Unilateral vs Bilateral Total Ear Canal Ablation

Total ear canal ablation and lateral bulla osteotomy (TECA-LBO) is a commonly performed salvage surgical procedure, most often for end-stage otitis. As with many salvage procedures, these challenges result in long anesthetic and operative times. This is of particular importance if dogs are bilaterally affected and single-session bilateral surgery is performed. 

This retrospective study sought to determine whether complication rates differ between unilateral and single- session bilateral TECA-LBO. A total of 39 and 40 ears underwent unilateral or bilateral surgery, respectively. Cases were operated over a 14-year period by board-certified veterinary surgeons or supervised surgery residents at an academic institution. Postoperative complications were found in 64.1% of unilateral and 72.5% of bilateral cases. Complications included facial nerve deficits (33.3% unilateral/40% bilateral), ocular problems (12.8%/15%), vestibular signs (23.1%/15%), wound complications (23.1%/32.5%), Horner syndrome (5.1%/7.5%), and major intraoperative hemorrhage (5.1%/2.5%). Wound complications included seromas, discharge, incisional infection, or suture reactions.

There were no significant differences in overall or specific complications between groups. The surgical time was similar for unilateral cases and each individual ear in bilateral cases (ie, overall anesthetic time in bilateral cases was twice that for unilateral cases).

Commentary

The decision to perform single-session or staged bilateral surgery is commonly encountered in surgical conditions affecting both limbs—or in this situation, both ears. The surgeon’s perspective may differ from the client’s desire to pursue a single-session procedure that is less expensive and has a faster recovery time. In many instances, increased operative time and prolonged anesthesia are associated with increased infection risk or perhaps a more difficult recovery. 

Data from this study suggested that although the complications following TECA-LBO are relatively high, they are similar when performing unilateral vs single-session bilateral surgery. A potential confounding factor is that a variety of individuals with variable experience levels performed these surgeries. As many of the complications arise from technical challenges and/or mistakes, more focus should be placed on the operative skill of the surgeon performing the procedure to limit risk and improve outcomes.—Jason Bleedorn DVM, MS, DACVS