Management of Otic and Nasopharyngeal, and Nasal Polyps in Cats and Dogs

Rigid normograde rhinoscopy-assisted traction-avulsion removal of small middle ear polyps from the auditory tube in five cats

CASE SERIES SUMMARY

This study aims to describe a novel minimally invasive technique for the removal of small middle ear polyps from the auditory tube openings in cats. Five cats with clinical signs of otitis externa and/or otitis media, and/or upper respiratory tract inflammation were included. All cats underwent pharyngolaryngoscopy under anaesthesia, CT scan of the head, neck and thoracic cavity, video-otoscopic examination, retrograde nasopharyngoscopy and normograde rhinoscopy. The five cats described in this study were all found to have significant respiratory tract inflammation (rhinitis, sinusitis, nasopharyngitis, otitis media) with small polypous protrusions from the auditory tube openings. A normograde rhinoscopy-assisted traction-avulsion (RATA) removal of these small polyps was performed in all cases without complications. The rostral nasopharynx was visualised by a unilaterally normograde advanced rigid endoscope passing the choana, and polyps were removed using a grasping forceps introduced in the contralateral nostril. Telephone follow-up revealed clear improvement in all cases. One of the cases was re-evaluated with a CT scan and endoscopy 4 weeks after treatment. The CT scan showed a significant improvement with no abnormalities in both external ear canals and air opacity in both tympanic bullae. Video-endoscopic examination revealed intact tympanic membranes with mild chronic abnormalities and patent auditory tube openings upon normograde rhinoscopy.

RELEVANCE AND NOVEL INFORMATION

Rigid normograde RATA is a novel, minimally invasive and effective technique for the removal of small middle ear polyps from auditory tube openings in cats with otitis media.

Evaluation of aural masses submitted as inflammatory polyps in 20 dogs (2000-2020)

BACKGROUND

Canine non-neoplastic aural polypoid masses (APMs) are uncommon, with few published studies.

OBJECTIVES

The aim of this retrospective study was to characterise the clinical presentation, diagnostic imaging and histopathological results for APMs submitted as aural inflammatory polyps (AIPs).

ANIMALS

Twenty dogs with APMs evaluated at a veterinary teaching hospital.

MATERIALS AND METHODS

Cases were selected by searching computerised medical records from 2000 to 2020, using keywords 'canine', 'aural/otic polyp' and 'aural/otic inflammatory mass'. Histological samples and medical records were reviewed.

RESULTS

In 14 of 20 dogs, external ear canal masses were characterised by keratinised squamous epithelium with or without adnexa. Tympanic bulla origin was confirmed in four of 20 dogs by the presence of cuboidal to ciliated columnar epithelium, with or without squamous epithelium. The site of origin could not be determined in two dogs. Diagnostic imaging (MRI or CT) confirmed APM presence in 14 of 20 dogs. Otitis media was diagnosed in four of four tympanic bulla APMs and seven of 13 ear canal APMs. In 18 of 20 dogs, debulking, traction avulsion, and total ear canal ablation and bulla osteotomy led to APM resolution in two of eight, four of six and four of four dogs, respectively.

CONCLUSIONS AND CLINICAL RELEVANCE

Type of epithelium was a key feature in determining the APM origin, and interpretation in conjunction with video otoscopy and diagnostic imaging was crucial. Canine APMs more commonly arose from the ear canal. Tympanic bulla APMs and APMs of undetermined origin were comparable to feline AIPs. Regardless of APM origin site, debulking had the greatest likelihood of recurrence.

Feline bilateral inflammatory aural polyps: a descriptive retrospective study

BACKGROUND

Feline inflammatory aural polyps (IP) have been reported as solitary growths, yet bilateral polyps may occur more commonly than described previously.

OBJECTIVES

To identify the prevalence and risk factors associated with bilateral feline IP within a population of cats evaluated at a veterinary teaching hospital over a 10 year period.

ANIMALS

Twenty-five cats with histologically confirmed IP.

METHODS AND MATERIALS

A retrospective study was performed by searching computerized medical records of cats seen at The University of Tennessee Veterinary Teaching Hospital from 2005 to 2015. Keywords used for the search included "feline polyp", "ventral bulla osteotomy", "inflammatory polyp ear canal" and "nasopharyngeal polyp".

RESULTS

Cats were separated into groups with unilateral or bilateral disease. Six of 25 (24%) cats had bilateral IP. Twelve cats had computed tomography performed (four of six with bilateral IP; eight of 19 with unilateral IP). Clinical signs, history of upper respiratory infection, post-treatment complications, and IP recurrence with and without local and systemic steroid administration were studied between groups and no differences were identified. In four of six cats with bilateral disease, the second polyp was identified with advanced imaging performed at the time of referral.

CONCLUSIONS AND CLINICAL IMPORTANCE

These findings demonstrate that bilateral IP occur more frequently than reported previously and establish a prevalence for bilateral IP. These findings also highlight the value of advanced imaging techniques in diagnosing bilateral IP.

A laryngeal inflammatory polyp in a miniature dachshund

A 15-year old, female miniature dachshund was presented for a 5-year history of progressive dyspnoea. A laryngeal mass was detected on cervical radiographs. Surgery was performed 5 days later to reduce the volume of the mass and to obtain biopsy samples; the dyspnoea improved. Based on the histopathological findings, the mass was diagnosed as inflammatory polyp. This case of inflammatory polyp in the larynx suggests that it should be listed in the differential diagnoses for laryngeal masses in dogs and that surgical treatment may be curative.

Distinguishing Between Dermatologic Disorders of the Face, Nasal Planum, and Ears: Great Lookalikes in Feline Dermatology

Facial dermatitis in cats can be caused by a broad range of infectious, allergic, immune-mediated and neoplastic disorders with very different treatments and prognoses. Baseline dermatologic diagnostics (skin scrapings for mites, cytology for infection and to characterize inflammatory infiltrate, and dermatophyte culture) are required, as well as possible further diagnostics, including therapeutic trials for parasites and feeding a hypoallergenic diet, bacterial culture, and skin biopsies for histopathology in order to achieve a diagnosis. Clinical presentations of diseases affecting different parts of the feline face are presented and discussed.

Clinical analysis and nonsurgical management of 11 dogs with aural cholesteatoma

BACKGROUND

Aural cholesteatomas, also called tympanokeratomas, are destructive and expansile growths of keratinizing epithelium that develop in the middle ear. They have been reported sporadically in dogs, and surgery is usually the recommended treatment.

OBJECTIVES

To describe the common clinical, radiological and histological findings of cholesteatoma; to report on the outcome of conservative management.

ANIMALS

Eleven dogs (13 ears) with cholesteatomas.

METHODS AND MATERIALS

Medical records were reviewed for dogs diagnosed with cholesteatoma between 2012 and 2018. All dogs had computed tomography (CT) and/or magnetic resonance imaging (MRI) followed by trans-canal endoscopic procedure (TEP) for removal and biopsy of middle ear lesions. Dogs were then treated with in-clinic flushing initially weekly tapered to monthly, as well as at-home ear cleaning and application of topical otic steroid medication, initially daily then tapered to once or twice weekly.

RESULTS

Nine dogs had a history of chronic otitis externa; head tilt or facial paralysis was present in seven and four cases, respectively. Otic examination identified a protruding nodule in seven ears. CT demonstrated soft tissue-like material in 12 bullae and expansion in seven bullae. MRI revealed minimally contrast-enhancing bulla contents in 12 ears. Post-TEP and with maintenance medical treatment, nine ears had no further signs of middle ear disease during a mean follow-up of 27.9 months.

CONCLUSIONS AND CLINICAL IMPORTANCE

The results suggest that otitis externa may not necessarily precede cholesteatoma in all dogs. MRI appears to be more sensitive than CT for identifying cholesteatomas. Conservative treatment of cholesteatomas could be useful before or as an alternative to surgery.