Trans-endoscopic diode laser fenestration of equine conchae via contralateral nostril approach.

OBJECTIVE: To describe and report preliminary outcomes of a contralateral trans-nasal endoscopic laser fenestration of the conchae for endoscopic examination and treatment of paranasal sinuses in horses. STUDY DESIGN: Cadaveric experimental and prospective clinical study. ANIMALS: Normal cadaveric equine heads (n = 7) and equine patients (horses n = 7, donkey n = 1) diagnosed with sinusitis. METHODS: Ex vivo: a video-endoscope containing a diode laser fiber in the working canal was passed through the nostril and retroflexed in the nasopharynx toward the contralateral conchae. Ventral or dorsal conchae were fenestrated. Duration of surgery, laser energy, visualization quality, and feasibility of sinoscopy through the fenestrations were recorded. In vivo: sinus drainage, sinoscopy 24 hours postoperatively, stoma persistence, and clinical results after 3 months were evaluated in 8 patients. RESULTS: Fenestrations were performed in 8 dorsal conchae (6 cadavers, 2 patients), 10 ventral conchae (5 cadavers, 5 patients), and 1 dorsal conchal bulla (1 patient). Visualization was good in 6 patients and affected by bleeding in 2 patients. Drainage through the fenestrations was observed in all patients. Trans-nasal sinoscopy was possible in all cadavers and in 6 out of 8 patients. Masses inside the sinuses precluded sinoscopy in 2 patients. Stomata persisted until discharge of the patients (mean of 14 days). Clinical signs improved in 6/8 patients. CONCLUSION: The endoscopic approach reported here provides good visualization during the trans-endoscopic laser fenestration of the conchae. The fenestrations may allow a trans-nasal sinoscopic examination and treatment in selected cases of sinusitis in horses.

Complication Rates After Bilateral versus Unilateral Total Ear Canal Ablation with Lateral Bulla Osteotomy for End-Stage Inflammatory Ear Disease in Dogs: 79 Ears.

OBJECTIVE: To determine whether perioperative complication rates are different between unilateral (ULS) versus single-stage bilateral (BLSS) total ear canal ablation-lateral bulla osteotomy (TECA-LBO) surgeries. STUDY DESIGN: Retrospective case series. ANIMALS: Fifity-seven dogs (79 ears) undergoing TECA-LBO at a single institution over 14 years. METHODS: Medical records of dogs undergoing TECA-LBO for end-stage inflammatory non-neoplastic ear disease from March 1999 to September 2013 at the Colorado State University Veterinary Teaching Hospital were evaluated for intraoperative and early postoperative complications associated with the procedure. Inclusion criteria were clinical and/or histopathologic diagnosis of chronic otitis externa, surgical treatment by TECA-LBO, and a minimum of 2 week follow-up data. RESULTS: Twenty dogs (40 ears) underwent BLSS and 37 dogs (39 ears) had ULS. Complications were recorded for 29 of 40 ears (72.5%) in the BLSS group (40.0% facial nerve, 15.0% ocular, and 32.5% minor incisional complications) and 25 of 39 ears (64.1%) in the ULS group (33.3% facial nerve, 12.8% ocular, and 23.1% minor incisional complications). Dogs undergoing BLSS did not have a significantly higher total complication rate, or higher neurologic, ocular, or incisional complication rates, than the ULS procedure. No major anesthetic complications affecting outcome were recorded for either group. CONCLUSION: Anesthetic and early surgical complication rates after ULS and BLSS were not significantly different in our study. Offering single-stage bilateral TECA-LBO procedures for otherwise healthy dogs with end-stage inflammatory otitis externa is a viable treatment option without additional risk for complication.

Management of complications associated with total ear canal ablation and bulla osteotomy in dogs and cats.

Total ear canal ablation combined with bulla osteotomy is a salvage procedure recommended primarily for end-stage inflammatory ear canal disease but also for neoplasia and severe traumatic injuries. Due to the complexity of the procedure and the poor exposure associated with the surgical approach, there is significant risk for a variety of complications. This review discusses intraoperative, early postoperative, and late postoperative complications reported in large retrospective studies, the causes for these complications, and recommendations about how to prevent them.

Treatment of age-related hearing loss in dogs with the vibrant soundbridge middle ear implant: short-term results in 3 dogs.

BACKGROUND: Age-related hearing loss (ARHL), or presbycusis, is the most common form of acquired hearing loss in dogs. Middle ear implants have been used successfully in people with ARHL who cannot benefit from conventional hearing aids. HYPOTHESIS: Audibility improves in dogs with ARHL after implantation of the Vibrant Soundbridge (VSB) middle ear implant. ANIMALS: Three Beagle dogs with ARHL, mean age 11.1 years. METHODS: The dogs were assessed pre- and postoperatively by brainstem-evoked response audiometry (BERA), otoscopy, and computed tomography scans of the ears. A VSB middle ear implant was implanted unilaterally. Three months later the functionality of the implants was assessed by auditory steady-state responses (ASSRs), after which the dogs were euthanized for histopathological examination. RESULTS: The VSB was implanted successfully in all dogs. Recovery from surgery was uneventful, except for transient facial nerve paralysis in 2 dogs. ASSRs showed that hearing improved after activation of the implants with a mean of 20.7, 13, and 16.3 dB at 1, 2, and 4 kHz, respectively. The implantation procedure did not affect residual hearing (with inactive implants) as measured by BERA. CONCLUSIONS AND CLINICAL IMPORTANCE: Implantation of the VSB resulted in lower ASSR thresholds, but only at the higher gain settings of the audioprocessor. As in humans, a more powerful audioprocessor is required to treat sensorineural hearing loss exceeding 20 dB in dogs. A substantial improvement in patient-owner communication will have to be demonstrated in future studies before the procedure can be recommended in clinical practice.

Diagnosis and treatment of otitis media in dogs and cats.

Otitis externa/media is commonly found in dogs with chronic ear diseases and in cats with upper respiratory disease and polyps. Diagnosis of otitis media requires attention to history and clinical signs, but it also requires other methods of determining disease within the bulla. If the integrity of the eardrum cannot be determined, assume that there is middle ear disease and proceed accordingly. It is prudent to take necessary precautions to avoid the use of potentially ototoxic ear cleaners or topical medications in suspected otitis media cases. Therapeutic success is possible using systemic and topical treatment within the cleaned bulla. Referral to a dermatology specialist or a radiologist for a CT scan may be indicated in some refractory cases. Surgical intervention may be required to cure these difficult cases.