Total Ear Canal Ablation/Lateral Bulla Osteotomy
Total Ear Canal Ablation and Lateral Bulla Osteotomy (TECA-LBO) surgery is recommended for end-stage otitis where permanent changes occur in the ear canal preventing resolution of the otitis and the animal is in constant discomfort, when there are tumours in the ear canal or where the cost of medical treatment for instance is likely to exceed the cost of surgery and the client wishes to pursue the surgical option.
I performed my first TECA-LBO in 1991 and since that time have performed the procedure around 300 times.
Although I do not consider myself a surgical specialist, I learnt to do the procedure as I felt I should be able to offer this procedure myself to my clients without the need to refer to a surgeon.
The main risks with surgery are permanent facial nerve paralysis and post operative draining tract formation, the latter which can take as long as 2-3 years post surgery to develop.
My best estimates of long term complications post TECA surgery since 1991 were about 3% for both facial nerve paralysis and draining tracts, however, in December 2017 I carried out a clinical audit of the previous 6 years TECA-LBO operations since changing our practice management system, looking at the clinical records of 55 cases. The incidence of permanent facial nerve paralysis over the previous 6 years has been 0% and the incidence of draining tract formation, necessitating repeat surgery to curette out the tympanic bulla was 3.6% (two cases, that fully recovered after a second surgery with 5 year follow up on both).
These results compare very favourably with the most recently published literature. For instance a retrospective analysis of 133 TECAs published by Spivack et al in JAAHA May/June 2013 p160-168 reported an incidence of residual facial nerve paralysis of 10.5% and Smeak’s review article in Vet Clin Small Anim 46 (2016) 609–621 quoted incidences of post operative draining tracts between 2-14%.
The cost of a TECA-LBO is between £1800-£2200 for one ear and around £3500- £4100 for both ears. I have carried out many bilateral TECA-LBO operations and feel that it is better to have only one episode of post -operative pain and recovery. The fears some vets have of swelling around the pharynx, if both ears are operated together, have proven unfounded in my experience. Recovery from Total Ear Canal Ablation surgery is usually rapid, the vast majority of dogs and cats not requiring a surgical drain and not needing to wear an E-collar.