Management strategies, complication rate and outcome following treatment of para-aural abscessation as a complication of total ear canal ablation and lateral bulla osteotomy surgery.

Abstract

OBJECTIVE: To evaluate management strategies, complication rates and outcomes of para-aural abscessation (PAA) following total ear canal ablation with lateral bulla osteotomy (TECA-LBO) in dogs, focusing on the difference of medical versus surgical treatment and associated neurological outcomes. STUDY DESIGN: Retrospective multicentre case series. POPULATION: Thirty-six dogs presenting with PAA post-TECA-LBO between 2010 and 2022. MATERIALS AND METHODS: Data were collected on signalment, presenting signs, surgical procedure, microbiological findings, management strategies and long-term outcomes. Neurological deficits, both pre- and post-treatment, were documented. Outcomes were classified as excellent, improved or poor based on clinical resolution and complications. RESULTS: PAA occurred at a median of 197.5 days after TECA-LBO (range, 7-1652 days). Brachycephalic breeds were overrepresented (15/36). Medical management resolved PAA in 30% (6/20) of cases compared to 73.3% (22/30 cases) resolution with surgery. Neurological complications following surgical management of PAA were common (13/30 cases), with resolution occurring in only seven cases. Culture results at incident surgery and at the time of PAA matched in only 13 cases and 50% of positive cultures revealed multidrug-resistant bacteria. CONCLUSION: In this case series, surgical management yielded higher resolution rates compared to medical treatment but carried significant risks of permanent neurological deficits. CLINICAL SIGNIFICANCE: Findings emphasise the importance of complete epithelial removal during the original surgery and culture-guided antimicrobial therapy. Surgical treatment of PAA carries a high risk of permanent neurological injury, with facial neuropathy being the most common.