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Stokowski S, Hespel AM, Drake E, de Swarte M, Cole R, Johnson K, Morandi F, Zhu X. Tympanic membrane perforations cannot be reliably detected using computed tomography based on 15 cadaver dogs. Vet Radiol Ultrasound 2024; 65:250-254. [PMID: 38414135 DOI: 10.1111/vru.13352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 01/12/2024] [Accepted: 01/26/2024] [Indexed: 02/29/2024] Open
Abstract
The integrity of the tympanic membrane is an important factor when deciding treatment and therapeutic recommendations for dogs with ear disease; however, otoscopic examination may be difficult to perform due to features of external ear canal disease or patient compliance. CT is useful for the evaluation of middle ear disease, including cases in which middle ear disease is detected incidentally. The tympanic membrane is detectable using CT, but anecdotally, apparent focal defects or discontinuities of the tympanic membrane are often seen in patients with and without ear disease. The purpose of this prospective, observer agreement study was to determine if perforations of the tympanic membrane are reliably detectable on CT. Fifteen cadaver dogs underwent CT and video otoscopy to verify the integrity of each tympanic membrane. Cadavers were randomly assigned to have the tympanic membranes left intact or to undergo a myringotomy on either the left, the right, or both sides. CT was performed immediately following the myringotomies. Four blinded evaluators evaluated the pre- and post-myringotomy scans for a total of 30 scans (60 tympanic membranes). Average accuracy was low (44%), and interobserver agreement for all four evaluators was fair. Although the tympanic membrane is visible on CT, perforations of the tympanic membrane are unlikely to be accurately detected or excluded. The appearance of an intact tympanic membrane or defect in the membrane on CT should not be used as criteria to guide clinical treatment recommendations based on this cadaver model.
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Affiliation(s)
- Scott Stokowski
- Department of Small Animal Clinical Sciences, University of Tennessee, Knoxville, Tennessee, USA
| | - Adrien-Maxence Hespel
- Department of Small Animal Clinical Sciences, University of Tennessee, Knoxville, Tennessee, USA
| | - Elizabeth Drake
- Department of Small Animal Clinical Sciences, University of Tennessee, Knoxville, Tennessee, USA
| | | | - Robert Cole
- Department of Clinical Sciences, Auburn University, Auburn, Alabama, USA
| | - Kryssa Johnson
- Department of Radiology, MedVet Animal Hospital, Cincinnati, Ohio, USA
| | - Federica Morandi
- Department of Small Animal Clinical Sciences, University of Tennessee, Knoxville, Tennessee, USA
| | - Xiaojuan Zhu
- Office of Information Technology, University of Tennessee, Knoxville, Tennessee, USA
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Neubert A, Tannert S, Pirk G. [Hearing loss following the use of topical otitis therapeutics in dogs]. TIERARZTLICHE PRAXIS. AUSGABE K, KLEINTIERE/HEIMTIERE 2022; 50:269-278. [PMID: 36067769 DOI: 10.1055/a-1907-4387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Hearing loss occurring in temporal association with the topical application of otic medications is regularly reported to the Federal Office of Consumer Protection and Food Safety (Bundesamt für Verbraucherschutz und Lebensmittelsicherheit - BVL) in the form of adverse event (AE) reports. Although deafness or impaired hearing are listed as possible adverse reactions in the Summary of Product Characteristics of the otic medications approved in Germany little information about the underlying causes is available to date. MATERIAL AND METHODS A search for cases reporting impaired hearing following the use of otic medication was conducted in the national AE database. Subsequently, descriptive analysis was performed. Due to their small number, cases involving cats were excluded. Possible risk factors and causes of hearing loss were considered against the background of current literature. RESULTS While dogs of all age groups were affected, the majority of reports referred to dogs older than 10 years of age. Besides crossbreds, dogs of the breeds West Highland White Terrier, Dalmatian, Miniature Poodle and French Bulldog were most frequently involved. The analysis of the available data does not point to specific products or active substances that could be associated with a more frequent occurrence of hearing loss. CONCLUSION AND CLINICAL RELEVANCE In addition to possible ototoxicity of a product, other causes of hearing loss should be considered. These include the underlying otitis itself, age-related hearing loss, previously undetected unilateral congenital deafness, or conductive deafness due to obstruction of the ear canal. Treatment options include discontinuation of potentially ototoxic substances or treatment of conductive deafness, e. g. by removal of drug residues and exudate or treatment of otitis media. In the case of hearing loss subsequent to the use of otic medication, the BVL should be notified of this event in as much detail as possible in order to further improve the data situation concerning this topic.
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Affiliation(s)
- Ann Neubert
- Bundesamt für Verbraucherschutz und Lebensmittelsicherheit
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Reinbacher E, Kneissl S, Hirt R, Spergser J, Panakova L. Myringotomy in dogs: Contamination rate from the external ear canal - a pilot study. Vet Anim Sci 2020; 10:100125. [PMID: 32734025 PMCID: PMC7386720 DOI: 10.1016/j.vas.2020.100125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 06/11/2020] [Accepted: 06/11/2020] [Indexed: 11/16/2022] Open
Abstract
Myringotomy for sample collection from the middle ear cavity for cytology and bacterial culture is considered a routine method to diagnose otitis media in dogs. The objective of this study was to determine the rate of contamination of middle ear aspirates with material from the external ear canal obtained by video-otoscopic guided myringotomy. In canine cadavers (n = 17) free from otitis externa the external ear canals were flushed under video-otoscopic control and a fluorescent dye was instilled. After removal of residual fluid a myringotomy was performed. If air was aspirated, 1 mL of saline was instilled through the same myringotomy needle into the middle ear cavity and re-aspirated. Contamination from the external ear canal was demonstrated by positive fluorescence of the aspirate. Bacterial cultures and cytological examinations of the external ear canals and middle ear cavities were performed. Data from 28 ears under investigation were included. In 19 of 28 middle ear aspirates (67.9%), clear yellow fluorescent fluid was obtained, indicating a contamination from the external ear canal. Microorganisms were detected in 4 of 26 middle ear samples (15.4%) and in 15 of 26 external ear canals (57.7%). Sample collection by myringotomy in this study was associated with a high contamination rate, implying that the suitability of this method for detection of otitis media in patients with concurrent otitis externa is questionable. Furthermore, the potential for iatrogenic spread of pathogenic microorganisms into the middle ear cavity needs to be considered.
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Affiliation(s)
- E. Reinbacher
- Clinical Unit of Internal Medicine Small Animals, Department for Companion Animals and Horses, Vetmeduni Vienna, Veterinärplatz 1, 1210 Vienna, Austria
| | - S. Kneissl
- Clinical Unit of Diagnostic Imaging, Department for Companion Animals and Horses, Vetmeduni Vienna, Veterinärplatz 1, 1210 Vienna, Austria
| | - R. Hirt
- Clinical Unit of Internal Medicine Small Animals, Department for Companion Animals and Horses, Vetmeduni Vienna, Veterinärplatz 1, 1210 Vienna, Austria
| | - J. Spergser
- Institute of Microbiology, Department of Pathobiology, Vetmeduni Vienna, Veterinärplatz 1, 1210 Vienna, Austria
| | - L. Panakova
- Clinical Unit of Internal Medicine Small Animals, Department for Companion Animals and Horses, Vetmeduni Vienna, Veterinärplatz 1, 1210 Vienna, Austria
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Cole LK, Samii VF, Wagner SO, Rajala-Schultz PJ. Diagnosis of primary secretory otitis media in the cavalier King Charles spaniel. Vet Dermatol 2015; 26:459-66, e106-7. [DOI: 10.1111/vde.12248] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Lynette K. Cole
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine; The Ohio State University; 601 Vernon Tharp Street Columbus OH 43210 USA
| | - Valerie F. Samii
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine; The Ohio State University; 601 Vernon Tharp Street Columbus OH 43210 USA
| | - Susan O. Wagner
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine; The Ohio State University; 601 Vernon Tharp Street Columbus OH 43210 USA
| | - Päivi J. Rajala-Schultz
- Department of Veterinary Preventive Medicine; College of Veterinary Medicine; The Ohio State University; 601 Vernon Tharp Street Columbus OH 43210 USA
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Leite C, Guimarães P. Diagnóstico da otite média em cães: comparação entre radiografia convencional, canalografia e audiometria de impedância. ARQ BRAS MED VET ZOO 2011. [DOI: 10.1590/s0102-09352011000600046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Tivers MS, Brockman DJ. Separation of the auricular and annular ear cartilages: surgical repair technique and clinical use in dogs and cats. Vet Surg 2009; 38:349-54. [PMID: 19573098 DOI: 10.1111/j.1532-950x.2008.00476.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To report a surgical technique for primary repair of separation of the annular and auricular cartilages of the ear and long-term outcome. STUDY DESIGN Case series. ANIMALS Cats (3) and dogs (2) with ear canal separation. METHODS Medical records (1998-2007) of dogs and cats with ear canal separation were reviewed. Long-term outcome was obtained by telephone interview of owners or referring veterinarians. RESULTS Three cats and 1 dog had ear canal separation after being hit by a car; there was no history of trauma in 1 dog. Successful repair was achieved by a caudal approach to the ear canal, identifying and debriding separated cartilage edges and using primary repair. A patent ear canal was confirmed in all animals by otoscopy 4-12 weeks later and by ear canalography in 3 animals. Long-term outcome was excellent with no reported complications 10-90 months later (median 24 months). CONCLUSIONS Both acute and chronic separation between the annular and auricular cartilages, in the absence of middle ear disease, can be successfully treated using primary repair via a caudal approach to the ear canal, with excellent long-term outcome. CLINICAL RELEVANCE Primary repair should be considered in animals with separation of the annular and auricular cartilages.
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Affiliation(s)
- Michael S Tivers
- Department of Veterinary Clinical Sciences, Royal Veterinary College, Hawkshead Lane, North Mymms, Hertfordshire, UK.
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Cole LK, Samii VF. CONTRAST-ENHANCED COMPUTED TOMOGRAPHIC IMAGING OF THE AUDITORY TUBE IN MESATICEPHALIC DOGS. Vet Radiol Ultrasound 2007; 48:125-8. [PMID: 17385368 DOI: 10.1111/j.1740-8261.2007.00216.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Computed tomography after contrast medium injection was performed in three mesaticephalic canine cadavers to image the auditory tube. Cadavers were positioned in lateral recumbency for imaging. A myringotomy incision was made in the left tympanic membrane of each dog, and contrast medium was infused into the ear canal and middle ear through a balloon-tip catheter. With this method, contrast medium filled the left bulla and auditory tube in all three cadavers. Computed tomography following contrast medium injection was effective for evaluation of the canine auditory tube. Future studies are required to determine the usefulness, as well as the safety, of this procedure in the evaluation of the auditory tube in other breeds of dogs as well as dogs with otitis
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Affiliation(s)
- Lynette K Cole
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA.
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Lee J, Eom K, Seong Y, Lee H, Park J, Lee J, Jang K, Lee K, Oh T, Lee S, Yoon J, Lee H, Choi H, Lee Y, Chang D. Ultrasonographic evaluation of the external ear canal and tympanic membrane in dogs. Vet Radiol Ultrasound 2006; 47:94-8. [PMID: 16429993 DOI: 10.1111/j.1740-8261.2005.00113.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Ultrasonographic imaging of the canine external ear canal, tympanic membrane, and tympanic bulla was described in five healthy beagle dogs before and after infusion of saline into the ear canal. Saline served as an acoustic window. With this method, the external ear canal, and tympanic bulla were visible in the same imaging plane and the integrity of the tympanic membrane could be evaluated indirectly by confirming an intact tympanic membrane, which appeared at the end of the ear canal as a hyperechoic line with reverberation. Experimentally, perforated tympanic membrane could be evaluated by identifying anechoic saline in the tympanic bulla lumen. The air and fluid-filled tympanic bulla were also visualized. Ultrasonography with saline as an acoustic window appears to be helpful for the evaluation of the external ear canal, tympanic membrane, and tympanic bulla and it may have the potential to be a useful clinical tool in evaluation of integrity of the tympanic membrane.
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Affiliation(s)
- Jeongmin Lee
- Department of Veterinary Diagnostic Imaging, College of Veterinary Medicine, Kyungpook National University, 1370, Sangyeok-dong, Buk-ku, Daegu, Korea
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Abstract
There are several disease processes of the ear and pinna that warrant surgical intervention. This article reviews surgical anatomy and common surgical procedures of the ear and pinna, including aural hematomas, lateral wall resection, vertical ear canal resection, total ear canal ablation and lateral bulla osteotomy, partial pinna resection, and feline inflammatory polyps. The clinical signs, diagnosis, and surgical treatment along with potential complications for each disease process are discussed.
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Affiliation(s)
- Otto I Lanz
- Department of Small Animal Clinical Sciences, Virginia-Maryland Regional College.
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Abstract
Radiographic evaluation of the tympanic bulla is limited. Improper obliquity or angulation of the skull for radiographs or malpositioning of the tongue can result in an inadequate study [4]. Additionally, because of the complex anatomy of the canine and feline skull, with superimposition of multiple osseous structures, radiography can result in false-negative examinations or understimation of the disease present [2]. When compared with surgical findings of 19 clinical cases of presumptive middle ear disease, false-negative radiographic findings were found in 25% of the surgically confirmed cases of otitis media [4]. Therefore, radiographs are not considered to be a highly sensitive mode of diagnosing otitis media. Radiographs may be helpful in determining lysis associated with neoplasia; however, the extent of involvement is still underestimated. In a study comparing CT and radiographic evaluation of otitis media, CT was determined to be more sensitive but less specific than radiography [11]. CT is the preferred modality for the evaluation of the tympanic bulla at our institution. This opinion may be biased by the fact that most cases are presented for recurrent or chronic otitis. Although radiography is more accessible, the availability of CT in local referral settings is increasing as opposed to being limited to university settings. After the cost (i.e., anesthesia, radiographs) and amount of time necessary to make optimum radiographic studies are taken into account, a CT study may actually be faster and more informative. Given our preference for the CT examination, the cost of the examination has been adjusted to make it more appealing to the owner and clinician. For example, a bulla CT study is only 1.3 times the cost of a radiographic bulla study. In conclusion, imaging of the ear canal can provide important information about ear disease, including unilateral or bilateral ear disease, the degree of middle or inner ear involvement, peripheral versus central vestibular disease, an infectious or inflammatory versus neoplastic process, the chronicity of the disease process, involvement of adjacent structures, and postsurgical complications.
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Affiliation(s)
- Matthew G Bischoff
- Department of Veterinary Clinical Medicine, University of Illinois, 1008 West Hazelwood Drive, Urbana, IL 61802, USA.
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11
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Abstract
Otitis externa/media is commonly found in dogs with chronic ear diseases and in cats with upper respiratory disease and polyps. Diagnosis of otitis media requires attention to history and clinical signs, but it also requires other methods of determining disease within the bulla. If the integrity of the eardrum cannot be determined, assume that there is middle ear disease and proceed accordingly. It is prudent to take necessary precautions to avoid the use of potentially ototoxic ear cleaners or topical medications in suspected otitis media cases. Therapeutic success is possible using systemic and topical treatment within the cleaned bulla. Referral to a dermatology specialist or a radiologist for a CT scan may be indicated in some refractory cases. Surgical intervention may be required to cure these difficult cases.
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Affiliation(s)
- Louis N Gotthelf
- Animal Hospital of Montgomery, 3310 Atlanta Highway, Montgomery, AL 36109, USA.
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Griffiths LG, Sullivan M, O'Neill T, Reid SWJ. Ultrasonography versus radiography for detection of fluid in the canine tympanic bulla. Vet Radiol Ultrasound 2003; 44:210-3. [PMID: 12718358 DOI: 10.1111/j.1740-8261.2003.tb01273.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The tympanic bullae of 20 previously healthy cadaver animals were randomly filled with sterile saline or air. The heads were positioned using tape ties and a rostrocaudal open mouth radiograph taken. The resulting radiographs were assessed by a blinded ECVDI diplomate, with each tympanic bulla being recorded as being either air or fluid filled. Ultrasound examination of the bullae was performed, by a blinded assessor, using a B-mode 5 mHz sector probe (Sonotron-VingMed Sound A/S, PO Box 141, N3191, Horten, Norway) operating at 3 mHz. Each bulla was recorded as being either air or fluid filled. Results of radiography and ultrasonography were each compared to the actual status of the bulla in a chi square analysis. Sensitivity of radiography was 80%, with specificity of 65%. Ultrasonographic sensitivity was 100% and specificity 100%. Ultrasonography may in future provide a cheap, noninvasive, rapid and widely available method for diagnosing otitis media in clinical cases.
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Affiliation(s)
- Leigh G Griffiths
- The University of Liverpool, Department of Veterinary Clinical Science and Animal Husbandry, Small Animal Hospital, Crown Street, Liverpool, Merseyside, L7 7EX, England
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Garosi LS, Dennis R, Schwarz T. Review of diagnostic imaging of ear diseases in the dog and cat. Vet Radiol Ultrasound 2003; 44:137-46. [PMID: 12718347 DOI: 10.1111/j.1740-8261.2003.tb01262.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Diagnostic imaging techniques (conventional radiography, computed tomography and magnetic resonance imaging) are an essential tool in the diagnostic work-up of ear diseases. Conventional radiography is commonly used, but often lacks sensitivity. Computed tomography (CT) and magnetic resonance (MR) are complementary imaging studies of the middle ear, labyrinth, internal auditory canal and their contents. CT provides excellent images of bony structures and is indicated where osseous changes are of greatest diagnostic importance. MR is superior in imaging soft tissue components including intralabyrinthine fluid. Therefore, more than one of these imaging techniques may be required in order to make a diagnosis.
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Affiliation(s)
- Laurent S Garosi
- Animal Health Trust, Centre for Small Animal Studies, Lanwades Park, Kentford, Newmarket CB8 7UU, England
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Russo M, Covelli EM, Meomartino L, Lamb CR, Brunetti A. Computed tomographic anatomy of the canine inner and middle ear. Vet Radiol Ultrasound 2002; 43:22-6. [PMID: 11866039 DOI: 10.1111/j.1740-8261.2002.tb00437.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
A series of high-resolution computed x-ray tomography (CT) images of the normal canine middle and inner ear are presented to serve as a reference for optimal interpretation of clinical CT images of animals with diseases affecting this region.
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Affiliation(s)
- Marco Russo
- Dipartimento di Scienze Cliniche Veterinarie, Centro di Radiologia Veterinaria, Polo delle Scienze e delle Tecnologie per la Vita, Università degli Studi di Napoli Federico II, Naples, Italy
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Abstract
Canalography was performed to measure the diameter of the horizontal ear canal and to assess the clinical relevance of the measurements in identifying abnormalities of the ear canal. The diameter of the proximal and distal end of the annular cartilage in the horizontal ear canal was measured using canalography in 222 ears. The tympanic membrane could not be visualized with otoscopic examination in 70 ears even after ear cleansing. These canals were classified as being stenotic. The diameter of the proximal annular cartilage in the stenotic canals ranged from 0.8 to 3.1 mm (mean = 2.6 +/- 0.8 mm). The proximal annular cartilage was consistently smaller in diameter than the distal annular cartilage. The ratio between the diameter of the proximal and distal annular cartilage varied between dogs. In stenotic ear canals (70 ears) the ratio was less than 0.65. Total ear canal ablations and histopathological analysis were performed in 70 ear canals classified as stenotic after canalography. Hyperplasia of the epidermal layer was found in 56 stenotic canals. Stenosis of the canal due to otitis externa was found in the other 14 canals. Three canals with severe otitis externa were also diagnosed with canalography as having a ruptured tympanic membrane. The results suggest that canalography can be used to measure the diameter of the horizontal ear canal and to assess whether or not the tympanic membrane is ruptured prior to conservative or surgical therapy.
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Affiliation(s)
- K Eom
- Department of Veterinary Radiology, College of Veterinary Medicine, Seoul National University, Korea
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Abstract
Otitis media/interna was diagnosed in a 20-month-old German shepherd with the assistance of magnetic resonance (MR) imaging. The MR images were acquired primarily to exclude a brain lesion responsible for vestibular signs. No brain lesion was detected, but obvious signs of chronic changes in the left bulla and external ear canal were confirmed. Thickening of the epithelium and soft tissue surrounding the external ear canal and a laminated appearance of high and low T2 intensities in the tympanic bulla's mucosa were present. The hypointense lines were suspected to be fibrous tissue, indicating chronic changes. This report suggests that MR imaging may serve as a useful imaging tool for otitis media and that it supplies information not obtained with radiography or computed tomography.
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Affiliation(s)
- E Dvir
- Department of Medicine, Onderstepoort Veterinary Academic Hospital, University of Pretoria, Republic of South Africa
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