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Rigid endoscopy: otoendoscopy

image of Rigid endoscopy: otoendoscopy
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Abstract

Ear diseases are among the most common health problems seen in dogs, and are also commonly observed in cats. Otoscopic examination of the ear canal can increase the chances of successful management of otitis by identifying treatable primary causes and evaluating the severity and extent of the pathological process. This chapter contains five video clips.

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Figures

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10.1 Veterinary otoscope set consisting of an otoscope for dogs and cats and a stopcock attachment with an integrated working channel. This otoscope is a straightforward telescope with a length of 8.5 cm, a tip diameter of 5 mm and a 5 Fr (1.65 mm) working channel. The configuration of the lens at the otoscope tip provides a 110-degree field of view and the long focal length of the instrument allows deep examination of the ear canal. (Courtesy of Karl Storz SE & Co. KG)
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10.2 VETPUMP 2 flushing and suction apparatus. (Courtesy of Karl Storz SE & Co. KG)
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10.3 CT examination of a 10-year-old American Cocker Spaniel with external bilateral chronic otitis. (a) Transverse post-contrast image of the head. (b) Transverse image of the tympanic bullae (bone algorithm). Both tympanic cavities are normally aerated and sections of the tympanic membrane are visible (arrowed). Note the dense material in the pre-tympanic segment of the external meatus (asterisks). (c, d) Multioblique multiplanar images from CT volume data show that the left and right tympanic membranes are intact (arrowed). (Courtesy of Dr Bertolini, Diagnostic and Interventional Division, San Marco Veterinary Clinic, Padova, Italy)
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10.4 CT examination of a 9-year-old Labrador Retriever with a cholesteatoma of the right middle ear. (a) Transverse pre-contrast image (bone algorithm). The tympanic cavity is filled with material of soft tissue density and the ventral wall of the bulla (arrowhead) and the petrosal portion of the temporal bone (arrowed) show bone lysis and destruction accompanied by extensive surrounding sclerosis. (b) Post-contrast image (soft tissue algorithm) showing the involvement of peripharyngeal soft tissue leading to pharyngeal eccentric stenosis (arrowed). (c, d) Three-dimensional volume rendering segmentation (frontal view) showing bony proliferative changes of the right bulla (arrowed). (Courtesy of Dr Bertolini, Diagnostic and Interventional Division, San Marco Veterinary Clinic, Padova, Italy)
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10.5 CT examination of a 4-year-old Domestic Shorthaired cat with right external and middle ear otitis but an intact tympanic membrane. (a) Transverse image through the tympanic bulla. There is increased opacity of the pre-tympanic segment of the right external acoustic meatus. The tympanic membrane is barely visible in this section. (b) Multioblique multiplanar reformatted (MPR) image of the right tympanic cavity, showing a normal tympanic membrane profile. There is increased opacity and thickening of the membrane, and some fluid in the tympanic and epitympanic cavities. (c) Multioblique MPR, thin maximum intensity projection image of the left middle ear, showing a normal appearance of the tympanic membrane and middle ear cavities. Arrows indicate the manubrium of the malleus. (Courtesy of Dr Bertolini, Diagnostic and Interventional Division, San Marco Veterinary Clinic, Padova, Italy)
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10.6 MRI examination of a 6-year-old Cavalier King Charles Spaniel with right-sided facial nerve paralysis. (a) T2-weighted transverse image showing both tympanic cavities filled with hyperintense fluid material (arrowed). (b) Pre-contrast and (c) post-contrast T1-weighted images showing contrast enhancement of the facial nerves (arrowed) and meninges, suggesting their possible involvement in the inflammatory process. (Courtesy of Dr Bertolini, Diagnostic and Interventional Division, San Marco Veterinary Clinic, Padova, Italy)
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10.7 (a) Patient positioning for an otoscopic examination. The patient under general anaesthesia is positioned in lateral recumbency and properly intubated. (b) Pads have been placed under the neck to slightly raise the caudal portion of the neck, and gauze has been applied over the eye as protection against exudate and washing fluid. (Courtesy of San Marco Veterinary Clinic, Padova, Italy)
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10.8 Normal canine ear canal.
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10.9 Normal canine tympanic membrane. A = pars flaccida; B = pars tensa; C = stria mallearis.
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10.10 Blood vessels in the pars tensa associated with the manubrium.
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10.11 Middle ear anatomy. Overlay of two-dimensional and three-dimensional CT images of the ear of a dog to emphasize the most relevant structures. The middle ear consists of three parts: the small dorsal epitympanic recess (a), which is occupied almost entirely by the head of the malleus and the incus; the tympanic cavity proper (b), adjacent to the tympanic membrane; and a large ventral cavity within the tympanic bulla (c). On the medial wall of the tympanic cavity proper there is a bony prominence, the promontory, which houses the cochlea. The cochlear (round) window (RW) and the vestibular (oval) window (OW) are located on the caudolateral and dorsolateral surfaces of the promontory, respectively. The Eustachian tube, a short canal that extends from the nasopharynx to the middle ear, opens in the rostral portion of the tympanic cavity proper. (Courtesy of Dr Bertolini, Diagnostic and Interventional Division, San Marco Veterinary Clinic, Padova, Italy)
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10.12 Stenosis of the ear canal of a dog with chronic otitis externa.
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10.13 Glandular proliferation of the horizontal ear canal of a dog with a history of chronic otitis externa.
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10.14 A hard concretion of wax at the eardrum of a dog.
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10.15 Mass of neoplastic origin discovered by video-otoscopy in the ear canal of a cat.
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10.16 Inflammatory polyp in a cat. Note the smooth pink to red surface.
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10.17 Inflammatory polyp from a cat. The polyp has been removed using the grasping and traction technique. The presence of a small peduncle at one end of the mass suggests that it has been correctly removed.
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10.18 Opaque, white appearance of the tympanic membrane in a dog with chronic otitis externa.
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10.19 Bulging appearance of the tympanic membrane in a dog.
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10.20 Rupture of the tympanic membrane in a dog.
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10.21 Otitis media in a dog. Note the absence of the tympanic membrane and the small ring of granulation tissue at the annulus fibrosus.
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10.22 Tympanic cavity filled with whitish debris in a dog with otitis media.
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10.23 Hard waxy secretions in the ear of a dog with ceruminous otitis externa.
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10.24 Purulent exudates in the ear of a dog with infection.
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10.25 Proper position for performing a myringotomy using an open-ended tomcat catheter. The incision is made in the caudoventral portion of the pars tensa (at 6–7 o’clock). C = caudal; D = dorsal; R = rostral; V = ventral.
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10.26 Ear cytology of a dog with otitis. (a) Numerous planktonic bacteria (rods) are present in the smear. (b) Probable biofilm formation. Note the aggregate of bacteria.

Supplements

Removal of plant awns.

Foreign bodies: removal of plant awns using grasping forceps passed through the working channel of the video-otoscope.

Removal of an inflammatory polyp.

Removal of an inflammatory polyp from the ear canal of a cat.

Flushing technique: flushing and suctioning cycles.

Flushing technique: flushing and suctioning cycles in the external ear canal of a dog with otitis externa.

Flushing technique: intact tympanic membrane.

Flushing technique: appearance of the intact tympanic membrane after the flushing procedure.

Myringotomy procedure.

Myringotomy procedure: the incision into the caudoventral quadrant of the pars tensa is made with a 3.5 Fr tomcat catheter.

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