Compared with ordinary hand-held examination equipment, video otoscopy offers superior optics, greater magnification, and provides greater detail for evaluating the condition of the ear including the external canal, tympanum, and bullae.

Otitis Media is a Surgical Disease

Otitis Media is present in approximately 82 percent of patients with chronic persistent otitis and/or cases of recurrent otitis externa of greater than 6 months duration.

The leading cause of treatment failure in otic disease is unrecognized concurrent otitis media. The infection in the outer canal may appear resolved, evidenced by the appearance of healthy tissue, BUT the bulla(e) may act as a reservoir for bacteria and/or yeast organisms. As the tympanum is chronically exposed to enzymes and microbial infection, it becomes fragile and less of an effective barrier between the external canal and the bulla(e). The residual debris within the middle ear can easily pass into the external canal and “re-seed” the area. Thus, many chronic and recurrent infections are actually infections that were never adequately resolved with the first therapeutic protocol. Any clinical evidence of middle ear disease is ALWAYS considered a surgical ear. 

Indications for anesthetic / surgical video otoscopy

• Chronic recurrent ear infections
• Purulent otitis externa / media
• Evaluation of a painful ear (practically all Pseudomonas cases)
• Bulging or abnormal tympanum (may indicate need for myringotomy)
• Polyps / otic masses
• PSOM (primary secretory otitis media) - primarily Cavalier King Charles Spaniels
• Clinical signs of otitis media:  facial nerve palsy, Horner’s Syndrome, conductive hearing loss
• Clinical signs of otitis interna:  ataxia, horizontal or rotary nystagmus (fast away from the affected ear), strabismus, head tilt toward affected side, circling toward affected ear, neurologic hearing loss (as documented with Brainstem Auditory Evoked Response)
• Final diagnostic / therapeutic option prior to total ear canal ablation (TECA)  

Advantages of Video Otoscopy under Anesthesia

• Otitis media is always a surgical disease
• Able to manipulate the canal and evaluate the patency and health of the proximal horizontal canal
• Evaluate the tympanum and extent of disease into the middle ear / may require myringotomy (puncture of the pars tensa to remove fluid pressure behind the tympanum and evaluate bullae content)
• Removal of exudate to allow for appropriate medication of the bullae and proximal canal (flush and suction with infusion of medication directly via catheter into the deep canal)
• Samples for cytologic evaluation and culture & sensitivity are obtained from the ventral bullae (the organism and/or antibiotic sensitivity of bacteria obtained from the middle ear may differ as much as 89.5 percent from sample collection from the external canal)
• Removal of chloesteatoma (congenital or the result of chronic otitis media) from the middle ear cavity
• Last diagnostic / therapeutic step prior to TECA 

Summary: Anesthetic Video Otoscopy / Myringotomy

• Improved visualization (you can easily detect the problem)
• Enhanced flushing and debris removal (pre- and post-op photos help the client understand the necessity of therapy and appreciate the severity of the infection / disorder)
• Precise sample collection:  a)  Cytologic sample;  b) Culture & Sensitivity from the deep canal (bullae);  c)  Visually-guided biopsy of a specific site
• Myringotomy - you can remove debris from the bulla and thus remove the source as well as direct medication infusion into the bullae / treat the “root of the problem”
• Increased accuracy of diagnosis
• Allows for a specific therapeutic plan
• Photographic recording for the patient medical record pre- and post-op
• Outpatient procedure (no overnight care required)

Contributed by: Karen Helton-Rhodes, DVM, Diplomate ACVD