Lateral Ear Resection in Cats

Lateral ear resection is a surgical procedure whereby the vertical part of the ear canal is remodeled so that it is open to the air. This improves ventilation to the lower, horizontal canal and improves access to treat recurrent ear infections. 

It is important that a thorough assessment of the patient and the underlying reason for their problem is done, in order to identify those cases which would benefit from this procedure. Lateral ear resections are generally carried out in first opinion practice. 

The cat is given pre-emptive pain relief and then a general anesthetic. The hair is clipped from the side of the face below the affected ear. Under sterile surgical conditions, the surgeon incises the flap of skin overlying the vertical canal and reflects it upward. Then the tissue around the cartilage tube of the ear canal is carefully blunt dissected away until the outer cartilage surface of the canal is exposed. 

The surgeon pre-scores the cartilage with a scalpel blade and then cuts the cartilage with straight scissors, to create a downward flap. The length of this flap is trimmed down to provide a baffle plate, which is then sutured into the space left by the skin flap. 

The cat is woken from the anesthetic and must wear a cone to prevent scratching of the op site. The cat is then sedated five days after the original surgery, in order to bathe and clean the area. Then five days later (10 days post op) the cat is sedated for the sutures to be removed. 

Only once the op site is fully healed, at the two to four week point, can the cone be removed. 

Lateral ear resections used to be performed more frequently in the past than they are now. This is in part due to better knowledge about the underlying causes of ear infections, which in turn helps the clinician to select which cases would benefit from the procedure, and avoid operating on those cases where the benefit is limited. 

When the right patient is selected this is an extremely successful procedure. Although it doesn't prevent ear infections altogether, what it does do is make access easier for cleaning and to apply medicated drops, plus the extra air circulation is hostile to many of the bacteria that infect ears as they prefer to grow in conditions which lack oxygen. 

The need for surgery may be avoided if a thorough work up is done of the case, and underlying causes such as food allergy (as a trigger for infection) are identified and eliminated.

This is painful surgery which requires the patient to take analgesics (pain relief) for several days post-operatively. There is also the inconvenience of wearing a cone, but this is essential to prevent self-trauma to the op site. 

Often the ear is too sore to be touched in the immediate postoperative period, so sedation is preferred in order to clean the area. Although the sutures are commonly removed at the 10-day mark, small areas of wound breakdown are not uncommon. These are not usually serious as the skin with heal eventually, but it does mean an owner can expect their cat to wear a cone for around three weeks. 

A lateral ear resection is delicate surgery that cannot be rushed. Expect the cost of anesthetic and surgery to start from $625. Some surgeons recommend doing both ears at the same time, so the cost of anesthetic is saved on the second ear, making the combined procedure in the region of $1,000- $1,150. 

However, you also need to factor in the sedation costs on two occasions, which will be around $55 upwards for each visit. 

This surgical procedure is usually undertaken in first opinion practice and has a high success rate. It should however be emphasised that the object is to make control of ear infections easier, and will not totally prevent recurrence. With this proviso, there are definite benefits to the procedure for the cat that suffers from repeat ear infections. 

To a large extent, a successful outcome depends on the right patients being taken forward for surgery. Those that already have a large amount of scar tissue formation and narrowing of the ear canal may not benefit, and a different operation which totally removes the ear canal is more appropriate. 

Preventing the need for a lateral ear resection is all about controlling recurrent ear infections. Thus the clinician needs to explore all possible inciting causes such as allergy (including food allergy) and parasites. In addition, it can be helpful to swab and culture the bacteria so that an antibiotic that is known to be effective can be selected. 

Ceasing antibiotic treatment too early and only delivering only part of the course of drops  into the ear can lead to bacterial resistance, which makes infection difficult to clear and create the need for a lateral ear resection. Thus, conscientious compliance with any dosing instructions should be followed, and if you are struggling to medicate the cat for any reason then inform your vet so an alternative strategy can be devised.