Q: What is the use of bacterial culture and sensitivity before surgery? How do you deal with multiple resistant bacteria during the surgical process to prevent post op infection?
A: Pre op bacteriology is not important. As your question suggests, some of these do have multi resistant infections, particularly Pseudomonas. However clinically significant early post op surgical site infection is rare. I assume because Pseudomonas does not thrive in healthy tissue (the intended result of the surgery). In summary, we do not expect to eliminate these infections pre op, but this does not usually cause a problem.
Q. How to minimise post op pain? Both through surgical technique and use of drugs. Have we got liposomal bupivacaine in the UK yet?
A: We do not have liposomal bupivacaine. However a combination of opiates, non-steroidal anti-inflammatories (NSAID's) and local infusion of bupivacaine appears adequate. I often discharge on the day of surgery and rely on NSAID's thereafter.
Q. From my point of view, for a surgery to be 100% successful we have to think about post-op so, what are the key postoperative care steps and potential complications following TECA surgery, and how can they be effectively managed to ensure optimal recovery?
A: That's a long answer and I think it’s answered well in the webinar and follow up question and answers.
Q. What length of time would you leave between operating on one ear and then performing a TECA on the second ear if they both need doing?
A: Around 6 weeks, certainly until the animal appears to have recovered.
Q. Does this surgery bleed a lot?
A: Bleeding from minor vessels is very common, because of local inflammation. I control this with bipolar electrosurgery. Ten percent of cases have major intra operative haemorrhage from the retroglenoid vein. I discuss this at length during the webinar.
Q. When is the best time to suggest TECA to pet owners?
A: This is very subjective. But once medical care has clearly failed and before further complications (such as para aural abscessation) develop (or the owners funds or patience have run out).
Q. What is the best approach to open the bulla but avoid vascular haemorrhage?
A: Ideally I prefer to use Rongeurs, but occasionally in large dogs the bone of the tympanic ring is too thick and then I use a 2-4 mm osteotome and mallet.
Q. Are you finding it increasingly difficult to perform this surgery with brachycephalic's? It feels like the horizontal canal is increasingly close to the vertical ramus.
A: Brachycephalic's, and I see an increasing number of Frenchies, are significantly more challenging. I recommend that novice surgeons avoid these cases.
Q. Swab for culture and sensitivity testing, should it be pre or post lavaging of the bulla prior to closure?
A: The sensible time to swab the bulla, if you wish, is post lavage. But the benefits of this are unclear: a publication many years ago suggested that this did not affect outcomes.
Q. Do you need TECA Gelpi’s to be able to perform the surgery?
A: You do need Gelpi's with long (deep legs). The ones I use have legs extending about 25 mm deep into the tissue and are suitable for almost all dogs.
