TOTAL EAR CANAL ABLATION
AND VENTAL BULLA OSTEOTOMY:
THE “TECA” PROCEDURE

Sometimes an ear infection is simply hopeless. Perhaps the organism growing is too resistant for treatment. Perhaps the ear canal has actually mineralized from chronic irritation.  Perhaps the ear canal is so scarred and narrowed that external cleaning is a useless activity.  The bottom line is irreversible disease. In these cases, all the diseased tissue: the entire ear canal, bones of the middle ear etc. are simply removed and the healthy tissue around the ear is closed. This ends what has generally been a long tribulation of pain, odor, ear cleaning, and expensive veterinary medications and rechecks. The nightmare is over and life is able to go on.

This seems like a beautiful dream to the owner of the dog with end-stage ears but happily it is a realistic dream so long as the process and its associated risks are understood.  This surgery essentially removes the ear. The round bone behind the ear, called the “tympanic bulla” (reach behind your own ear and feel yours right now if you are not sure what the bullae are), is opened and flushed. A normal bulla is hollow and air-filled. After years of otitis, the bulla is usually packed with pus, slime, or cheesy infectious material which must be scooped or rinsed out. Many important nerves travel through the area of the ear  and these are exposed for damage in surgery.

PREPARING FOR THE TECA

1. Radiographs to assess the tympanic bullae are helpful. Sedation is generally required but it will be useful to know before surgery how bad the bullae look, how narrowed the ear canals are and if they are mineralized, if there is an obvious tumor growing in the area. This helps confirm that this very aggressive surgery is really appropriate for this patient.
    
2. The ear may be cultured prior to surgery. This helps get the patient on an effective antibiotic right from the beginning. Further cultures may still be required once the bullae are opened.
    
3. It is important to assess the cranial nerve function of the patient prior to surgery. If these nerves are diseased prior to surgery it is unlikely that they will regain function after surgery.  Nerve disease that results from surgery is usually temporary so it is important to know if the nerve problems existed prior to surgery.

The facial nerve runs just near the base of the ear. This nerve controls facial expression. A facial paralysis is not uncommon after long standing ear disease. This means that the patient is slack-jawed on usually one side of the face and may not be able to blink. After a time, the eye usually retracts into the eye socket facilitating tear lubrication so that the loss of blinking does not lead to eye damage. Initially, though, lubricating gels are helpful to the eye.

Hearing is usually diminished after long term ear infections so further hearing loss after ear ablation may not represent a dramatic change in hearing. Most owners have a good sense of whether or not their pet can hear so it is rarely necessary to formally test hearing. After the ears are ablated, some hearing remains in many patients as sound waves can still be transmitted through the tissues.

4. A complete blood panel and urinalysis are important prior to any anesthetic procedure and this procedure is no exception.

WHAT HAPPENS IN SURGERY

The ears and head are shaved with the patient sleeping and the ear canal is flushed one last time to remove as much infected material as possible. This is done to minimize bacterial contamination of the normal tissue.

The ear canal, both the vertical and horizontal portions, are removed as one long intact curved cylinder. The bones of the middle ear and the ear drum are removed as well.

The bone of the tympanic bulla is exposed and opened. Any material is flushed out and the cellular lining of the bone is scraped away. Any material left inside after closure will lead to chronic drainage of liquid from the area of the incision.  Often an external drain is left in place during the healing period.

normal ear   dotted lines indicate where incision is made ear canal is then removed from ear opening into ear is sewn shut

Bandaging, oral antibiotics and pain medication can be expected after surgery as can an Elizabethan collar to protect the delicate incisions from scratching.

POTENTIAL COMPLICATIONS

The area of the tympanic bulla and very bottom of the ear canal share space with some important structures. These structures can easily be damaged during surgery or by the inflammation that results during the healing process.

• The “great auricular vasculature” is located on the deep surface of the ear canal being removed. If this vasculature is damaged, the pinna (or furry ear flap) may lose part of its blood supply. Tissue dies along the margin of the ear flap and trimming may be necessary.
   
• The facial nerve is also located in this vicinity. If the facial nerve is disturbed, a facial paralysis as described above may result. This is one of the more common complications of TECA but is usually temporary.  (Facial paralysis after surgery is permanent in 10-15% of cases where it occurs.)
   
• The “retroglenoid vein” is located just below the tympanic bulla. If this vein is broken, the resulting bleeding is not dangerous but will obscure the visibility of the area making surgery more difficult.
   
• Sometimes there is enough swelling in the area of the throat to make breathing labored.
   
• Aproximately 5-10% of TECA patients experience chronic drainage from the incision and require a second surgery of some sort to repair the problem. Usually the drainage comes from salivary gland damage, residual cells left in the tympanic bulla, remaining middle ear bone left behind, or the production of more fluid than can drain normally into the throat from the Eustachian tube (the natural connection between ear and throat).

In most cases, the results are near miraculous. Patients demonstrate more energy now that their headaches are gone. There is no more odor, ear cleaning or pain. This surgery requires advanced skill and referral to a specialist is usually necessary.