Total Ear Canal Ablation and Bulla Osteotomy (TECA-BO)

What is a total ear canal ablation and bulla osteotomy?

A total ear canal ablation and bulla osteotomy, also known as a TECA-BO, is a surgery that completely removes the ear canal and tympanic bulla (middle ear), leaving only the pinna (ear flap). Typically, a specialist performs this surgery, although some general practice veterinarians may also perform it.

Why would my veterinarian recommend a TECA-BO?

Your veterinarian may recommend a TECA-BO if your dog or cat has chronic, end-stage otitis (ear infection) and medical treatment is no longer effective. The surgery removes infected, abnormal ear tissue, reducing chronic pain and inflammation and improving your pet's quality of life. Situations may include:

• When a bacterial infection is resistant to antibiotic treatment and surgically removing the infected tissue is the most effective way to control the infection. 
• When longstanding infection and inflammation cause extensive scarring and mineralization, eventually narrowing the ear canal and making it impossible to remove accumulated debris. 
• When there are neoplastic (cancerous) growths in the ear canal. If a growth is confined to the ear canal, a TECA-BO allows it to be completely removed.

What does a TECA-BO surgery involve?

A TECA-BO requires careful planning and specialized surgical techniques.

Pre-operative assessment 

Your pet will have a pre-operative assessment to help the surgical team plan the procedure.

• Physical exam: Your veterinarian will perform a physical exam to assess the extent of your pet’s ear abnormalities and evaluate the function of the nerves that run alongside the ear canal. 
• Blood tests. Your pet will have pre-anesthetic blood tests to evaluate internal organ function before anesthesia.
• Imaging. Radiographs (X-rays) can be used to view the skull and tympanic bulla. Advanced imaging, such as a CT or MRI, can provide more detailed images of the ears.

Surgery

During surgery, your pet will be placed under general anesthesia. The surgeon will create a skin incision around the ear and carefully cut through the underlying tissues so the ear canal can be removed as a single intact cylinder. The eardrum and middle ear bones will also be removed, exposing the tympanic bulla. 

Infected material will be removed from the tympanic bulla and submitted to a laboratory for bacterial culture. This culture identifies the bacteria causing the infection and helps determine which antibiotics are most likely to be effective. The surgeon will then scrape the tympanic bulla clean and close the incision. An external drain may be left in place so any remaining fluid or material can leave the surgical site.

What post-operative care is required?

After surgery, your pet may be sent home with a drain still in place. There may also be bandages covering the surgical site. Your veterinarian will provide instructions for caring for and removing these drains and bandages.

Your pet will also go home with pain medication and antibiotics. Antibiotics are typically continued for two to four weeks after surgery, depending on your pet’s overall health and the severity of the ear disease.

As the incision heals, your pet will need to wear an Elizabethan collar (E-collar or cone) to prevent scratching, which could damage the incision and interfere with healing.

Are there complications associated with TECA-BO surgery?

The primary risks of TECA-BO surgery involve the blood vessels and nerves that run near the ear canal. Damage to the blood supply in this area may cause partial loss of blood flow to the pinna. If this occurs, tissue along the edge of the ear flap may begin to die, and a second surgery may be needed to remove the affected tissue and prevent infection. 

Damage to the facial nerve may result in paralysis on the affected side of the face. In most cases, this paralysis is temporary and resolves without treatment. However, it can be permanent in some cases.

Many pet owners expect their pet’s hearing to be reduced after surgery because the eardrum is removed. While this can occur, it is not always the case. By the time a TECA-BO is recommended, the ear canal is often so severely diseased that owners notice little change in their pet’s hearing after surgery.

Approximately 5% to 10% of patients experience chronic drainage from the incision, which may indicate that some infection remains. This drainage may occur months to years after surgery. Although it often improves temporarily with antibiotics, a second surgery may be needed to completely resolve the infection. Overall, the prognosis for pets receiving a TECA-BO is very good. The surgery relieves a source of chronic pain and inflammation, while also eliminating the odor and ongoing ear cleaning or medication often associated with chronic ear infections.