A total ear canal ablation (TECA) describes a surgical procedure in which the ear canal is completely removed. This procedure is often indicated in patients with severe chronic otitis externa. Chronic ear infections often become refractory to conventional treatments over time. The TECA procedure is especially useful in otitis cases with hyperplasia and stenosis of the ear canal, which can make the regular treatment with drops or ointments impossible. Diagnosis of a malignant neoplasm in the ear canal is also an indication for this procedure.
As with other surgical procedures requiring general anesthesia, the patient’s blood work should be tested pre-operatively. Important tests to include are a complete blood cell count and an internal organ chemistry panel. It is also important to evaluate the function of the facial nerves pre-operatively. The facial nerves run adjacent to the ear canal and may be temporarily damaged during the procedure. It is important to know the level of nerve function the patient has before the procedure to determine if there is damage post-operatively.
Facial nerve damage that is present before the procedure will likely not resolve. If available, a CT scan or MRI are recommended. While radiographs can provide information about the skull and bony structures, a CT scan or MRI allows for better visualization of the ear canals and structures in the middle ear cavity. Patient preparation involves clipping and surgically preparing the entire side of the patient’s face. As this procedure is generally performed bilaterally, both sides of the face will need to be clipped and scrubbed.
The canal should be flushed before the procedure to remove as much of the contaminants as possible. The flush can be diluted chlorhexidine solution; other solutions can be used as long as the tympanic membrane is intact. The patient will be positioned in lateral recumbency with the head elevated. To begin the procedure, the doctor will make parallel incisions lateral to the vertical ear canal. The canal will be dissected from the surrounding tissue. The ear canal has two basic sections, the vertical and horizontal canals. These canals are mostly surrounded by cartilage, with the exception of a thin bony structure near the tympanic membrane that supports the most inner part of the middle ear. This is called the tympanic bulla. The ear canal, both vertical and horizontal sections, is removed in one cylindrical piece. The tympanic membrane (ear drum) and the bones of the middle ear are also removed. Patients with chronic ear disease often have disease of the middle ear as well. In these cases, the cellular lining of the tympanic bulla is scraped away and flushed to remove the infected material. This accompanying procedure is called a lateral bulla osteotomy. When these procedures are performed concurrently, it is referred to as TECA-LBO or TECA-BO. Once the procedure is complete, the incision is surgically closed. Occasionally, an external drain, such as a Penrose drain, may be placed to allow for further drainage of infected material. Once healed, there is no external opening at the base of the ear pinna. As with any anesthetic and invasive surgical procedure, complications can occur. However, complications from a TECA-BO surgery are rare. As there are many veins and nerves present near the ear canals, damage to these structures is the primary risk. If damage to the vasculature occurs, the blood supply to the ear pinna may be affected. This may cause partial loss of blood supply and the edges of the pinna may become necrotic. In this case, the dead tissues must be trimmed. Damage to the nerves in this area may cause facial paralysis. This is generally temporary and will resolve with time. Although hearing loss is often expected, many times the patient’s hearing is already diminished due to chronic ear infections or stenosis of the canal. Usually there is little change in the patient’s hearing ability. Chronic drainage from the incision is another potential complication. This can often be resolved with antibiotics, but sometimes an additional surgery is needed. Overall, the TECA-BO procedure yields great results and a good prognosis.Discharge InstructionsActivity RestrictionYour pet’s activity needs to be restricted for the next 10-14 days until your recheck appointment. Your pet needs to wear an e-collar at all times to prevent irritation or disruption of the incision. Your pet should be leash walked for bathroom trips and no heavy, rough play or strenuous activity should be allowed.Dietary RestrictionsFor your pet’s first meal at home after anesthesia, feed …”-Ѕ of their normal amount of food. Feeding amount can return to normal the following day. There are no dietary restrictions necessary for the rest of your pet’s recovery.MedicationsYour pet has been sent home with a pain medication. Please continue to give this medication as prescribed. Your pet has also been sent home with an antibiotic. Please give this medication as prescribed. Give until gone, even if no signs of infection are seen.Your pet has been sent home with lubricating eye drops. There is the potential for temporary facial nerve damage during the procedure, which will cause your pet to be unable to blink and keep their eyes properly lubricated. Please administer these eye drops until your recheck appointment.If external drains have been placed, the bandage will need to be changed 1-2 times daily for the first 7 days, and then removed. (Drains are not commonly used, but if present, patient would most likely stay in the hospital to receive these frequent bandage changes.)Potential Complications and What to Look ForNerve DamageThe facial nerves are located near the ear canal and may be affected during the procedure. This damage is most often temporary and will resolve without further treatment. Damage to Blood Supply There are also veins that run adjacent to the ear canals. Damage to these veins during the procedure may result in compromised blood supply to the ear pinna (ear flaps). Monitor the ear flaps, checking the edges for any change in color or texture. With compromised blood flow, the edges of the ear will begin to die, resulting in necrotic tissue. The skin may look black and have a bad smell. If you are seeing these signs, please contact your veterinarian.Incision Site Please check the incision site twice daily for any swelling, redness, or drainage. While some degree of drainage is expected, excessive signs can indicate infection, either persistent infection in the ears or infection of the incision itself. If you see any of these signs, please contact your veterinarian. Recheck AppointmentsYour recheck appointment is in 10-14 days. At this time, the sutures will be removed and the progression of healing will be evaluated.