By Dr Soo Kuan
Dog ear infections that keep coming back
Ear infections that keep coming back, or recurrent ear infections, can be a painful and uncomfortable for your dog, and distressing and frustrating for owners and vets. With repeated infections, some dogs may develop a phobia of treatment and medication administration, making it even harder to manage the condition.
After managing your dog’s recurrent ear infections for a long time, your vet may refer you to one of our specialist Surgeons at SASH. The first step is usually to set up a consultation with our specialist Dermatologists to ensure that there are no further medical options that can be considered before major surgery. Whilst SASH Surgeons love and specialise in the field of surgery, they also want to make sure that they perform it on patients where it is the best option.
Dogs have an external ear, a middle ear, and an inner ear. The external ear is the cartilaginous ear canal, which is the section that you are usually treating with ear infections. The middle ear (tympanic bulla) is a round hollow ball made of bone, lined with skin-like cells. The inner ear consists of small bony structures, which are predominantly involved with balance.
Symptoms of severe ear infections in dogs
In more severe or long-standing conditions, the infection can spread to the middle ear, causing a head tilt, and to the inner ear leading to balance difficulties and even meningitis (brain infection).
Treating recurring ear infections in dogs with TECALCO surgery
TECALBO or total ear canal ablation and lateral bulla osteotomy is the most common surgery to treat dog ear infections. This surgery involves the removal of:
- The entire external ear canal (total ear canal ablation)
- The side wall of the middle ear (lateral bulla osteotomy)
- The skin-like lining (known as epithelium)
Often, a CT scan is recommended prior to surgery, to assess the middle and inner ear; and also to ensure that there is no evidence of cancer present.
A TECALBO is a delicate surgery for several reasons. First, the facial nerve runs alongside the ear canal, and needs to be identified and avoided during the surgery. Secondly, it is vital during the lateral bulla osteotomy to be extremely careful not to damage the inner ear structures. Finally, we aim to remove every last fragment of the lining of the middle ear. Any tiny fragment left behind may result in a persistent infection and development of a draining tract. In the rare instance that this occurs, a second surgery may be required.
During surgery, a swab is always taken from the middle ear, and submitted to the laboratory to check what bacteria is causing the infection, and what antibiotics are required to treat the infection. This is important even if a previous swab has been collected from the external ear canal, as there may be different bacteria growing in the middle ear. Most patients who have undergone a TECALBO will be on 10-14 days of antibiotics after surgery, which may be changed after several days, depending on what bacteria found in the middle ear.
Caring for dogs after TECALCO surgery
Usually, dogs are almost immediately much happier than they were prior to surgery because they have usually had a constant ear-ache for weeks to months leading up to surgery. You can nearly see the relief in their faces. Once home, they rarely require more than anti-inflammatory medications for pain relief. We may ask that an Elizabethan collar (dog cone) is used to stop them from scratching at the surgical site, and to keep them reasonably quiet for the 2 weeks after surgery. Some dogs will require a head bandage for a few days
If your dog has pointy ears, it may become a little floppy after surgery.
Potential risks of TECALBO surgery for dogs
As with any surgery, there is some risk with TECALBO surgery. For example, there is risk with anaesthesia. This risk is significantly lower with SASH having specialist Anaesthetists on-site, who work closely with our Surgery team.
Potential complications associated with the surgical site include infection and wound breakdown. TECALBO can also be associated with the additional risk of residual infection left behind in the middle ear, which may require either additional surgery, or life-long medication – this risk is very low and the vast majority of patients will have a good outcome.
There is also the additional risk of facial nerve injury. Approximately 20% of dogs are reported to have some injury to the facial nerve. However 75% of these dogs will improve greatly or recover completely after 2 months. Facial nerve injury is not life-threatening – the most significant effect is an inability to blink fully. The treatment for this while waiting for nerve function to return is to apply eye lubrication regularly (every 6-8 hours) to ensure the surface of the eye does not dry out.
In most instances the success of TECALBO is excellent, providing long term relief from what has usually been a chronic painful condition.