Bulla Osteotomy_Procedural Details, Complications, Cost, & More

Chronic ear infections can be a nightmare for the pet's owner as there are high chances that the pet will become deaf. In addition, the continual growth of the ear infection can make its treatment even more complicated. However, due to technological advancement in the medical industry, veterinarians can deal with almost all inflectional diseases. Indeed, the ear canal is narrow, and it is not possible to clean the infected ears of your pet at home. Therefore, the final option is to go for surgical treatment.
In most cases, it's all about the diseased tissues. The surgery includes the removal of the entire ear canal; the middle ear goes through draining to remove the infected material, and then the ear is closed. No doubt, it is painful and involves plenty of complications that we will be discussing below. Most of the pet owners are unaware of this structure (bulla). According to the industrial experts, the procedure will cost $2000, including the CT scan. Plus, a Bilateral CT scan will make the procedure cost $2500.

Major Indications Of Bulla Middle Ear Cavity

The common signs of the bulla middle ear cavity include the following:

1. Scratching at the ear
2. Discharge from the ear
3. Rubbing of the ear
4. Malaise
5. Loss of appetite
6. Vestibular signs (head tilting towards the infection, walking in circles, inability to walk, and eye shifting)
7. Paralysis of the facial never is a common sign in the middle ear bulla (lack of control on lips, sagging of the lips, incapability of eye blinking, and pain in mouth).
8. Difficulty in breathing
9.  Snorting because of the discharge draining
10. Polyp extension from the middle ear
11. Chronic diseases due to bulla include inflammatory polyps, cancer, and infection (otitis media).

Why Do Veterinarians Recommend Bulla Osteotomy?

To make your pet's ear infection-free is the primary reason to recommend this treatment. So, does it sound like complete eradication of the ear structures? Well, the infectious portions require cleaning and flushing. Then, the ear ablation becomes necessary. Thus, it is crucial to remove the entire channel that entails infection. After the treatment, it will leave smooth skin without any opened base of the ear flaps. Mostly, the ear flap consists of dermatitis issues, and it continues to increase and results in hearing loss.
The tympanic bulla should be cracked and completely opened to clean the slime, pus, and other cheesy infections. If you are unaware of the tympanic bulla, you can touch the skin behind your ears and notice the smooth, round structure of your skull. A normal and uninfected bulla will have air-filled. But after the infection, its lining will have secretory cells which produce an unpleasant odor and destroy the bone. Several nerves use that area through the ear, and they should be entirely exposed for surgical procedures. For instance, the damage can be permanent or temporary hearing loss after the surgical procedure.
There are some other potential complications, but before that, we will describe the preparation method for the procedure of bulla osteotomy.

Preparation

1. CT scanning or radiographs are best to assess the tympanic bulla. However, stillness is crucial to get the right CT scan and how bad the bulla situation is. Moreover, it lets the veterinarian identify how narrow the ear canals are after the infection. Also, it identifies if the tumor is growing or not. Finally, the images will describe if a simple or aggressive surgery is essential for the patient.
2. The ear drainage culture is the perfect option for the patient to get rid of the infection. Also, there are chances that other ear drainage cultures could be necessary once the bulla opens.
3. It is vital to have ample access to the cranial nerve function before performing the surgical procedure. For instance, the nerves which have any disease will be functioning properly after the surgical procedure. Remember that nerve diseases are not permanent and occur from any surgical procedure.

No doubt, less hearing ability is a common drawback after a chronic long-term ear infection. However, the hearing loss after ear ablation in the bulla osteotomy does not relate to a massive change in the patient's hearing. Most of the pet owners know whether their pet can hear or not. So, the formal test of hearing is not essential. After ablation, the patients will hear some sound because the sound waves will be transmitting through the tissues present in the ear canal. Nevertheless, the CBC and urinalysis are crucial to any surgical procedure, and this surgery is no exclusion at all.

Surgical Procedure

The bulla osteotomy surgical process encompasses removing the ear structures and cleaning the tympanic bulla. In the beginning, the head and ears are shaved when the patient is sleeping. Also, the ear canal is flushed out for the last time for removing the infected material. Minimization of bacterial contamination is a crucial step. Both ear canal portions, including horizontal and vertical, are removed. Next, the bones of the eardrum and middle ear are removed too. Now the bone of bulla is opened. All the material is flushed out, and the cellular lining of the bone scrapes away. Besides, the material left behind will lead towards the liquid's chronic drainage from the wound. Lastly, the external draining could be left for the duration of healing. 
After the surgical procedure, oral antibiotics, bandaging, and pain medication is provided. Correspondingly, the veterinarians recommend the Elizabethan collar for protecting the incision from any injury or scratch.

Possible Complications

• The bulla is present at the ear canal's bottom, and it is close to some other essential ear structures. For instance, the structures are prone to damage throughout the surgical procedure. Even inflammation can occur in the healing process.
• The removal of the great auricular vasculature is another drawback in the bulla osteotomy procedure. For instance, the tissue of the great auricular vasculature dies along with the ear flaps. Therefore, the trimming of this portion is crucial as well. Other than that, there would not be any blood supply in the great auricular vasculature.
• In some cases, the retro glenoid vein can burst up, and the bleeding does not stop. Therefore, the visibility of the incision decreases. The retro glenoid vein is just beneath the bulla. Again, though, the bleeding reduces the procedure's efficacy.
• Sometimes the swelling in the throat creates a difficult situation for the patient to breathe.
• There are 5 to 10 % cases of bulla osteotomy where the patient goes through chronic drainage due to the incision. Further, the second surgery is held to repair the issues. For example, the residual cells leftover in bulla and other fluids are drained from the eustachian tube.
• The facial nerves run quite near the ear's base. Also, it will control the facial expressions. Unfortunately, facial paralysis is not common after an ear disease. It means that the pet will have its jaw slacked on one side. As a result, the eyes would not be able to blink normally. After some time, the eyes will start retracting to assist in tear lubrication. Thus, the blinking loss does not cause any damage to the patient's eyes. Nonetheless, it is a common complication of total ear canal ablation (TECA), but sometimes it can be permanent (chances are 10 to 15 %).

Other Complications

Hearing can be limited after the surgical procedure. The hearing ability reduces due to the chronic ear infection. Thus, the hearing disruption should be kept in mind because the eardrum is removed. Some of the patients still hear the sounds normally after TECA. But the prediction of hearing loss can be wrong after the procedure sometimes.
Another complication includes cholesteatoma, and it is crucial to remove otherwise, there will be continuing drainage from the affected area. More than that, the patient will be suffering from oral pain while chewing or opening the mouth. Hence, a CT scan is vital for knowing the patient's condition and planning the surgical procedure appropriately.

Results of the Surgery

In plenty of cases, the surgical results of bulla osteotomy are miraculous. The patients feel more energetic, and they do not feel any headaches. There would not be any more bad odor or pain to the patient. Even the ears will not require frequent cleaning. Above all, the surgical procedure requires modern technical skills, and some veterinarians do not feel comfortable performing this surgery. Thus, do discuss in detail with your veterinarian so they can recommend the best specialist for your pet.

Final Thought!

Bulla osteotomy is a delicate procedure that involves removal of the ear canal as well as a tympanic bulla and leaves only the pinna (middle ear). As a result, the patient will suffer from hearing loss no matter how successful the surgery goes. Mostly, the pets recover quickly after the surgery, but post-operative care is also necessary. The pet should rest for at least two weeks to let the wound heal properly. Overall, the prognosis of the surgery is reliable, but some complications are likely to occur.