AJ Debiasse, a technician in Stroudsburg, PA, contributed to this article.
Hershey, a 6 year old cocker spaniel, had been in and out of the vet for ear infections for almost all of his life. He had been treated with just about every oral antibiotic, and every type of ear medication known to man. Sadly, with little to no success. Tablets, capsules, lotions, potions— nothing worked long-term. The ear infections just kept coming back. As he became more and more uncomfortable, Hershey came to be head-shy and sometimes even aggressive when his guardians tried to administer ear medications. Eventually, the smell caused by the infection had invaded every room of the house. Something had to change.
Examining infected dog ears
Frustrated by the lack of results, Hershey’s guardians finally decided to get a second opinion, but the poor dog would not allow the veterinarian to examine his ears. The vet recommended an exam of the ears under sedation. An instrument (called an otoscope) would not even fit inside the ear canals because they had become so narrow. Years of ear infections had transformed the soft and delicate cartilage of the ear canals into a hard, painful, infected mess. Such ear canals have become calcified, which means they are full of calcium deposits.
Treating infected dog ears
“This is end-stage ear disease” said the vet, and the only effective treatment is surgery.” He referred Hershey to yours truly, a board-certified surgeon. I recommended a Total Ear Canal Ablation or TECA. “A TECA involves removing the entire ear canal,” I explained. “The next step is to completely clean up the bulla.” The bulla is a bony “bubble” at the bottom of the ear canal. At this stage of the disease, it routinely contains pus, which needs to be removed to reach good results. A sterile swab, called a culture, will also reveal which bacteria lives there, and which antibiotic will take care of it.
Hershey’s guardians asked if there were less invasive options. “Other surgeries do exist, but they will fail in Hershey’s case. Only a TECA will take care of the entire problem. And only a TECA allows cleaning up the bulla.”
Understanding TECA to treat Hershey’s ear infection
A TECA is a challenging procedure which, like any surgery, presents some risks. The most common complication of a TECA is called facial nerve paralysis. The facial nerve is connected to multiple muscles of the face. If that nerve is damaged during surgery, the patient will lose function of several of those muscles.
The most significant consequence is the inability to blink. This causes dry eye, since the tears are no longer able to spread over the entire eye. When this happens, artificial tears need to be applied to the eye.
Other complications include a head tilt and bleeding. Veterinary surgeons work hard to avoid infection. Although surgeons strive to work in a sterile environment, it is impossible to achieve that while performing a TECA. This is especially true while cleaning out the bulla. If one tiny (and invisible) bacteria is left behind during surgery, it will fester and cause a delayed infection, weeks to months after surgery.
Hearing doesn't change much after a TECA in most patients. The ear canal is so swollen, that it has already become pretty useless to transmit sound. It seems that TECA patients can feel vibrations through the skull.
Why is a TECA important in this case?
Despite the possible risk of complications, a TECA will typically have a very positive impact on patients like Hershey, when performed by an experienced surgeon.
Hershey went home the day after surgery. He received antibiotics and pain medications for 2 weeks. He had to wear an E collar (plastic cone) around his head to prevent him from scratching the incision for 3 weeks. He also had to rest strictly for 3 weeks to protect the surgery site from any addition trauma. After 3 weeks, the incision looked great and surgery was then scheduled for the second ear.
After another 3 weeks of rest, Hershey was allowed to resume his normal activity. He clearly felt comfortable and much happier than before the surgeries. His guardians were thrilled to have their Hershey back. He regained his sweet disposition after becoming pain-free.
Questions to ask your veterinarian:
- Could my dog, with chronic ear infections, benefit from a TECA?
- Which surgeon do you recommend to have it treated effectively?
Wednesday, September 28, 2016
2 Replies to “Total Ear Canal Ablation in Dogs”
I have a four week old German Shepherd puppy that started tilting his head to one side. Five days after him being on antibiotics it went away. Then three days latter he started tilting it the other way. The vet has know idea what is going on. He is now six month old. His head will be straight for two weeks, then tilts off to one side for two weeks then straight for two weeks then tilts to opposite side for two weeks then straight for to weeks. He walks, runs jumps straight even if his head is tilted and no eye movement from side to side. Now if you pick him up when his head is titled then he has issues with balance. But when his head is not tilted he is fine when you pick Jim up. Any idea what could be going on with this poor guy.
Hi Anita. I’m sure your vet has had a good look inside the ears, but it’s possible the problem lies deeper within, or is found somewhere else completely. This is probably a good case for referral to a specialist, who may perform advanced imaging if the answer isn’t immediately clear. It certainly sounds serious.
Can Dogs Hear After an Ear Ablation?
Typically, vets will do this procedure on dogs when they have ruptured eardrums, lots of ear infections, cancer, or perforation in their ear canals. It's a delicate surgery, and unfortunately, it's unlikely that your dog will be able to hear after having a total ear canal ablation, also called a TECA.
Regardless of how well the surgery is conducted, it's likely that most dogs will suffer from some degree of hearing loss, some more than others. Are you wondering if a TECA is necessary for your dog? Are you curious about the signs your dog might be giving you to let you know they might need a TECA? Read on for more information.
Signs Your Dog Might Need an Ear Canal Ablation
If your dog frequently has ear infections, faces issues like crust or scabs on the outer ear, has hair loss around their ears, or is obviously suffering from hearing loss, it might be worth taking your pup to the vet to talk about hearing issues, ear problems, and the potential of a TECA procedure for your dog.
Your pup might also face issues like blood in the ear, yellow or brown discharge from their ears, excessive head shaking and ear tilting, loss of coordination, and other serious issues.
- Head tilting
- Sweaty paws
- Dropped Ears
- Ears back
- Ears up
- Chronic ear infections
- Red or inflamed inner rear
- Cauliflower appearance of ear canal
- Scabbing or crusting
- Head shaking
- Coordination malfunctions
- Hearing loss
- Ear discharge
- Bloody ears
Historic Reasons for a TECA
For example, dogs who typically suffer from chronic ear infections are ideal candidates for TECA procedures. This condition, also called Chronic Otitis, is a common disease in pups and, if left untreated, can do serious damage to your dog.
Typically, undergoing TECA will help remove the facets that contribute to chronic ear infections. Other causes for a TECA procedure typically revolve around infection, tumors, ruptured ear drums, perforated ear canals, and cancer.
The Science Behind a TECA
Then, the vet will insert drains into the surgical site to allow the infection to drain out before closing the wound. The dog's incision will be closed and the dog will be left to heal.
The reason that dogs typically lose their hearing following a TECA is because they have removed a vital part of the ear. While the removal of the middle ear will result in an impossibility for the ear to hold onto bacteria, yeast, or infection, it will alter the shape of the ear canal and likely affect the dog's ability to hear.
Training Your Dog to Cope with Hearing Loss
First, we suggest monitoring your dog much more closely than before - because he or she is unable to hear, it will take a while to get used to using other senses to aid in detection. Deaf or hard-of-hearing dogs are not able to hear traffic or other dangers around them, so it's important that you're training your dog to stick close to you while training yourself to keep a more watchful eye on your pooch.
That being said, you can teach your dog to abide by special hand signals in order to keep their behavior in tip-top shape. You'll first want to ensure that your dog is associating a hand gesture with a common command. While your dog might not be able to hear you say "sit" anymore, you could make a specific motion with your hand, then guide your dog's behind to the ground - do this until they understand that sit is associated with this command. We suggest rewarding your dog with affection, play time, and lots of treats.
It's also important that you re-learn how to approach your dog, as well as teaching others to approach your dog carefully. While a dog's other senses surely can help him or her know when someone is coming, a deaf dog is more inclined to be surprised, so it's important to teach yourself and your guests to be sensitive to your dog's ear issues.
Ear Infections in Dogs: When External Ear Canals are Removed
A surgical solution for otitis externa is necessary in the most severe cases.
Cocker spaniel Fred, an active dog who loves to chase deer and squirrels in the field behind his home, was about five years old when his owner, Dick Moreau, noticed that his pet had been shaking his head and scratching his ears. This went on for a couple of weeks until Mr. Moreau took a close look at Fred’s ears and found what looked like a growth inside the left one. He took Fred to the vet, who did not feel comfortable going deep down into the ear but removed what he could.
It was after the operation that Fred started to have chronic infections in both ears. “We were at the vet very, very often,” Mr. Moreau recounts. “You could feel a hardness underneath” each ear flap. “It protruded” on both sides. “We went through any number of medications,” he adds. “Some of them were antibiotics, and what made it all the more difficult was that Fred has had allergic reactions to antibiotics like amoxicillin.”
Finally, after a couple of years, recalls Mr. Moreau, the vet said that “we’ve reached the point that no matter what we try to treat Fred with, the canals are obstructed so badly that we’re not getting to the deep-rooted infection way down. Ultimately, I think the only solution you’re going to have is an operation called total ear canal ablation,” which veterinarians refer to as TECA.
Surgery for an Ear Infection?
Mr. Moreau’s veterinarian referred him to Dr. John Berg, a surgeon at Tufts Cummings School and the editor-in-chief of Your Dog. Dr. Berg wasn’t at all surprised by Fred’s condition. “Ear canal infections are among the most common conditions dogs get,” he says. “Most are manageable with medications, but with some, the infection becomes end-stage and requires a surgical solution.”
Mr. Moreau’s family practice vet had followed standard procedure by prescribing medications for Fred to try to vanquish the infection. First, the doctor will attempt to find the underlying cause of the infection, Dr. Berg says. Consider, he comments, that bacteria are “all over the place. But if a dog’s skin is healthy, he won’t get a bacterial infection. It takes any of one of a variety of situations to cause the bacteria to gather and cause illness. It could be an underlying allergy to food or an environmental allergy, or foreign material in the ear canal, or even a tumor in the ear canal. Tumors on the surface of the body are not normal tissues, so they don’t have the normal defense mechanisms for keeping an infection from developing.”
An otoscopic exam sometimes yields clues. The doctor puts the little otoscope cone into the dog’s ear and closes one eye to better see through the lens that magnifies what’s in the ear canal. But often enough, Dr. Berg says, the underlying cause can’t be identified, so the veterinarian simply treats the infection, which is what happened with Fred.
Sometimes that works, says Dr. Berg, “sometimes not.” One of the most common reasons it doesn’t, he explains, is thickening of the lining of the ear canal in response to the chronic infection. The lining also gets wrinkly, Dr. Berg says, and the canal itself, normally made of rubbery cartilage, becomes hardened with calcium deposits. In the end, he comments, “the ear canal becomes this very thick, hard thing that’s very painful for the dog. And the lumen — the opening of the canal — becomes pinched off.” It’s called end-stage otitis externa, “otitis” meaning ear infection and “externa” meaning in the external ear canal.
You can actually feel a bump on the outside of the ear where the canal has thickened, just as Mr. Moreau was able to feel the protrusions outside each of Fred’s ears when he lifted the dog’s ear flaps. Adds Dr. Berg, “it’s kind of a uniquely cocker spaniel problem,” which is why he wasn’t at all surprised to see that it had occurred in Fred. He says that “sometimes English bulldogs develop it, sometimes German shepherds, or French bulldogs. Almost any dog could get it. But cockers are by far the most usual victims.”
Common Concerns About Total Ear Canal Ablation
Total ear canal ablation, performed when it’s beyond hope that the infection will respond to medical management, is total removal of the ear canal. It’s usually bilateral, meaning the end-stage infection has taken hold in both ears. Many owners, by the time the operation is recommended, are so frustrated with trying to make the disease go away they’re glad for a new option, Dr. Berg says. However, given that both external ear canals are removed, their usual first question is: “How is my dog going to hear?”
“But this is not a surgery that’s really about hearing,” Dr. Berg says. “It’s about pain, about making a dog comfortable. Remember ear pain as a little kid? Imagine constant pain like that going on for months or years.” A lot of owners don’t recognize the severe pain that the head shaking and ear scratching indicate, he comments.
Besides, Dr. Berg says, some dogs actually hear better after the operation. “They’ve got this mass of calcified tissue that’s blocking sound transmission, like a thick horn felt through the skin on either side of the skull, and then it’s removed. Electrical tests of hearing both pre- and post-surgery have been done. The most common change is that the dog’s hearing gets better. All the abnormal tissue interfering with the ear’s function is removed. Granted, there’s no opening where the ear canal was when you lift up the dog’s ear. But the sound goes straight through the tissues. One dog I treated, after his surgery, was able to hear the clicking of the turn signal in the car again. He always knew it meant his owner was turning into the park where he could start to play, and he’d get excited. That response returned.”
The Ear Surgery Procedure
A total ear canal ablation involves more than removing the thickened, calcified, wrinkled external ear canal. The middle ear, a cavity that contains the tiny bones responsible for amplifying sound waves, is involved, too, because the infection has inevitably spread there. “What separates the external ear canal from the middle ear is the ear drum,” Dr. Berg explains. “In dogs that have severe, chronic end-state otitis externa, the ear drum almost invariably gets eaten away by the infection, so the infection extends right into the middle ear as well. When we do the surgery, we enlarge the opening into the middle ear so we can remove as much of the infection from there as possible.
“But you cannot physically remove all of the infection from the middle ear,” he says. It literally goes into the bone, and you can’t remove all the bone. For that reason, a dog needs to be on antibiotics after the surgery to get rid of any residual infection that’s bound to be there.
That was the case with Fred. For five weeks post-operatively, he was on antibiotics to kill any infection-causing bacteria still lurking.
Possible Complications of Dogs Undergoing TECA
“Overwhelmingly,” says Dr. Berg, “the majority of dogs have a complete resolution of their infection. They become normal, happy, pain-free dogs again.” In fact, he says, a lot of owners interpret their dog’s return to exuberance and activity as a sign that their pet can hear once again. “But it’s really that the dog is not in pain anymore,” he comments. Still, there are a couple of potential complications.
One is that a facial nerve located very close to the ear canal is susceptible to damage during the surgery. When damage does occur, it’s usually temporary, lasting a week to a month. “The nerve just kind of gets a little traumatized,” Dr. Berg says. “But artificial tears are required until it heals because it’s the nerve that’s responsible for tear production. We know by the morning after the procedure. If the dog isn’t blinking properly, we administer the artificial tears.” Fred had that complication on his left side, in combination with a little drooping on the left side of his face. But it cleared up in a week.
The other possible complication is that some dogs have such highly resistant bacteria in their middle ear canal that the usual arsenal of antibiotics doesn’t kill them and there’s a relapse of serious infection even though the dog has gone through the surgery. “So on rare occasions,” Dr. Berg says, “we’ll see dogs come back six months to a year later shaking their heads again or scratching the side of their face, or even having some drainage on the side of their face — all signs of an infection.” The antidote is often a very extended course of antibiotics. “You can keep the infection down to a dull roar with long-term antibiotics,” Dr. Berg says, although in some cases “repeating the surgery is the best option.”
Fortunately, Fred had his operation months ago and there has been no return of infection. “The surgery went great,” Mr. Moreau says. “He’s laying at my feet right now, not shaking his head, not scratching his ears. He’s very comfortable.
“I brought Fred in on a Monday night,” Mr. Moreau adds, “and Dr. Berg was going to operate early Tuesday morning. But he texted me on Tuesday that the operation before Fred’s was taking more time than expected. That way, I knew he wouldn’t be going in till about 11,” a communication Mr. Moreau appreciated because, he says, “as a pet owner you worry like crazy.” You want to know when your pet is actually on the table. You don’t want to think he was wheeled into the OR at 8 and you haven’t heard from the doctor after hours and hours of operating.
Dr. Berg was pleased with the proceedings, too, not to mention the results. “There are many dogs out there like Fred,” he says, “who are suffering with chronic ear infections that aren’t responding to medical therapy but for whom there’s a good solution to their pain.”
Total Ear Canal Ablation (TECA)
The ear is comprised of inner, middle, and external portions. The inner ear is responsible for balance and the transfer of sound waves to the brain. The middle ear contains the tympanic bulla and ear drum. The external portions contain the ear canal and the pinna (ear flap). Total ear canal ablation (TECA) is the surgical removal of the entire ear canal. A second procedure, called a bulla osteotomy, is performed during the same surgery. This osteotomy involves opening and clearing the bulla of all infected materials. Simultaneous TECA and bulla osteotomy greatly decrease the risk and incidence of infection.
Indication for TECA Surgery
Pets with chronic, severe ear infections often develop severe ear pain, which may lead to lethargy, inappetance, and frequent scratching at the ear. The infection may also progress to cause neurologic signs. When appropriate medical therapy is no longer effective in controlling ear canal infections, surgical removal of the entire ear canal is indicated. This surgery can greatly improve the quality of life for many dogs and cats. Total ear canal ablation is also the treatment of choice in most cases of cancer within the external ear canal.
Most pets recover quickly following surgery. Strict rest is advised for 2 weeks to insure incision healing, but most patients seem eager to return to full activity before this period of rest is complete.
Potential Risks or Complications
Hearing will be decreased following surgery. Many owners, however, do not notice a significant change since these patients typically have already diminished hearing due to chronic inflammation and thickening of the ear canal. Damage to the facial nerve may occur during surgery, which leads to a loss of the blink reflex, typically for a temporary period. Until this reflex returns, eye lubrication is required to moisten and protect the eye. Permanent facial nerve damage is possible, but rare. Infection and/or abscess formation may occur up to 2 years after surgery the risk of this occurring is quite low (about 5% of cases).