Middle Ear Polyp Removal: A Lateral Approach

In the Literature

Janssens SDS, Haagsman AN, Ter Haar G. Middle ear polyps: results of traction avulsion after a lateral approach to the ear canal in 62 cats (2004-2014). J Feline Med Surg. 2017;19(8):803-808.

The Research …

Cats with middle ear polyps can be presented with wax buildup, ear scratching, and head shaking. Some affected cats have more serious clinical signs (eg, ataxia, head tilt, nerve deficits). Treatment consists of polyp removal, with antibiotics and anti-inflammatory drugs administered after surgery.

This retrospective study of 62 cats examined polyp removal concomitant with a lateral approach to the bulla for treatment. The procedure consisted of an incision just ventral to the ear opening through the horizontal cartilage so that the bulla could be seen. The polyp was then removed via deep traction avulsion and the bulla was curetted. Meloxicam was administered postoperatively, along with either amoxicillin–clavulanic acid or enrofloxacin. Owners were interviewed by telephone within 6 months after surgery.

Complications included Horner’s syndrome (11.5%) and facial nerve paralysis (3%). There was a 14.3% recurrence rate of polyp regrowth when an experienced surgeon performed the procedure; for less experienced surgeons, the recurrence rate was 35%. An additional 11.3% had suspected but unconfirmed recurrence due to loss of follow-up. Median time to recurrence was 27.5 months; however, one cat had a polyp recur nearly 8.5 years later. 

The described surgical technique was associated with a lower complication rate as compared with the traditional ventral bulla osteotomy but had a higher recurrence rate.¹ The authors reported a lower recurrence rate associated with more surgical experience with the lateral bulla osteotomy.

… To Your Patients

Key pearls to put into practice:

• A lateral approach to the bulla by incising the ear cartilage in conjunction with traction is feasible for treatment of ear polyps in cats.

• Fewer complications were noted as compared with historic ventral bulla osteotomy.

• Polyp recurrence was more common with this technique as compared with ventral bulla osteotomy.