. Sharp incision was then proceeded along side of ear canal to separate it from surrounding muscles. Necessary crushing and ligation of underlying capillary done to prevent bleeding. Ossified part of ear canal attachment is separated with the help of bone nebular. Carefully blunt incision was then given to separate ear canal attachment with tympanic cavity.

Tympanic Bulla Osteoctomy (TBO) - Tympanic bulla was exposed by separating attachments of ear canal. Oliver Bone Curator were then used to scrape the inside of bulla, removing as much secretory epithelium as possible. Washing and suction of bulla cavity along with surgical site was done by 0.9% Normal saline. Lixen (c) (Cephlexin) was installed locally after washing the surgical site.

The muscles surrounding tympanic cavity were opposed together with Alles tissue forcep and sutured with Catgut number 0. Surgical drain was applied by using Malecot catheter number 18 to facilitate serum drainage. The inner cartilaginous lining of ear pinna was sutured with skin of line of incision to completely close the wound.

Post-Operative Treatment

Animal was kept on clean and dry shade for 10 days. Post-operative care as regular dressing of wound twice daily was advised. Inj. Ceftriaxone 3 gm i.v O.D, Inj. Amikacin 2 gm i.v O.D, Inj. Neuroxin (b) 5ml i.v O.D, inj. Meloxicam (a) 5ml i.v and 10 ml s/c B.D along with inj. DNS 5000ml i.v O.D were given once daily for first 3 days after surgery. Animal was given fresh green fodder along with liquid feed from 3rd day of surgery. Medicines changed to Inj. Streptopenicillin 5 gm i.m O.D, Inj. Meloxicam (a) 10ml i.m, 10 ml s/c B.D, Inj. Hivit 10ml i.m O.D, Rumicare (d) (125gm) orally OD from 4th day and continued till 10th day of surgery. Suture of skin and drain were completely removed on 10th day post surgery. Animal started eating normally from 10th day post surgery.

Discussion

The surgical procedure as TECA along with TBO should be done to prevent poor evacuation of bulla which may ultimately result in intractable deep infection a problem that is often clinically worse for the patient than the original external and middle ear disease. Effective post operative pain management is required as patients undergoing TECA and TBO often show extreme postoperative pain due to inflammation and nerve stimulation from deep wound dissection and bone removal. Broad spectrum antimicrobial therapy was undertaken for gram negative bacterial infection in chronic end stage ootitis. Proper monitoring and wound care is required for patients undergoing TECA and TBO.

References

Blood, D.C., Henderson J.A and Radostits, O.M; Veterinary Medicine, 10th edition. Philadelphia, Lea and Febiger.

Krahwinkel, D.J. (2003). External ear canal. In: Slatter D (ed): Textbook of Small Animal Surgery. Philadelphia, WB Saunders, pp 1746-56.

Mathews, K.A. (2000). Management of pain. Vet Clin North Am Small Anim Pract 30.

Turner, S.A., Mcilwraith, W.C. Techniques in Large Animal Surgeries, 2nd edition, Philadelphia, Lippincott Williams and Wilkins.

P. Dubey (1)

Pet Medics Small Animal Veterinary Care Center Vypar Vihar Road Bilaspur - 495006 (Chhattisgarh)

(1.) Coordinator- Animl Health Program, Jan Swasthya Sahyog (NGO), Ganyari, Bilaspur, Chhattisgarh and Corresponding author. E-mail: piyush_vet@yahoo.co.in.

(a) - Brand of Intas Animal Health, Ahmedabad

(b) - Brand of Zydus Animal Health, Ahmedabad

(c) - Brand of Virbac Animal Health, Mumbai

(d) - Brand of MSD Animal Health, Pune
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Title Annotation:Short Communication
Author:Dubey, P.
Publication:Intas Polivet
Article Type:Clinical report
Date:Jul 1, 2016
Words:1130
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