Tumors of the ear canal

Clinical presentation and outcome in cats with aural squamous cell carcinoma: a review of 25 cases (2010-2021)

CASE SERIES SUMMARY

Ear canal neoplasia is uncommon in cats. Ceruminous gland adenocarcinoma is the most frequently reported malignant neoplasm of the feline ear canal, and squamous cell carcinoma (SCC) is the most common malignant neoplasm diagnosed in the feline middle ear. However, limited information exists on the outcome of cats diagnosed with SCC of the ear canal, middle or inner ear. Therefore, the objective of this study was to describe the outcome of cats diagnosed with SCC affecting these locations. Medical records were reviewed at multiple institutions to identify cats with a definitive diagnosis of SCC. Twenty-five cats were identified. Eleven cats were treated with surgery, eight with medical management, two with coarse fractionated radiation therapy, two with a combination of coarse fractionated radiation therapy and chemotherapy, one with a combination of surgery and coarse fractionated radiation therapy, one cat with systemic chemotherapy and one cat received no treatment following diagnosis. The median survival time of cats treated with surgery was 168 days vs 85 days (P = 0.28) for those treated palliatively with either medical management, radiation therapy, chemotherapy, or a combination of radiation therapy and chemotherapy.

RELEVANCE AND NOVEL INFORMATION

This case series documented that SCC of the ear canal, middle and/or internal ear is a locally aggressive tumor that carries an overall poor prognosis. The median survival time for cats treated with surgery was longer than that with any other modality, but this difference was not statistically significant.

Partial vertical ear canal resection in two cats

CASE DESCRIPTION

An 18-year-old domestic medium-hair cat (cat 1) and a 16-year-old domestic shorthair cat (cat 2) were evaluated because of obstructive skin lesions involving the perimeter of the left external auditory canal.

CLINICAL FINDINGS

Otitis externa was present in affected ears secondary to obstructive soft tissue growths involving the outer margin of the external auditory canal and outer third of the vertical ear canal. Histologic examination of a preoperative biopsy sample revealed multiple ulcerated ceruminous gland adenomas in the affected ear of cat 1. Histologic examination of the submitted tissue from cat 2 confirmed ceruminous cystomatosis with surface colonization of yeast compatible with Malassezia spp.

TREATMENT AND OUTCOME

Both cats underwent partial resection of the upper third of the affected vertical ear canal and associated diseased skin. The incised margin of the pinna was sutured to the margin of the remaining portion of the vertical ear canal with absorbable sutures. Both cats were disease free over a 12-month (cat 1) or 10-month (cat 2) follow-up period. Cat 1 later developed a small ceruminous gland adenocarcinoma in the adjacent rostrolateral margin of the vertical ear canal 1 year after surgery; the mass was resected, and the patient was free of recurrence 4 months later.

CLINICAL RELEVANCE

Partial resection was an effective alternative to complete vertical ear canal resection for lesions involving the upper third of the vertical ear canal in these cats; the partial resection procedure was deemed simpler to perform and less traumatic to the cat. Functional and cosmetic results were excellent, with preservation of the overall anatomy of the external auditory canal.

Ceruminous gland adenocarcinoma in a domestic Persian-mix cat (Felis catus)

A nine years old Persian-mix female cat has been suffering from recurrent bilateral ceruminous gland adenocarcinoma for many years. Masses were first noticed and resected five years ago, but reoccurred later on two more occasions. The animal has usually experienced distressful ear canal problems in association with these masses. The tumor cellular morphology was reviewed, described and discussed. This article is the first in documenting ceruminous gland adenocarcinoma in a Persian-mix cat in Libya.

Evaluation of the cryosurgery for treatment of squamous cell carcinoma in cats

ABSTRACT The cryosurgery is a very useful therapy for the treatment of a variety of neoplastic and non-neoplastic processes. Nevertheless, it is still poorly described as an option for the treatment of specific cutaneous neoplasms, such as squamous cell carcinoma. The purpose of the present study was to analyze the clinical response of cryosurgery for the treatment of squamous cell carcinoma in cats. For this 13 squamous cell carcinoma lesions were selected in 11 cats, diagnosed through citopathological and/or histopathological examinations. The lesions were frozen using liquid nitrogen spray, and the evaluations were performed in the moment of freeze and approximately every 15 days until the wound was completely healed. The response of cryosurgery was considered complete with tumoral remission on 38.5% of the cats, and partial on 46.1%. The main complications included crusting and nostril stenosis. The presented results suggested that cryosurgery is effective and may be a viable option for the treatment of squamous cell carcinoma in cats. The effectiveness of the therapy; however, depends on the correct selection of the candidates for cryosurgery based on the lesion size, and the attendance to some criteria, such as the freezing time and post-operative care.

Prevalence of select infectious agents in inflammatory aural and nasopharyngeal polyps from client-owned cats

Benign, inflammatory polyps may affect the nasopharynx and auditory canal of cats. It has been proposed that inflammation induced by infectious disease agents could trigger polyp formation. The objective of this pilot study was to determine the prevalence of feline herpesvirus-1 (FHV-1), feline calicivirus (FCV), Mycoplasma species, Bartonella species and Chlamydophila felis nucleic acids in polyp tissues collected from 30 clinically affected cats. Samples collected from the tympanic bulla from 12 clinically normal cats were also assayed. DNA or RNA of some of the target agents were amplified from samples from 25% of normal cats and 33% of affected cats; however, statistical associations were not detected for individual agent results or grouped results. The study documents that common oropharyngeal or blood borne agents can be detected in the tympanic bullae of normal cats. Failure to consistently amplify RNA or DNA of the select agents from polyp tissues suggests the agents studied were not directly associated with the pathogenesis of this syndrome in the cats tested. Alternately, the inflammatory response may have cleared microbial nucleic acids to undetectable levels by the time of sample collection.

Fibroma with osseous metaplasia of external auditory canal in a dog

The present report describes a case of fibroma with osseous metaplasia of the external auditory canal in a 7-year-old male Pomeranian dog. Upon otoscopic examination, the right external auditory canal was almost completely obstructed by a well-circumscribed mass adjacent to the eardrum. The mass was surgically excised. Grossly, it was well demarcated, firm when cut, pink, and measured 0.3 cm x 0.2 cm x 0.7 cm. The cut surface of the mass exhibited a central portion of homogeneously white osseous components surrounded by brown to pink soft tissue. Microscopically, the resected external auditory canal mass mainly consisted of fibroblastic spindle cells showing differentiation to metaplastic osteoblast-like cells. Metaplastic osteoblasts and osteoclasts lining the osteoid bony trabeculae were also observed. Bony trabeculae and spicules were separated by abundant collagen and neoplastic fibroblastic cells. Fibromatous components, irregular formation of woven bone spicules, and the presence of osteoblasts lining bony trabeculae led to a diagnosis of fibroma with osseous metaplasia.

Multiple follicular cysts of the ear canal in a dog

An 11-year-old, 18-kg, neutered male standard schnauzer was presented for evaluation of recurrent otitis externa with para-aural swelling and fistulation of the right external ear canal of 6 months' duration. Otoscopic examination was impossible because of the severe stenosis of the ear canal. Right para-aural ultrasound examination and ultrasound-guided fine-needle aspiration of a mass-like lesion were performed. Cytology was suggestive of a follicular cyst. Magnetic resonance imaging revealed severe ear canal stenosis with a heterogeneous mass in the horizontal portion of the ear canal and associated otitis media. Total ear canal ablation with lateral bulla osteotomy was performed. Histopathological diagnosis was chronic otitis externa associated with multiple follicular cysts confined to the ear canal. Surgical treatment proved curative. This is the first report of multiple follicular cysts originating from the ear canal in a dog.

Middle ear tumours with brainstem extension treated by ventral bulla osteotomy and craniectomy in two cats

Two geriatric domestic shorthaired cats (DSH) were treated surgically with a ventral bulla osteotomy and craniectomy for middle ear tumours that invaded the calvarium. Both cats had a history of vestibular disease. One cat had a normal neurological examination. Both cats underwent computed tomographic imaging of the head. After intravenous injection of an iodinated contrast material, one cat had a ring-enhancing intracranial lesion and the other had a uniform contrast-enhancing intracranial lesion, which either communicated with the bulla or was associated with bulla osseous lysis/production. One cat had a papillary adenoma and the other had an adenocarcinoma. Both cats had prolonged survivals (630 days; alive and lost to follow-up at 840 days), which is longer than reported in cats with middle ear neoplasia. Craniectomy, in addition to ventral bulla osteotomy, may be part of the treatment plan for middle ear tumours that invade the calvarium.

Atypical manifestations of feline inflammatory polyps in three cats

Inflammatory polyps of the feline middle ear and nasopharynx are non-neoplastic masses that are presumed to originate from the epithelial lining of the tympanic bulla or Eustachian tube. The exact origin and cause are unknown, however, it is thought that inflammatory polyps arise as a result of a prolonged inflammatory process. It is unclear whether this inflammation initiates or potentiates the development and growth of inflammatory polyps. Cats with inflammatory polyps typically present with either signs of otitis externa and otitis media or with signs consistent with upper airway obstruction. Traditional diagnostics involve imaging of the tympanic bulla either with skull radiographs or computed topography (CT). Treatment consists of traction and avulsion of the polyp with or without ventral bulla osteotomy (VBO) to remove the epithelial lining of the tympanic bulla. The three cases described here are unusual manifestations or presentations of feline inflammatory polyps that address the following issues: (1) concurrent otic and nasopharyngeal polyps, (2) potential association with chronic viral infection, (3) polyp development in the contralateral middle ear, (4) CT appearance of the skull following VBO, and (5) development of secondary pulmonary hypertension.

Bilateral ear canal neoplasia in three dogs

Bilateral ear canal infections are common in dogs. Ear canal neoplasia is usually associated with unilateral problems, and is uncommon in dogs. To the best of the author's knowledge, bilateral aural neoplasia has not been reported in dogs, and only four case reports were found in the human literature. This report presents three dogs that had bilateral tumours in their ear canals. They were presented with bilateral otitis externa. All three dogs exhibited tissue proliferation of both ear canals that did not respond to glucocorticoids. Treatment consisted of total ear canal ablation, and tissues were submitted for histopathological evaluation. Case # 1 (a 10-year-old, male cocker spaniel) was diagnosed as ceruminious gland carcinoma. Cases # 2 and 3 were diagnosed as squamous cell carcinoma. Case # 1 was diagnosed 4 years earlier as having keratinization disorder, which was causing its chronic ear problems. Case # 2 (a 5-year-old, female French bulldog) was diagnosed 4 years earlier as having atopic dermatitis, which did not respond to hyposensitization, and only partially responded to glucocorticoids therapy. Case # 3 (a 9-year-old, male German shepherd) was diagnosed by the referring veterinarian as having unilateral ear canal proliferation 2 months prior to presentation. However, otoscopic examination showed bilateral proliferation that obstructed both canals. In summary, bilateral ear canal neoplasia should be considered in cases of nonresponsive, proliferative aural pathology.

Otoscopic evaluation of the ear canal

Otoscopic evaluation of the external ear canal and tympanic membrane is the first diagnostic procedure that should be performed in animals presented with otitis externa. It is important to become familiar with the normal structures of the ear to identify any abnormalities. The video otoscope greatly enhances visualization of these structures as well as aiding in retrieval of foreign bodies, biopsy of masses, and performance of a myringotomy. In some cases, a complete otoscopic examination is not possible on the first visit, and the animal may require anti-inflammatory medications or otic flushing to visualize the entire ear canal as well as the tympanic membrane. The purpose of the otoscopic examination is to address the otitis by evaluating the condition of the ear, looking for any masses or foreign bodies; noting the presence, consistency, and color of any exudate; and evaluating the patency of the tympanic membrane. Once a complete otic evaluation has been performed, additional diagnostics as well as a treatment plan can be formulated.

Total ear canal ablation in the cat: indications, morbidity and long-term survival

Fifty-two total ear canal ablation (TECA) procedures in 44 cats were reviewed. The indication for surgery was neoplasia in 41 per cent of the cats, 86 per cent of which had ceruminous gland adenocarcinoma. Chronic inflammatory or polypoid disease accounted for 50 per cent of surgical procedures. Postoperative complications included Horner's syndrome (42 per cent) and facial paralysis (56 per cent) and these were permanent in 14 per cent and 28 per cent of cases, respectively, with the rest resolving in the ensuing weeks or months. The higher incidence of Horner's syndrome and facial paralysis in the cat, compared to the dog, was attributed to greater fragility of the feline tympanic plexus and facial nerve. The median survival time of cats with ceruminous gland adenocarcinoma was 50-3 months, and did not differ significantly from that for inflammatory or polypoid disease. A potential prognostic indicator for this tumour was the mitotic index (MI): cases with MI < or = 2 survived significantly longer than those with MI > or = 3.

Review of diagnostic imaging of ear diseases in the dog and cat

Diagnostic imaging techniques (conventional radiography, computed tomography and magnetic resonance imaging) are an essential tool in the diagnostic work-up of ear diseases. Conventional radiography is commonly used, but often lacks sensitivity. Computed tomography (CT) and magnetic resonance (MR) are complementary imaging studies of the middle ear, labyrinth, internal auditory canal and their contents. CT provides excellent images of bony structures and is indicated where osseous changes are of greatest diagnostic importance. MR is superior in imaging soft tissue components including intralabyrinthine fluid. Therefore, more than one of these imaging techniques may be required in order to make a diagnosis.

Feline inflammatory polyps: historical, clinical, and PCR findings for feline calici virus and feline herpes virus-1 in 28 cases

Inflammatory polyps are associated with significant aural or nasopharyngeal disease in cats. It has been proposed that chronic viral infection may induce the masses. Ventral bulla osteotomy (VBO) is usually recommended for definitive therapy but removal of masses from the nasopharynx or external ear canal by traction/avulsion is also used. A retrospective study of 28 cats with inflammatory polyps was conducted to correlate recurrence with mode of therapy. Tissues from 41 polyps were assayed for feline calicivirus and feline herpesvirus-1 by RT-PCR and PCR, respectively. Of the 14 cats initially treated by traction/avulsion, recurrence was detected in five of nine cats with radiographic evidence of bulla disease but none of the cats with normal bullae. Traction/avulsion is a reasonable treatment for inflammatory polyps if the bullae are radiographically normal. Failure to detect feline calicivirus and feline herpesvirus-1 suggests that tissue persistence of these viruses is not associated with the development of inflammatory polyps.

Nasopharyngeal polyps in cats

Nasopharyngeal polyps are non-neoplastic, inflammatory growths that arise from the middle ear or the eustachian tube and extend into the pharynx. The exact etiology of nasopharyngeal polyps is unclear; proposed etiologies include a response to chronic upper respiratory tract infection, chronic otitis media, ascending infection from the nasopharynx, or a congenital origin. Clinical signs usually relate to obstruction of the nasopharynx, with Horner's syndrome and head tilt being consistent with otitis media and otitis interna, respectively. Diagnostic tools include digital or visual examination above the soft palate, flexible fiberoptic caudal rhinoscopy, radiography, computed tomography, and magnetic resonance imaging. Ventral bulla osteotomy combined with traction removal of the polyp is the recommended treatment, although traction only followed by prednisolone therapy can be considered in some cases, especially when there is no evidence of otitis media.

Comparison of three methods for relief of pain after ear canal ablation in dogs

This study compared three methods of pain relief in dogs that had total ear canal ablation with lateral bulla osteotomy. The hypothesis was that systemic opioids with preoperative local nerve blocks would provide superior pain relief. Thirty-one dogs with chronic otitis externa were included in the study. Dogs were randomly assigned to one of three protocols: systemic opioids alone (10 dogs, group 1), systemic opioids with bupivacaine splash block (11 dogs, group 2), and systemic opioids with preoperative local bupivacaine nerve blocks (10 dogs, group 3). Twenty-one dogs had bilateral ear ablation and 10 had unilateral ablation. Pain was assessed preoperatively, at extubation, 2 hours postextubation, and 1 day postoperatively by a single observer blinded to the analgesic protocol used. Pain scores were not significantly different within or between groups, nor did unilateral versus bilateral ablation have a significant effect on the score. Mean scores were less than 3 (scale 1 to 5) for all groups at all observation times. Rough recoveries were noted in 30% of group 1 dogs, 0% of group 2, and 20% of group 3 dogs. Ninety-four percent of dogs were moderately to heavily sedated at extubation. Sixty percent of group 3 dogs remained moderately to heavily sedated 2 hours postextubation. Rectal temperature, pulse rate, respiratory rate, and postoperative change in serum cortisol levels were not significantly different between groups. Postoperative increase in blood glucose was significantly higher in groups 1 and 3 compared with preoperative levels. Twenty-three percent of the dogs required additional analgesia or tranquilization after surgery, as determined by the anesthetist; 1 dog in group 1, 2 in group 2, and 4 in group 3. Each of the three analgesic protocols provided similar pain relief in dogs undergoing total ear canal ablation.

Feline cutaneous and subcutaneous neoplasms

This article contains practical information about the more common feline skin tumors and an update on recent treatments. The tumor type, gross appearance, clinical behavior, prognosis, and treatment are provided.

Wound healing and brain stem auditory evoked potentials after experimental total ear canal ablation with lateral tympanic bulla osteotomy in dogs

Experimental total ear canal ablation with lateral tympanic bulla osteotomy (TECA-LBO) was performed in 13 normal dogs to evaluate healing and retention of brain stem auditory evoked potentials (BSAEP) after surgery. Healing was evaluated by gross and microscopic examination of the surgery sites after 1 (n = 2), 4 (n = 8), 5 (n = 1), and 6 (n = 1) weeks. One dog was eliminated from the study. Brain stem auditory evoked potentials were measured using an air-conducted sound stimulus before and after surgery and before killing. Two dogs had nearly complete obliteration of the tympanic cavity by immature fibrous connective tissue. Eight dogs responded to surgery by either complete or partial re-formation of the tympanic cavity. Retention of the tympanic membrane in three dogs promoted re-formation of the tympanic cavity and blind epithelialized pockets in the surgery site with accumulation of keratinized debris. Granulation tissue formation and extensive proliferation of new bone on the internal surface of the tympanic bulla was seen in 10 dogs. Proliferative bone completely obliterated the tympanic cavity in two of these dogs. Eleven of 13 dogs had no detectable air-conducted BSAEP after surgery. There was no change in BSAEP measurements before killing compared with postoperative measurements in any dog. Two dogs with retained tympanic membranes had measurable BSAEP after surgery. This study shows that healing after TECA-LBO may be highly variable. Retention of the tympanic membrane and small osteotomies appeared to promote reformation of tympanic cavities and prevent ingrowth of granulation tissue.(ABSTRACT TRUNCATED AT 250 WORDS)

Diseases of the ear canal

Otitis externa can be a complicated and difficult disease to diagnose and treat. Because of the unique physiology of the ear canal and common pathophysiology of otitis externa regardless of the underlying cause, the clinician must rely on history, dermatologic examination, and ancillary tests to determine the cause and appropriate therapy for a particular case.