Long‐term non‐surgical management of canine aural tympanokeratoma with repeated removal of middle ear keratinous debris and CT follow‐up

Abstract

An 8‐year‐old, male fox terrier with otitis externa was presented because of decreased activity, pain in the ears and deterioration of hearing. Video‐otoscopic flushing was performed, revealing yellowish, spongious debris protruding from the left middle ear cavity. The dog was referred to cone beam computed tomography, which revealed non‐contrast‐enhancing soft tissue opacity filling the left tympanic bulla. Three months later, video‐otoscopic removal of keratinous debris from the tympanic bulla was performed, and histological examination of the debris confirmed the presence of tympanokeratoma. Because the owner refused surgical management, recurrence was followed by video‐otoscopic examination and/or computed tomography, and debris removal was repeated when recurrence was observed, altogether four times over 23 months. Four computed tomography scans during the follow‐up period revealed only very mild progression of the disease.

Middle ear cholesteatoma in two cats diagnosed with the aid of video-otoscopy

“…Early diagnosis of cholesteatoma seems to be associated with a lower chance of recurrence. 2,5,12 The cats in this report had cholesteatomas to the external and middle ears, without affecting the surrounding structures, with mild bulla expansion and sclerosis in one cat. It is unclear whether these bulla changes were due to the cholesteatoma, the polyp or both.…”

“…11 The presence of the findings of keratinic material and connective tissue in the middle ear has been considered adequate to diagnose cholesteatoma. 2,8,11,12 However, an otologic history and otoscopic examination with histopathological findings and advanced imaging are important to support the diagnosis. 2,3,5,7,8,11,12 Clinical signs in dogs include otorrhea, ear scratching, head shaking, pain and neurological signs.…”

“…2,8,11,12 However, an otologic history and otoscopic examination with histopathological findings and advanced imaging are important to support the diagnosis. 2,3,5,7,8,11,12 Clinical signs in dogs include otorrhea, ear scratching, head shaking, pain and neurological signs. 2,4,5 By contrast, the clinical signs reported in the first feline report 7 were lethargy, vocalization and snorting with late onset of neurological signs, while in the other report, 8 unilateral Horner and facial nerve paralysis were present.…”

“…These cats remained stable post-flushing; however, although the bulla was thoroughly flushed, it is possible that some of the keratinous material remained present, considering the bulla septum of cats that can impede a thorough flush and the short follow-up period. 2,11,12 Surgery appears to be the preferable treatment in dogs, despite the reported recurrence rate. 2 Although studies are needed to investigate the ideal treatment of cholesteatoma in cats, conservative video-otoscopic flushing may be a palliative alternative treatment to surgery, similar to the reports in dogs, especially in cats with an early diagnosis and less severe disease and when surgical intervention is not possible.…”

“… 2 , 8 , 11 , 12 However, an otologic history and otoscopic examination with histopathological findings and advanced imaging are important to support the diagnosis. 2 , 3 , 5 , 7 , 8 , 11 , 12 …”