This article does not deal with cosmetic ear surgery. Cosmetic surgery or ear cropping is performed for the vanity of pet owners. I try to talk owners out of that, and tail-docking, whenever I can.
This article discusses legitimate surgery that usually cures stubborn ear infections that no longer respond to medications. The surgery is radical, but it is such a joy to see pets that have suffered so long be finally free of pain. It is one of the most rewarding procedures a veterinarian can perform.
Another article in this series discusses the various causes of ear infections and how to control them. Infections that reoccur over and over again all result in a similar situation – a disease that no longer respond to antibiotics with permanent changes in the ear canal.
Most veterinarians postpone this operation longer than we should. The usual sequence of events is that we try every form of ear mediations sold and concoct a few of our own before we inform the owners that surgery is the best answer.
The ear is an ideal place for recurrent infection. Read more about the problem here. Floppy-eared dogs have poor air circulation within the canal to begin with. Their ear canals slopes upward so that they do not drain readily. The canals are lined with a membrane which, when inflamed for any reason, secretes a moist exudates ideal for bacterial and mold growth. In normal ears, sebaceous glands secret a translucent, protective ear wax. In ears that have long been infected, apocrine tubular glands become more numerous and secrete a sticky brown material, rich in nutrients, that support bacterial and mold growth. Infections also cause scaring which narrows the canal and obstructs drainage and air circulation. These changes, once they occur, are irreversible.
It is unclear why so few dogs undergo total canal surgery since the results are usually excellent. There are a number of surgical operations. The less drastic ones spare varying amounts of diseased ear canal tissue. These include lateral or vertical ear canal resection, Zepp Otoplasty and some forms of ventral bullar osteotomy. In my experience, these other procedures are ineffective in more than fifty percent of the cases.
Total ear canal ablation is almost always successful while less extensive types of surgery often fail. The secret of this success is in choosing surgical candidates wisely. Canal ablation must be combined with middle ear drainage and curettage (scraping) if it is to succeed in deep infections. In deep ear canal disease, infections have passed beyond the eardrum and affected the middle and inner ear. These pets have specific signs related to the deeper infection. They often hold their heads cocked with the affected ear down. They may circle toward the affected ear and the eyelids and lip on that side may be droopy. They often walk cautiously and have problems keeping their balance. X-rays of the head sometimes show the extent of damage to the bones that surround the ear canal.
Once your veterinarian decided which procedure to use, they will often begin the dog or cat on 10-14 days of pre surgical antibiotics. It is helpful to have a bacterial culture taken from the ear to help chose the best antibiotic possible. Every veterinarian has their own unique techniques and procedures they find most successful for them. When I do this surgery (with the pet asleep) , I shave the ear and then flush it with detergents, iodophors and antibiotics. I use a blue surgical marker i to delineate the area that is to be removed. Because the ear canal is very vascular (bloody) I like to perform this surgery with an electric knife (electro surgical apparatus). A T-shaped incision is made over the ear canal and all diseased tissue and ear canal cartilage is removed (see diagram).
I take special care to locate and avoid the facial nerve, which runs just below the ear canal. This nerve is responsible for tear secretions in the eye as well as eyelid and lip function on that side of the face. Stretching or cutting this nerve will lead to complications. I also isolate and avoid nicking the parotid salivary gland that surrounds the base of the ear. I do not worry that much about hearing loss. Most of the dog and cats that have ear disease extensive enough to warrant surgery already have extensive hearing loss.
After the surgery I put dogs on meperidine (Demerol) , a narcotic pain reliever, for several days. Meperidine is still a wonderful pain reliever, but most veterinarians now send the pets home with fentanyl narcotic patches. You can read about all of the pain relievers available to your pet here.
I keep patients at the hospital until they are eating well and up and around. During this period they receive injectable broad-spectrum antibiotics. I send them home on oral antibiotics for an additional two to three weeks.
Occasional complications are to be expected in any surgery. The older the dog is when this surgery is performed, the slower healing occurs and the greater the risk of complications Salivary gland leakage into the surgical field occurs occasionally. These generally resolve themselves with time. Damage to the facial nerve, either due to the ear infection or stretching of the nerve during surgery usually resolves during the next few weeks. If it should remain, it may be necessary to apply eye drops to the affected eye on a routine basis to prevent dry eye.