Hazards during lateral ear canal resection include injury to the parotid salivary gland and the facial nerve's superficial
branches. Long-term complications can include stricture or stenosis of the newly created opening to the horizontal canal and
progression of the underlying otitis despite the surgery and ongoing medical therapy, necessitating revision surgery (usually
conversion to TECA).
Potential complications with TECA-BO are more numerous and serious. These include facial neuropraxia or neurotmesis with resultant
transient or permanent paralysis, severe hemorrhage from branches of the maxillary artery, vestibular dysfunction if trauma
to the inner ear occurs during bulla osteotomy or curettage and late abscess formation if a nidus of infected tissue is left
in situ. The latter potential complication provides a rationale for the aforementioned cultures during surgery, as those results
may help guide antibiotic therapy should a late infection or abscess occur.
Although a surgeon's experience and meticulous dissection help avoid most of these complications, many dogs undergoing TECA
may have such severe mineralization and distortion of their ear canals, or periauricular inflammation and fibrosis, that iatrogenic
neurovascular trauma is unavoidable. Because some dogs with end-stage otitis have an underlying atopic dermatitis, these patients
may yet have some pinna dermatitis problems that require ongoing treatment even after successful TECA.
Markedly decreased hearing acuity is expected after bilateral TECA in dogs with no other abnormalities. Patients with bilateral
end-stage otitis undergoing TECA usually already have marked hearing loss before surgery, and the differences between preoperative
and postoperative acuity is typically less dramatic or problematic. Nonetheless, be sure to discuss deafness with the clients
as part of the preoperative consultation.
Despite the potential complications after TECA-BO surgery, most dogs have a vastly improved quality of life compared with
their preoperative status. The clients also may report improved companionship with their pets, as they no longer have to chase
their dogs to apply painful treatments. The alleviation of chronic pain also allows many of these dogs to regain a more tractable
Other ear canal surgeries, such as vertical ear canal resection, may also be considered based on the indications, with the
goal again being to do enough surgery to achieve the desired long-term objective, without the need to do more extensive surgery
that might increase the risk for complications.
Dr. Fingeroth is senior staff surgeon at the Orchard Park Veterinary Medical Center in New York. He is also a consultant to the Veterinary
Information Network in the areas of orthopedics and general soft tissue surgery, as well as oncologic, endocrine and neurosurgery.
He has been ACVS board-certified since 1988.