Surgery STAT: Examining options to treat feline inflammatory polyps
Polyps are identified by otoscopic and/or nasopharyngeal examination. Diagnostic imaging (skull radiographs, CT) is indicated to document evidence of middle-ear disease. The origin and cause are unknown, but it is thought that polyps arise as a result of prolonged inflammation. It is unclear whether this inflammation initiates or potentiates the development and growth of inflammatory polyps.
Ongoing investigations into infectious-agent association with polyp development have yet to identify a definitive cause.The two most common methods of polyp removal are by traction and ventral bulla osteotomy (VBO). Traction is effective; however, the owner must be made aware of the potential for recurrence.
Auricular polyps are visualized externally or by otoscopic examination. Regardless of location, the polyp is grasped with Allis tissue, alligator, or right-angled forceps and avulsed from its origin. Significant hemorrhage following traction removal is uncommon. A dental mirror or flexible endoscope helps visualize the nasopharynx following polyp removal to look for residual tissue.
Recurrence following removal by traction is reported to be approximately 40 percent; therefore conventional treatment advocates VBO to remove the epithelium of the tympanic bulla for definitive therapy.
However, one study describing prednisolone therapy following traction had a zero recurrence rate in eight cats vs. 64 percent recurrence in 14 cats receiving traction alone.
Response to prednisolone supports an etiology of chronic inflammation. Another study had recurrence in five of 14 (36 percent) cats treated with traction alone, but all of these cats had radiographic evidence of bulla disease. Results of these studies suggest that routine VBO for treatment of inflammatory polyps may not be necessary. Traction plus prednisolone may be a good option, particularly when no clinical signs or radiographic evidence of middle ear disease is present.