Ear & Eye

Question 2

What are the 3 ossicles from lateral to medial?

Answer 2

a. Malleus: comma shaped
b. Incus: within epitympanic recess
c. Stapes: separates tympanic cavity from perilymphatic space

Question 3

Describe path of facial nerve in relation to ear canal

Answer 3

Motor innervation
Through internal acoustic meatus > through fascial canal of petrons temporal bone > exists stylomastoid foramen (caudodorsal osseous ear canal) *caudomedial to bulla * > crosses ventral horizonal ear canal»_space; palpebral branch or lingual branch

Question 4

What nerve is sensory to ear canal?

Answer 4

Vagus n.

Question 5

What are the names of the margins / cartilages around the external ear canal opening?

Answer 5

a. Cranial: helix
b. Medial: Antehelix
c. Caudal: Antitragus
d. Lateral: Tragus

Question 6

Where are the 5 major described vessels located associated with ear canal?

Answer 6

a. Great auricular a. > overlies vertical portion (medial to dorsal apex of parotid gland)
b. Maxillary v. + external carotid > ventral to tympanic bulla
c. Retroglenoid v > rostral to osseous ear canal
d. Internal carotid a > medial to bulla

Question 7

Simplified, describe hearing and balance

Answer 7

a. Hearing: sound waves hit tympanic membrane > [x] by ossicles > + movement of endolymph within cochlea > converted to nerve impulse by organ of Corti > brain via cochlear n.
b. Balance: fluid movement within vestibule and semicircular canals > hair cells (maculae) and detection depends on canal, otoliths of saccule, and utricle

Question 8

What are 3 parts of inner ear?

Answer 8

a. Vestibule > middle, contains saccule + utricle
b. Cochlea > seashell contains organ of Corti
c. Semicircular canals > 3 (anterior, lateral, posterior)

Question 9

What is the vascular supply to middle ear? Nerve supply to inner ear?

Answer 9

a. Tympanic a (from maxillary a) + meningeal + pharyngeal vessels
b. Vestibulocochlear > vestibular > semicircular canals > cochlear n > Organ of Corti

Question 10

What are 3 components of tympanic cavity called and what do they contain?

Answer 10

a. Dorsal: epitympanum (epitmpanic recess), incus, and part of malleus
b. Middle: mesotympanum – 2 membranes covering middle ear chamber, manubrium of malleus, eustachian tube, bone promontory
c. Ventral: hypotympanum – longest, within bulla > communicates with the tympanic cavity proper

Question 11

1. What can actinic keratosis turn into? Which breed or type of cat most likely gets it?
2. Treatment for it?
3. What is most common feline cutaneous neoplasm?
4. Which breeds predisposed?
5. List tx options of SCC of ear in cats?

Answer 11

1. SCC - white cats
2. Pinnectomy or laser surgery; sunblock preventative?
3. Basal cell tumor
4. Siamese, Himalayan, Persion
5. Partial or total pinnectomy; cryosurgery; laser ablation; pinnectomy + vertical canal ablation; radiation; chemotherapy

Question 12

1. Most common cause of para-aural abscess? % incidence?
2. Tympanic membrane can be intact up to __% ears with otitis media?
3. List radiographic views to evaluate ear.

Answer 12

1. Incomplete debridement of epithelial lining of TECA –> 6-11% dogs with TECA
2. 71%
3. Lateral;
   Dorsoventral or ventrodorsal;
   Latero 20 deg ventral -laterodorsal oblique;
   Rostro 30 deg ventral - caudodorsal open mouth oblique

Question 13

1. List tx options of auricular hematoma
2. With cryotherapy, what is recommended # of cycles for max tumor destruction?

Answer 13

1. Repeated needle aspirates
   Passive drainage
   Active drainage
   Chronic hematoma - S drainage incision + stures
   CO2 laser drainage / ablation
   Human fibrin sealant
   Drainage + methylprednisolone into cavity w/ or w/o oral systemic steroids
2. Two

Question 14

1. What % cats have facial palsy pre-op TECA?
2. What % have post-op facial n deficits w/ TECA for dog and cat & what % is permanent?
3. % risk for hemorrhage? Which vessel usually?
4. % cases that get dehiscence?
5. What is failure rate of lateral wall resection?

Answer 14

1. 8% pre-op cats
2. Post-op
   Dogs: 13-39% ; permanent 4-13%
   Cats: 12-56% ; permanent 28%
3. 3-14% hemorrhage; retroglenoid v.
4. 25% dehiscence
5. 42-55% failure rate

Question 15

1. With pinna SCC in cats, what % recur w/ cryotherapy & what is DFI?
2. With grade 3 MCT of ear, what is median DFI w/ pinnectomy?
3. With complete excision, what is DFI & MST for feline pinna SCC?
4. For aural ACA, what is MST if within ear canal vs extensive involvement after surgery?

Answer 15

1. 73%; DFI ~184 days
2. 5 months
3. DFI 19-22 months; MST 800 days
4. Extensive involvement: 5 months
   Excision and within canal: 30 months

Question 16

1. List 3 routes of middle ear bacteria
2. What are the most common organisms causing otitis media?
3. List Ddx for tumors of tympanic membrane
4. What breed often gets secretory (serous) otitis media?

Answer 16

1. External auditory meatus via tympanic membrane
   Nasopharynx via auditory tube
   Hematogenous
2. Staph intermedius
   Malassezia
   Pseudomonas
3. Ceruminous gland ACA
   SCC
   Carcinoma
   Lymphoma
4. Cavalier King Charles Spaniels

Question 17

1. List 3 congenital anomalies of inner ear leading to loss of hearing / balance & their associated breeds
2. What view is best in cats to look at bullae?
3. List 3 alternative diagnostic tools to evaluate middle / inner ear (not the usual tests)

Answer 17

1. Collapse of scala media - Dalmatian
   Neuroepithelial degeneration - Rottweilers
   Changes in organ of Corti - Pointers
2. 10 deg ventrocaudodorsal view
3. CSF
   Brainstem Auditory Evoked Responses (BAER)
   Impedance Audiometry

Question 18

1. What is recurrence rate of non-endoscopic traction vs endoscopic transtympanic + curettage + steroid (all endoscopic) for polyps?
2. What are options (less invasive) for managing middle ear drainage dysfunction?
3. Bullae located / bordered by what for VBO surgical approach in cats?
4. Prognosis for cholesteatoma?

Answer 18

1. 57% vs 13.5% !
2. Myringotomy
   Tympanostomy tube or “grommets”
3. Mandibular symphysis
   Caudal mandible
   Larynx
4. Guarded - 45-50% recurrence

Question 19

1. What drug can help tx pain after corneal procedures by decreasing ciliary spasm?
2. List types of eyelid speculums
3. What muscles elevate superior eyelid?
4. What muscle lowers inferior eyelid?

Answer 19

1. Cycloplegics (atropine)
2. Lightweight Barraquer Wire Speculum
   Self-retaining Castroviejo speculum
3. Levator anguli oculi medialis, levator palpebrae superioris, Müller’s, frontalis
4. Malaris muscle

Question 20

1. What are 3 causes of ectropion?
2. What is general idea of treatment for each?
3. What is Euryblepharon?
   Breeds seen often?
   Treatment?

Answer 20

1 and 2. Excessively long palpebral fissure –> shorten eyelid
Contraction of scar tissue from previous laceration –> V to Y blepharoplasty
Overcorrection from entropion surgery –> V to Y blepharoplasty
3. Enlargement of palpebral aperture secondary to longer eyelids
– Neopolitan mastiffs, Bloodhounds, Newfies, Clumber spaniels
– Pocket technique for permanent medial canthoplasty

Question 21

1. List tx of distichia
2. What are the temperatures to avoid with cryo?
3. List Ddx of eyelid tumors in dogs. What is most common in dogs? Cats?
4. What is it called to have enlargement of Meibomian gland from intraglandular accumulation of meibum secondary to duct obstruction?

Answer 21

1. Cryoepilation
   Electroepilation
2. Below −30°C
3. Dogs: Meibomian glands (most common), melanomas, squamous papilloma, histiocytoma
   Cats: most common - SCC
4. Chalazion

Question 22

1. What are treatment options for nasolacrimal duct?
2. Treatment for tear film deficiency?
3. What are the 5 forms of conjunctiva?

Answer 22

1. Nasolacrimal flushes and systemic / topical abx therapy
   Catheterization conservative flushing
   Exploratory dacryocystotomy
   Conjunctivorhinostomy
2. Immunosuppressives (cyclosporine or tacrolimus)
   Parotid duct transposition
3. Palpebral conjunctiva
   Conjunctiva of bulgar and palpebral sides of nictitans
   Bulbar conjunctiva
   Conjunctival fornix

Question 23

1. List types of nonneoplastic conjunctival masses.
2. List Ddx feline conjunctival neoplasia

Answer 23

1. Dermoid
   Subconjunctival prolapse orbital fat
   Onchocerciasis
   FBs
   Nodular granulomatous episcleritis
   Conjunctival cyst
   Fibrous histocytoma
   Nodular fascititis

Question 24

1. List predisposing factors to get otitis externa

Answer 24

a. Pendulous ears (Spaniel)
b. Narrow ear canals (Shar peis)
c. Hair growth in canal (Poodles)
d. Excess cerumen (Cockers)
e. Chronic ear moisture (bathing/ swimming)
f. Inappropriate abx use, polyp, or tumor in external ear

Question 25

What is most significant perpetuating factor of otitis/ externa/media?

Answer 25

a. Proliferation and overcolonization of bacteria

Question 26

List pathologic bacteria of ear canal

Answer 26

a. Staph intermedius, Staph pseudintermedius, pseudomonas, proteus, E coli, Corynebacterium, enterococcus, streptococcus

Question 27

List Ddx of malignant external ear canal masses

Answer 27

a. Ceruminous carcinoma b. SCC c. Plasmacytoma d. Anaplastic carcinoma e. STS f. Melanoma

Question 28

What breed predisposed to ceruminous ACA?

Answer 28

a. Cocker Spaniels

Question 29

What % of ear canal tumors malignant?

Answer 29

a. 60%

Question 30

List tx options of traumatic separation of annular / auricular cartilage junction described in dogs/cats

Answer 30

a. TECA-BO b. Horizontal ear ablation & lateral bulla osteotomy + preserve vertical canal c. Primary repair – caudal approach

Question 31

With lateral wall resection; recurrence of clinical signs for otitis media / externa?

Answer 31

a. 11%

Question 32

What is concern for brachycephalic breeds and TECA-BO approach?

Answer 32

a. Majority bullae medial to mandible – so lateral approach tough

Question 33

Lavage of ear canal decreases positive culture by __%?

Answer 33

33%

Question 34

Horner’s post-op TECA in cats? What % permanent? What % have it pre-op?

Answer 34

a. 6% pre-op; 27-42% post-op; 14-27% permanent

Question 35

What is ankyloblepharon?

Answer 35

a. Delayed opening of eyelid

Question 36

List types of entropion

Answer 36

a. Conformational b. Cicatrical c. Involutional d. Spastic

Question 37

List options to treat entropion

Answer 37

a. Temporary correction - vertical mattress b. Permanent: i. Hotz-Celsus ii. “Stades” procedure modification (upper eyelid) iii. Modified Kubut-Szymanouski

Question 38

List reconstructive strategies for large eyelid defects

Answer 38

a. Sliding pedicle advancement flap b. Myocutaneous pedicle graft c. Semicircular flap d. Lip to lid flap

Question 39

What are 3 components of tear film & where produced?

Answer 39

a. Aqueous – by lacrimal gland (thickness) b. Mucin – globlet cells in conjuction (innermost) c. Lipid – Meibomian glands (outermost)

Question 40

What is a Dacryops?

Answer 40

a. Lacrimal cysts in dorsolateral conjunctival area of globe or mass between medial canthus & third eyelid

Question 41

List options for surgical tx of prolapse of nictitating membrane gland?

Answer 41

a. Orbital rim anchoring technique OR Morgan pocket technique

Question 42

What breed has inheritability of everted nictitating membrane

Answer 42

a. German Shorthaired Pointer

Question 43

What is a plasmoma and what breed is predisposed?

Answer 43

a. Nodular or diffuse thickening of nictitating membrane; GSD most

Question 44

What are disadvantages of Nictitating membrane flaps?

Answer 44

a. Obscure visualization of cornea b. No blood supply c. Less support than conjunctival pedicle graft d. Inhibits topical meds from access

Question 45

What are 3 types of ways to perform keratotomy?

Answer 45

a. Grid – 25 gauge needle b. Punctate c. Battery powered – hand-held diamond burr

Question 46

When in cats do you not do keratotomy?

Answer 46

a. Cats with indolent ulcers – increases sequestra formation

Question 47

What breed commonly gets Indolent ulcers

Answer 47

Boxers

Question 48

If keratectomy is deeper than ___ corneal thickness – pedicle graft placed

Answer 48

a. Half

Question 49

List approaches to orbit

Answer 49

a. Modified orbitotomy (lateral) b. Anterior or dorsal orbitotomy c. Transoral orbitotomy d. Orbitectomy

Question 50

List 2 types of enucleation approaches

Answer 50

a. Subconjunctival approach b. Transpalpebral approach

Question 51

List types of conjunctival grafts

Answer 51

a. Pedicle graft b. Bridge graft c. Island graft d. 360 deg graft

Question 52

Corneoconjunctival transposition – which types of lesions best used for?

Answer 52

a. Axial lesions <= 5 mm

Question 53

What are extracellular matrix graft examples for corneal defects?

Answer 53

a. Porcine small intestinal submucosa or porcine urinary bladder

Question 54

Phacoemulsification is great for which lens issues but not great for which?

Answer 54

a. Great: unstable lens with zonal integrity b. Not great: complete luxation

Question 55

List surgical treatment for glaucoma

Answer 55

a. Temporary keratostomy (IOP decreased) b. Gonioimplantation c. Cyclophotoablation