The most common cases presented for ear surgery are chronic infections (otitis externa/media) and tumors of the ear canal. Ear infections are very common in both dogs and cats. Often there is an underlying cause for ear infections such as allergies, systemic diseases (hypothyroidism, Cushing's disease), parasites or a tumor. Other factors that contribute to ear infections include hair in the canal, narrow canals, increased moisture due to "floppy" ear conformation or increased amounts of normal sebaceous secretions. Initial therapy should be directed at treating any underlying causes and predisposing factors. There are many topical medications that can be used to treat otitis externa including antibiotics, antifungals and steroids.

The ear of the dog is composed of the external ear canal which has a horizontal and vertical component (see Figure 1), the middle ear which is behind the tympanum or ear drum and is contained in a hollow bony cavity (bulla), and the inner ear responsible for hearing and balance. Which parts of the ear are diseased helps determine which type of surgery is needed. The ear can be evaluated by otoscopic exam, radiographs and recently by computed tomography (CT or CAT scan).

Early in the course of treatment for otitis in cases that are not responding well, a procedure called a lateral ear resection may be helpful. This surgery may also be used to treat tumors of the lateral side of the vertical canal. The lateral wall of the vertical ear is incised and folded down. A flap is created which is sutured to the skin below the ear and serves as a drainboard. This creates a direct opening from the outside to the horizontal ear canal which makes drainage easier and facilitates infusion of medications into the horizontal canal. It is important to note that following a lateral ear resection treatment of otitis is often still necessary.

Diseases of the middle ear exclusively are often treated with a ventral bulla osteotomy. This technique is most often performed in cats with middle ear disease (inflammatory polyps, infection or tumor). The bulla is approached from underneath through an incision in the neck. A hole is drilled through the bone to expose the middle ear. Polyps or tumors can be removed for biopsy and infectious or inflammatory debris can be flushed from the bulla. The bone is left open to allow drainage.

In cases that do not respond to medical therapy for otitis or for tumors deep in the canal a procedure called a total ear canal ablation (TECA) with bulla osteotomy is recommended. Once ear canals have become thickened, painful and sometimes even calcified, medical therapy is useless. The TECA is performed by incising around the outer opening of the ear and dissecting the canal to the point where it attaches to the skull. The canal is removed and the opening to the middle ear is enlarged by removing the lateral wall of the bulla. The lining of the bulla is gently removed along with any debris or exudates in the bulla. Removed tissue is submitted for biopsy to look for any evidence of tumor tissue. The benefits of the TECA include removal of the source of chronic pain and discomfort for your pet and the end of medicating your pet's ears. Cosmetic results are good especially in flop eared dogs which are the most common recipients of this surgery. (See figures 2, 3, and 4.)

Dogs do retain some hearing ability after the TECA and are usually not hearing very well prior to the surgery so little to no difference is expected in hearing ability after surgery. Potential complications of TECA surgery include paresis of the facial nerve after surgery (decreased blink reflex, lip droop), head tilt and wound infection. Complications are usually temporary when present and resolve with time. Most dogs stay in the hospital for a few days for pain management and continue to recover at home on oral pain medication and antibiotics. An Elizabethan collar is often needed to prevent self-trauma to the ears from scratching. Sutures are removed in 10-14 days.