Anesthetized Ear Flushing

 

The Importance of Cleaning

Cleaning the external ear canal is absolutely imperative for two reasons.  First, topical medications need to come into contact with the skin of the ear canal.  If the skin is covered by inflammatory byproducts, wax, or old dried medications, this necessary contact can not happen.  Second, it is essential to evaluate the ear drum in order to successfully treat the disease.  The ear drum is the only thing separating the external ear from the middle ear, and if it is not intact there will be middle ear disease as well.  Because treating the middle ear involves different methods, we must know if middle ear disease is present.  In addition, most medications we put into the external ear canal are not safe to use in the middle ear, therefore cannot be used if the integrity of the ear drum is unknown.  But, if we are assured of an intact structure, we are able to use whichever drug best fits the external ear disease.  In severe cases of ear disease, or those in which home cleaning isn’t adequate, it is necessary to do a deep ear flushing.  In these situations the only way to clean the ear is to physically remove debris.  Because of the length of the procedure and the sensitivity of the patient, anesthesia is absolutely necessary.

The Steps of the Procedure

1.      Anesthesia

Your pet will be dropped off the morning of the procedure, or may stay the night before at no charge if it is more convenient for you.  The check-in process involves reviewing the estimate and deciding on pre-anesthetic bloodwork and intravenous fluids during anesthesia.  In some cases one or both of these precautions may be required, but for young animals with shorter procedures, they are often options.  If you have ANY questions about the value of either of these procedures, please ask.

2.      Flushing

We use a video otoscope to visualize the procedure and maximize safety and efficacy.  The ear canals are flushed and suctioned.  In many cases manual removal with a curette is necessary.  This process is performed until the ear canals are completely cleaned out and may take 30-90 minutes.

3.      Radiographs

If there is concern about the presence of middle ear disease, radiographs (x-rays) will be taken of one or both bullae (middle ears).  In addition to the doctor examining the films, they will also be sent to a radiologist for interpretation.

4.      Myringotomy

A myringotomy is performed if there is confirmed or suspected middle ear disease with an intact ear drum.  The procedure involves intentional puncture through the ear drum in order to sample contents of the middle ear and to flush the middle ear out.  Because this is the only way to clean the middle ear (short of surgery), this procedure needs to be done more than once.

5.      Sample Collection

Samples for cytology, cultures and sensitivities will likely be taken from deep within the ear canal and the middle ear, if indicated.  Because many ear pathogens are becoming resistant to various antibiotics, it is essential to know the sensitivity patterns of the bacteria involved.  If there is a growth or suspicious tissue found, a biopsy may also be performed.

6.      Treatment

After the flushing, cleaning and sampling has been accomplished, medicine will be instilled deep within the ear.  This is especially important with middle ear disease because medicine administered in the awake animal will not get into the middle ear.  This is another reason that the treatment of middle ear disease requires multiple anesthetic procedures.

Frequency of the Procedure

In cases where there is only external ear disease and the patient allows treating at home, the initial flushing procedure may be all that is necessary.  However, most cases that require this anesthetized procedure have changes associated with chronic or long-term disease and often require multiple treatments.  These visits are done weekly (in some cases there can be two weeks in between) and most patients require 2 to 4 treatments.  Patients with middle ear disease will require more than one treatment, the average number of weekly visits being between 3 and 5.  While your doctor will do her best to prepare you for how many treatments are likely to be necessary, unfortunately it is impossible to predict.

Cost

Because of the anesthesia, equipment involved, time of procedure, the necessity of assistants and cost of outside laboratories, these procedures can be hard on the wallet.  The first flushing usually takes the longest, and is usually when radiographs and samples are taken.  For a large dog with bilateral (both side) disease, this first treatment may reach $1000.  Subsequent treatments generally take less time and only involve cleaning and medicating, so usually range $200-600.  While we do not finance payment plans ourselves, there are a few options that may be of benefit, and we are happy to go over them with you.