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Ear and sinus surgery
British Small Animal Veterinary Association , 212 (2013); https://doi.org/10.22233/9781910443163.16
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Ear and sinus surgery

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Abstract

Ear disease is a common presentation in rabbits; as in other species, it takes the form of otitis externa, media and/or interna. In cases of otitis externa or otitis media, where medical management is either impossible or unsuccessful or the situation is recurrent, surgery may be indicated. This chapter considers ear and sinus disease and surgery. : Ear syringing; Lateral wall resection; Total ear canal ablation via lateral bulla osteotomy; Total ear canal ablation via a ventral bulla osteotomy; Flushing the dorsal conchal sinus via a dorsal approach; Flushing the dorsal recess of the maxillary sinus via a lateral approach; Flushing the ventral recess of the maxillary sinus via a lateral approach.

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Figures

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16.1
External ear canal anatomy and vasculature. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2013 British Small Animal Veterinary Association
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16.1 External ear canal anatomy and vasculature. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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16.2
Dissection of the ear canal in a lop-eared rabbit, showing the gap between the cartilaginous acoustic meatus and the tragus. (© John Chitty) © 2013 British Small Animal Veterinary Association
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16.2 Dissection of the ear canal in a lop-eared rabbit, showing the gap between the cartilaginous acoustic meatus and the tragus. (© John Chitty)
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16.3
This dissection of the ear canal in a lop-eared rabbit shows where ear discharges tend to accumulate. (© John Chitty) © 2013 British Small Animal Veterinary Association
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16.3 This dissection of the ear canal in a lop-eared rabbit shows where ear discharges tend to accumulate. (© John Chitty)
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16.4
Otoendoscopic view of the normal ear canal, showing golden-coloured cerumen. (© John Chitty) © 2013 British Small Animal Veterinary Association
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16.4 Otoendoscopic view of the normal ear canal, showing golden-coloured cerumen. (© John Chitty)
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16.5
Otoendoscopic view of the ear canal of a lop-eared rabbit, showing abnormal white purulent discharge. The fold in the ear can be seen on the right, running vertically. In this case of otitis externa, the purulent discharge is associated with canal inflammation. When touched, haemorrhage occurred. (© John Chitty) © 2013 British Small Animal Veterinary Association
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16.5 Otoendoscopic view of the ear canal of a lop-eared rabbit, showing abnormal white purulent discharge. The fold in the ear can be seen on the right, running vertically. In this case of otitis externa, the purulent discharge is associated with canal inflammation. When touched, haemorrhage occurred. (© John Chitty)
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16.6
Otoendoscopic view of the normal ear canal. (© John Chitty) © 2013 British Small Animal Veterinary Association
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16.6 Otoendoscopic view of the normal ear canal. (© John Chitty)
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16.7
Ear wick placed in the ear canal before addition of ‘filling’ antibiotic. Once antibiotic has been added, the sponge swells to fill the ear canal. Sponge fully swollen. (© John Chitty) © 2013 British Small Animal Veterinary Association
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16.7 Ear wick placed in the ear canal before addition of ‘filling’ antibiotic. Once antibiotic has been added, the sponge swells to fill the ear canal. Sponge fully swollen. (© John Chitty)
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16.8
A case of otitis externa: after syringing but before placement of an ear wick; immediately after removal of the ear wick. Note the reduction in inflammation. (© John Chitty) © 2013 British Small Animal Veterinary Association
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16.8 A case of otitis externa: after syringing but before placement of an ear wick; immediately after removal of the ear wick. Note the reduction in inflammation. (© John Chitty)
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16.9
Advanced avascular necrosis of the cranial part of the pinna due to traumatic damage to the rostral auricular blood vessels. This is an indication for amputation of the pinna. (© Aidan Raftery) © 2013 British Small Animal Veterinary Association
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16.9 Advanced avascular necrosis of the cranial part of the pinna due to traumatic damage to the rostral auricular blood vessels. This is an indication for amputation of the pinna. (© Aidan Raftery)
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16.10
The proximal portion of the auricular cartilage has been removed in this rabbit because of neoplasia. The level of an incision for a full amputation of the pinna can be seen (black arrow). The cartilage of the remaining acoustic meatus is filled with ceruminous exudate (white arrow). (© Aidan Raftery) © 2013 British Small Animal Veterinary Association
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16.10 The proximal portion of the auricular cartilage has been removed in this rabbit because of neoplasia. The level of an incision for a full amputation of the pinna can be seen (black arrow). The cartilage of the remaining acoustic meatus is filled with ceruminous exudate (white arrow). (© Aidan Raftery)
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16.11
Postoperative images following lateral wall resection in a lop-eared rabbit. The opening created in the lateral wall and the ‘anastomosis’ to the skin can be seen. Close-up of the area where the horizontal canal has been separated from the vertical canal and marsupialized to the skin. (© John Chitty) © 2013 British Small Animal Veterinary Association
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16.11 Postoperative images following lateral wall resection in a lop-eared rabbit. The opening created in the lateral wall and the ‘anastomosis’ to the skin can be seen. Close-up of the area where the horizontal canal has been separated from the vertical canal and marsupialized to the skin. (© John Chitty)
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16.12
Exposure keratitis due to facial nerve damage. Ocular lubricants can be used to avoid the eye becoming dry during surgery. (© Aidan Raftery) © 2013 British Small Animal Veterinary Association
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16.12 Exposure keratitis due to facial nerve damage. Ocular lubricants can be used to avoid the eye becoming dry during surgery. (© Aidan Raftery)
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16.13
Contrast material leaking from the nasolacrimal duct and outlining the ventral recess of the maxillary sinus. (© John Chitty) © 2013 British Small Animal Veterinary Association
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16.13 Contrast material leaking from the nasolacrimal duct and outlining the ventral recess of the maxillary sinus. (© John Chitty)
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16.14
Contrast study of the sinuses in a cadaver to demonstrate their anatomy. The red arrow marks the position of the large opening from the dorsal conchal sinus into the dorsal recess of the maxillary sinus. The black arrow marks the position of the connection between the dorsal and ventral recesses of the maxillary sinus. (© Aidan Raftery) © 2013 British Small Animal Veterinary Association
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16.14 Contrast study of the sinuses in a cadaver to demonstrate their anatomy. The red arrow marks the position of the large opening from the dorsal conchal sinus into the dorsal recess of the maxillary sinus. The black arrow marks the position of the connection between the dorsal and ventral recesses of the maxillary sinus. (© Aidan Raftery)
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Alligator forceps suitable for use in rabbit ears via the otoscope. (© John Chitty)
Alligator forceps suitable for use in rabbit ears via the otoscope. (© John Chitty) © 2013 British Small Animal Veterinary Association
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Image of Alligator forceps suitable for use in rabbit ears via the otoscope. (© John Chitty)
Alligator forceps suitable for use in rabbit ears via the otoscope. (© John Chitty) Alligator forceps suitable for use in rabbit ears via the otoscope. (© John Chitty)
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Spreull needle on syringe. (© John Chitty)
Spreull needle on syringe. (© John Chitty) © 2013 British Small Animal Veterinary Association
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Image of Spreull needle on syringe. (© John Chitty)
Spreull needle on syringe. (© John Chitty) Spreull needle on syringe. (© John Chitty)
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Spreull needle in position via otoscope cone. (© John Chitty)
Spreull needle in position via otoscope cone. (© John Chitty) © 2013 British Small Animal Veterinary Association
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Image of Spreull needle in position via otoscope cone. (© John Chitty)
Spreull needle in position via otoscope cone. (© John Chitty) Spreull needle in position via otoscope cone. (© John Chitty)
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A drainage board can be made from the epithelium of the ear canal in lop-eared rabbits with a diverticulum that is causing a bulge at the base of the ear. Once the soft tissue over the swelling has been cleared away, two parallel incisions can be made to form a flap. (Courtesy of Frances Harcourt-Brown)
A drainage board can be made from the epithelium of the ear canal in lop-eared rabbits with a diverticulum that is causing a bulge at the base of the ear. Once the soft tissue over the swelling has been cleared away, two parallel incisions can be made to form a flap. (Courtesy of Frances Harcourt-Brown) © 2013 British Small Animal Veterinary Association
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Image of A drainage board can be made from the epithelium of the ear canal in lop-eared rabbits with a diverticulum that is causing a bulge at the base of the ear. Once the soft tissue over the swelling has been cleared away, two parallel incisions can be made to form a flap. (Courtesy of Frances Harcourt-Brown)
A drainage board can be made from the epithelium of the ear canal in lop-eared rabbits with a diverticulum that is causing a bulge at the base of the ear. Once the soft tissue over the swelling has been cleared away, two parallel incisions can be made to form a flap. (Courtesy of Frances Harcourt-Brown) A drainage board can be made from the epithelium of the ear canal in lop-eared rabbits with a diverticulum that is causing a bulge at the base of the ear. Once the soft tissue over the swelling has been cleared away, two parallel incisions can be made to form a flap. (Courtesy of Frances Harcourt-Brown)
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The flap of ear epithelium is reflected and sutured to the skin. It is important to ensure that the flap is stretched out but not under tension. In most cases an additional section of skin needs to be removed in order to place the flap correctly to form the drainage board. (Courtesy of Frances Harcourt-Brown)
The flap of ear epithelium is reflected and sutured to the skin. It is important to ensure that the flap is stretched out but not under tension. In most cases an additional section of skin needs to be removed in order to place the flap correctly to form the drainage board. (Courtesy of Frances Harcourt-Brown) © 2013 British Small Animal Veterinary Association
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Image of The flap of ear epithelium is reflected and sutured to the skin. It is important to ensure that the flap is stretched out but not under tension. In most cases an additional section of skin needs to be removed in order to place the flap correctly to form the drainage board. (Courtesy of Frances Harcourt-Brown)
The flap of ear epithelium is reflected and sutured to the skin. It is important to ensure that the flap is stretched out but not under tension. In most cases an additional section of skin needs to be removed in order to place the flap correctly to form the drainage board. (Courtesy of Frances Harcourt-Brown) The flap of ear epithelium is reflected and sutured to the skin. It is important to ensure that the flap is stretched out but not under tension. In most cases an additional section of skin needs to be removed in order to place the flap correctly to form the drainage board. (Courtesy of Frances Harcourt-Brown)
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The end result of a lateral wall resection that was performed 3 years previously on this lop-eared rabbit. The surgery was carried out because the rabbit had a persistent ear infection and an aural diverticulosis at the ear base. Surgery was curative in this case. During the operation, care was taken to separate the epithelial lining of the ear from the cartilage along the cut edge of the ear canal. This meant that any excess cartilage could be trimmed away and the epithelium could be attached to the skin with no tension on the wound. A soft suture material (1.5 metric (4/0 USP) polyglactin 910 (Vicryl Rapide)) was used in this case. (Courtesy of Frances Harcourt-Brown)
The end result of a lateral wall resection that was performed 3 years previously on this lop-eared rabbit. The surgery was carried out because the rabbit had a persistent ear infection and an aural diverticulosis at the ear base. Surgery was curative in this case. During the operation, care was taken to separate the epithelial lining of the ear from the cartilage along the cut edge of the ear canal. This meant that any excess cartilage could be trimmed away and the epithelium could be attached to the skin with no tension on the wound. A soft suture material (1.5 metric (4/0 USP) polyglactin 910 (Vicryl Rapide)) was used in this case. (Courtesy of Frances Harcourt-Brown) © 2013 British Small Animal Veterinary Association
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Image of The end result of a lateral wall resection that was performed 3 years previously on this lop-eared rabbit. The surgery was carried out because the rabbit had a persistent ear infection and an aural diverticulosis at the ear base. Surgery was curative in this case. During the operation, care was taken to separate the epithelial lining of the ear from the cartilage along the cut edge of the ear canal. This meant that any excess cartilage could be trimmed away and the epithelium could be attached to the skin with no tension on the wound. A soft suture material (1.5 metric (4/0 USP) polyglactin 910 (Vicryl Rapide)) was used in this case. (Courtesy of Frances Harcourt-Brown)
The end result of a lateral wall resection that was performed 3 years previously on this lop-eared rabbit. The surgery was carried out because the rabbit had a persistent ear infection and an aural diverticulosis at the ear base. Surgery was curative in this case. During the operation, care was taken to separate the epithelial lining of the ear from the cartilage along the cut edge of the ear canal. This meant that any excess cartilage could be trimmed away and the epithelium could be attached to the skin with no tension on the wound. A soft suture material (1.5 metric (4/0 USP) polyglactin 910 (Vicryl Rapide)) was used in this case. (Courtesy of Frances Harcourt-Brown) The end result of a lateral wall resection that was performed 3 years previously on this lop-eared rabbit. The surgery was carried out because the rabbit had a persistent ear infection and an aural diverticulosis at the ear base. Surgery was curative in this case. During the operation, care was taken to separate the epithelial lining of the ear from the cartilage along the cut edge of the ear canal. This meant that any excess cartilage could be trimmed away and the epithelium could be attached to the skin with no tension on the wound. A soft suture material (1.5 metric (4/0 USP) polyglactin 910 (Vicryl Rapide)) was used in this case. (Courtesy of Frances Harcourt-Brown)
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The lateral approach to the bulla. In this case there were severe changes of the lateral wall of the bulla caused by osteomyelitis. All the necrotic bone has to be carefully removed. The pinna has also been removed in this case. (© Aidan Raftery)
The lateral approach to the bulla. In this case there were severe changes of the lateral wall of the bulla caused by osteomyelitis. All the necrotic bone has to be carefully removed. The pinna has also been removed in this case. (© Aidan Raftery) © 2013 British Small Animal Veterinary Association
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Image of The lateral approach to the bulla. In this case there were severe changes of the lateral wall of the bulla caused by osteomyelitis. All the necrotic bone has to be carefully removed. The pinna has also been removed in this case. (© Aidan Raftery)
The lateral approach to the bulla. In this case there were severe changes of the lateral wall of the bulla caused by osteomyelitis. All the necrotic bone has to be carefully removed. The pinna has also been removed in this case. (© Aidan Raftery) The lateral approach to the bulla. In this case there were severe changes of the lateral wall of the bulla caused by osteomyelitis. All the necrotic bone has to be carefully removed. The pinna has also been removed in this case. (© Aidan Raftery)
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The position of the ventral approach incision is marked with a black line. Clipping of this patient is not complete. A sandbag has been placed under the neck to give better exposure. (© Aidan Raftery). Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
The position of the ventral approach incision is marked with a black line. Clipping of this patient is not complete. A sandbag has been placed under the neck to give better exposure. (© Aidan Raftery). Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2013 British Small Animal Veterinary Association
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Image of The position of the ventral approach incision is marked with a black line. Clipping of this patient is not complete. A sandbag has been placed under the neck to give better exposure. (© Aidan Raftery). Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
The position of the ventral approach incision is marked with a black line. Clipping of this patient is not complete. A sandbag has been placed under the neck to give better exposure. (© Aidan Raftery). Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. The position of the ventral approach incision is marked with a black line. Clipping of this patient is not complete. A sandbag has been placed under the neck to give better exposure. (© Aidan Raftery). Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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Ball-tip seeker instrument, sometimes called a frontal ostium seeker, used for atraumatic exploration of the sinus. The balls at either end of the handle are of different sizes and set at different angles.
Ball-tip seeker instrument, sometimes called a frontal ostium seeker, used for atraumatic exploration of the sinus. The balls at either end of the handle are of different sizes and set at different angles. © 2013 British Small Animal Veterinary Association
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Image of Ball-tip seeker instrument, sometimes called a frontal ostium seeker, used for atraumatic exploration of the sinus. The balls at either end of the handle are of different sizes and set at different angles.
Ball-tip seeker instrument, sometimes called a frontal ostium seeker, used for atraumatic exploration of the sinus. The balls at either end of the handle are of different sizes and set at different angles. Ball-tip seeker instrument, sometimes called a frontal ostium seeker, used for atraumatic exploration of the sinus. The balls at either end of the handle are of different sizes and set at different angles.
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Anatomical landmarks for trephination of the maxillary sinus. The dorsal recess puncture point is marked with the black arrow. (© Aidan Raftery)
Anatomical landmarks for trephination of the maxillary sinus. The dorsal recess puncture point is marked with the black arrow. (© Aidan Raftery) © 2013 British Small Animal Veterinary Association
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Image of Anatomical landmarks for trephination of the maxillary sinus. The dorsal recess puncture point is marked with the black arrow. (© Aidan Raftery)
Anatomical landmarks for trephination of the maxillary sinus. The dorsal recess puncture point is marked with the black arrow. (© Aidan Raftery) Anatomical landmarks for trephination of the maxillary sinus. The dorsal recess puncture point is marked with the black arrow. (© Aidan Raftery)
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Anatomical landmarks for trephination of the maxillary sinus. The ventral recess puncture point is marked by the black arrow. (© Aidan Raftery)
Anatomical landmarks for trephination of the maxillary sinus. The ventral recess puncture point is marked by the black arrow. (© Aidan Raftery) © 2013 British Small Animal Veterinary Association
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Image of Anatomical landmarks for trephination of the maxillary sinus. The ventral recess puncture point is marked by the black arrow. (© Aidan Raftery)
Anatomical landmarks for trephination of the maxillary sinus. The ventral recess puncture point is marked by the black arrow. (© Aidan Raftery) Anatomical landmarks for trephination of the maxillary sinus. The ventral recess puncture point is marked by the black arrow. (© Aidan Raftery)
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