Editorial Type:
Scientific Reports

Effect of empirical versus definitive antimicrobial selection on postoperative complications in dogs and cats undergoing total ear canal ablation with lateral bulla osteotomy: 120 cases (2009–2019)

Christian A. FolkDepartment of Small Animal Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY

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Cassie N. LuxDepartment of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN

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Xiaocun SunOffice of Information and Technology, University of Tennessee, Knoxville, TN

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Katy J. FryerVeterinary Specialty Hospital, San Diego, CA

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DOI:
https://doi.org/10.2460/javma.21.10.0462
Volume/Issue:
Volume 260: Issue 8
Online Publication Date:
24 Mar 2022
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Abstract

OBJECTIVE

To evaluate dogs and cats undergoing total ear canal ablation with lateral bulla osteotomy (TECA-LBO), document antimicrobial choices, and determine relationships associated with infection-related and neurologic postoperative complications.

ANIMALS

107 client-owned dogs and 13 client-owned cats that underwent TECA-LBO.

PROCEDURES

A retrospective analysis of medicals records of dogs and cats with TECA-LBO from 2 veterinary hospitals with postoperative data for at least 6 months was performed. All information associated with the TECA-LBO surgery including follow-up was recorded. Logistic regression analyses were performed and corrected using a false discovery rate to identify significance between antimicrobial administration and other perioperative variables and the outcomes of short- and long-term neurologic and infection-related complications, need for revision surgery, and euthanasia due to recurrence of infection-related signs.

RESULTS

Intraoperative cultures were performed in 111 animals, and 95 (85.5%) had bacterial growth, with Staphylococcus spp most commonly isolated. Revision surgeries due to infection-related signs occurred in 13 of 120 (10.8%) patients. If intraoperative bacterial cultures were positive and antimicrobials were administered within 1 month of surgery, patients were 85.8% less likely to exhibit infection-related complications, whereas patients not administered antimicrobials were 10.3 times as likely to require a revision surgery. Longer durations of postoperative antimicrobial administration were associated with revision surgery and euthanasia due to infection-related signs.

CLINICAL RELEVANCE

Administration of systemic antimicrobials within the first postoperative month may be necessary to prevent complications when intraoperative cultures exhibit bacterial growth and plays a role in the successful outcome of TECA-LBO.

Abstract

OBJECTIVE

To evaluate dogs and cats undergoing total ear canal ablation with lateral bulla osteotomy (TECA-LBO), document antimicrobial choices, and determine relationships associated with infection-related and neurologic postoperative complications.

ANIMALS

107 client-owned dogs and 13 client-owned cats that underwent TECA-LBO.

PROCEDURES

A retrospective analysis of medicals records of dogs and cats with TECA-LBO from 2 veterinary hospitals with postoperative data for at least 6 months was performed. All information associated with the TECA-LBO surgery including follow-up was recorded. Logistic regression analyses were performed and corrected using a false discovery rate to identify significance between antimicrobial administration and other perioperative variables and the outcomes of short- and long-term neurologic and infection-related complications, need for revision surgery, and euthanasia due to recurrence of infection-related signs.

RESULTS

Intraoperative cultures were performed in 111 animals, and 95 (85.5%) had bacterial growth, with Staphylococcus spp most commonly isolated. Revision surgeries due to infection-related signs occurred in 13 of 120 (10.8%) patients. If intraoperative bacterial cultures were positive and antimicrobials were administered within 1 month of surgery, patients were 85.8% less likely to exhibit infection-related complications, whereas patients not administered antimicrobials were 10.3 times as likely to require a revision surgery. Longer durations of postoperative antimicrobial administration were associated with revision surgery and euthanasia due to infection-related signs.

CLINICAL RELEVANCE

Administration of systemic antimicrobials within the first postoperative month may be necessary to prevent complications when intraoperative cultures exhibit bacterial growth and plays a role in the successful outcome of TECA-LBO.

Contributor Notes

Corresponding author: Dr. Folk (CAF242@Cornell.edu)
Cover Journal of the American Veterinary Medical Association
Journal of the American Veterinary Medical Association
ISSN:
0003-1488
Publication Date:
01 May 2022
  • 1.

    Spivack RE, Elkins AD, Moore GE, Lantz GC. Postoperative complications following TECA-LBO in the dog and cat. J Am Anim Hosp Assoc. 2013;49(3):160–168.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    McAnulty JF, Hattel A, Harvey CE. Wound healing and brain stem auditory evoked potentials after experimental total ear canal ablation with lateral tympanic bulla osteotomy in dogs. Vet Surg. 1995;2(1)4:1–8. doi:10.1111/j.1532-950x1995.tb01285.x

    • Search Google Scholar
    • Export Citation
  • 3.

    Doust R, King A, Hammond G, Cave T, Weinrauch S, Mellow D, Sullivan M. Assessment of middle ear disease in the dog: a comparison of diagnostic imaging modalities. J Small Anim Pract. 2007;48(4):188–192.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    White RA, Pomeroy CJ. Total ear canal ablation and lateral bulla osteotomy in the dog. J Small Anim Pract. 1990;319(11):547–553.

  • 5.

    Smeak DD, Crocker CB, Birchard SJ. Treatment of recurrent otitis media that developed after total ear canal ablation and lateral bulla osteotomy in dogs: nine cases (1986-1994). J Am Vet Med Assoc. 1996;209(5):937–942.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Smeak D, Dehoff W. Total ear canal ablation clinical results in the dog and cat. Vet Surg. 1986;15(2):161–170.

  • 7.

    Smeak DD, Inpanbutr N. Lateral approach to subtotal bulla osteotomy in dogs: pertinent anatomy and procedural details. Compend Contin Educ Pract Vet. 2005;27(pt 4):377–384.

    • Search Google Scholar
    • Export Citation
  • 8.

    Smeak DD, Kerpsack SJ. Total ear canal ablation and lateral bulla osteotomy for management of end-stage otitis. Semin Vet Med Surg Small Anim. 1993;8(1):30–41.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Williams JM, White RA. Total ear canal ablation combined with lateral bulla osteotomy in the cat. J Small Anim Pract. 1992;33(5):225–227.

    • Search Google Scholar
    • Export Citation
  • 10.

    Sharp NJ. Chronic otitis externa and otitis media treated by total ear canal ablation and ventral bulla osteotomy in thirteen dogs. Vet Surg. 1990;19(2):162–166.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Mason LK, Harvey CE, Orsher RJ. Total ear canal ablation combined with lateral bulla osteotomy for end-stage otitis in dogs. Results in thirty dogs. Vet Surg. 1988;17(5)263–268.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Cole LK, Kwochka KS, Kowalski JJ, Hillier A. Microbial flora and antimicrobial susceptibility patterns of isolated pathogens from the horizontal ear canal and middle ear in dogs with otitis media. J Am Vet Med Assoc. 1998;212(4):534–538.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Cole LK, Kwochka KW, Hillier A, Kowalski JJ, Smeak DD. Comparison of bacterial organisms and their susceptibility patterns from otic exudate and ear tissue from the vertical ear canal of dogs undergoing a total ear canal ablation. Vet Ther. 2005;6(3):252–259.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Hariharan H, Coles M, Poole D, Lund L, Page R. Update on antimicrobial susceptibilities of bacterial isolates from canine and feline otitis externa. Can Vet J. 2006;47(3):253–255.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Fossum T. Surgery of the ear. In: Fossum T, ed. Small Animal Surgery. 5th ed. Mosby; 2002:229–253.

  • 16.

    Rohleder JJ, Jones JC, Duncan RB, Larson MM, Waldron DL, Tromblee T. Comparative performance of radiography and computed tomography in the diagnosis of middle ear disease in 31 dogs. Vet Radiol Ultrasound. 2006;47(1):45–52.

    • Search Google Scholar
    • Export Citation
  • 17.

    Shell LG. Otitis media and otitis interna. Etiology, diagnosis, and medical management. Vet Clin North Am Small Anim Pract. 1988;18(4):885–899.

  • 18.

    Doyle RS, Skelly C, Bellenger CR. Surgical management of 43 cases of chronic otitis externa in the dog. Ir Vet J. 2004;57(1):22–30.

  • 19.

    Beckman SL, Henry WB Jr, Cechner P. Total ear canal ablation combining bulla osteotomy and curettage in dogs with chronic otitis externa and media. J Am Vet Med Assoc. 1990;196(1):84–90.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Matthiesen DT, Scavelli T. Total ear canal ablation and lateral bulla osteotomy in 38 dogs. J Am Anim Hosp Assoc. 1990;26(3):257–267.

  • 21.

    Mathews KG, Hardie EM, Murphy KM. Subtotal ear canal ablation in 18 dogs and one cat with minimal distal ear canal pathology. J Am Anim Hosp Assoc. 2006;42(5)371–380.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Hardie EM, Linder KE, Pease AP. Aural cholesteatoma in twenty dogs. Vet Surg. 2008;37(8):763–770.

  • 23.

    Bacon NJ, Gilbert RL, Bostock DE, White RA. Total ear canal ablation in the cat: indications, morbidity and long-term survival. J Small Anim Pract. 2003;44(10):430–434.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Devitt CM, Seim HB III, Willer R, McPherron M, Neely M. Passive drainage versus primary closure after total ear canal ablation-lateral bulla osteotomy in dogs: 59 dogs (1985–1995). Vet Surg. 1997;26(3):210–216.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Smeak DD. Management of complications associated with total ear canal ablation and bulla osteotomy in dogs and cats. Vet Clin North Am Small Anim Pract. 2011;41(5):981–994.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Coleman KA, Smeak DD. Complication rates after bilateral versus unilateral total ear canal ablation with lateral bulla osteotomy for end-stage inflammatory ear disease in dogs: 79 ears. Vet Surg. 2016;45(5):659–663.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Guillaumot P, Poncet C, Bouvy B. Outcome after total ear canal ablation and subtotal bulla osteotomy (TECASBO) in 23 dogs. Wien Tierärztl Monatsschr. 2011;98(5-6):106–113.

    • Search Google Scholar
    • Export Citation
  • 28.

    Holt D, Brockman Dj, Sylvestre Am, Sadanaga KK. Lateral exploration of fistulas developing after total ear canal ablations: 10 cases (1989–1993). J Am Anim Hosp Assoc. 1996;32(6):527–530.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Appendix B: intrinsic resistance. In: VET01S Performance Standards for Antimicrobial Disk and Dilution Susceptibility Tests for Bacteria Isolated from Animals. 5th ed. Clinical and Laboratory Standards Institute; 2020:188–195.

    • Search Google Scholar
    • Export Citation
  • 30.

    Marino D, MacDonald J, Mattiesen D, Patnaik AK. Results of surgery in cats with ceruminous gland adenocarcinoma. J Am Anim Hosp Assoc. 1994;30(1)54–58.

    • Search Google Scholar
    • Export Citation
  • 31.

    Bacon N. Pinna and exteral ear canal. In: Johnston S, Tobias K, eds. Veterinary Surgery: Small Animal. 2nd ed. Elsevier; 2018:2310–2328.

    • Search Google Scholar
    • Export Citation
  • 32.

    Love NE, Kramer RW, Spodnick GJ, Thrall DE. Radiographic and computed tomographic evaluation of otitis-media in the dog. Vet Radiol Ultrasound. 1995;36(5):375–379.

    • Search Google Scholar
    • Export Citation
  • 33.

    Gotthelf LN. Diagnosis and treatment of otitis media in dogs and cats. Vet Clin North Am Small Anim Pract. 2004;34(2):469–487.

  • 34.

    Krahwinkel DJ. External ear canal. In: Slatter D, ed. Textbook of Small Animal Surgery. 3rd ed. Saunders; 2003:1746–1755.

  • 35.

    Saridomichelakis MN, Farmaki R, Leontides LS, Koutinas AF. Aetiology of canine otitis externa: a retrospective study of 100 cases. Vet Dermatol. 2007;18(5):341–347.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36.

    Hettlich BE, Boothe HW, Simpson RB, Dubose KA, Boothe DM, Carpenter M. Effect of tympanic cavity evacuation and flushing on microbial isolates during total ear canal ablation with lateral bulla osteotomy in dogs. J Am Vet Med Assoc. 2005;227(5):748–755.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37.

    Vogel PL, Komtebedde J, Hirsh DC, Kass PH. Wound contamination and antimicrobial susceptibility of bacteria cultured during total ear canal ablation and lateral bulla osteotomy in dogs. J Am Vet Med Assoc. 1999;214(11):1641–1643.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38.

    Remedios AM, Fowler JD, Pharr JW. A comparison of radiographic versus surgical diagnosis of otitis media. J Am Anim Hosp Assoc. 1991;27:183–188.

    • Search Google Scholar
    • Export Citation
  • 39.

    Axlund T. Otitis interna and vestibular disease. In: Gotthelf L, ed. Small Animal Ear Diseases. 2nd ed. Philadelphia: Saunders Co, 2005;339–348.

    • Search Google Scholar
    • Export Citation
  • 40.

    Little CJ, Lane JG, Gibbs C, Pearson GR. Inflammatory middle ear disease of the dog: the clinical and pathological features of cholesteatoma, a complication of otitis media. Vet Rec. 1991;128(14):319–322.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41.

    Risselada M. Diagnosis and management of cholesteatomas in dogs. Vet Clin North Am Small Anim Pract. 2016;46(4):623–634.

  • 42.

    Greci V, Travetti O, Di Giancamillo M, et al. Middle ear cholesteatoma in 11 dogs. Can Vet J. 2011;52(6):631–636.

  • 43.

    Bai H, Konat GW. Hydrogen peroxide mediates higher order chromatin degradation. Neurochem Int. 2003;42(2):123–129.

  • 44.

    Mehdipour O, Kleier DJ, Averbach RE. Anatomy of sodium hypochlorite accidents. Compend Contin Educ Dent. 2007;28(10):544–546.

  • 45.

    Rack M, Rubly N, Waschow C. Effects of some chemical reagents on sodium current inactivation in myelinated nerve fibers of the frog. Biophys J. 1986;50(4):557–564.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 46.

    Matousek JL. Diseases of the ear pinna. Vet Clin North Am Small Anim Pract. 2004;34(2):511–540.

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