Carbon Dioxide Laser Surgery for Otitis Externa in Dogs

In the Literature

Aslan J, Shipstone MA, Mackie JT. Carbon dioxide laser surgery for chronic proliferative and obstructive otitis externa in 26 dogs. Vet Dermatol. 2021;32(3):262-e72.

The Research …

Dogs with chronic otitis externa can develop several pathologic changes to the ear canal that cause inflammation and infection. Severe hyperplastic changes that affect the dermis and epidermis around the opening of the external ear canal can also develop, despite an essentially normal horizontal and proximal vertical canal. Historically, these patients have been referred for total ear canal ablation and bulla osteotomy (TECABO), as medical management alone may be unable to resolve the hyperplastic changes and prevent otitis. 

This study evaluated use of a carbon dioxide laser to ablate hyperplastic tissue; 42 ears from 26 dogs were included. During the laser procedure, a carbon dioxide surgical laser was used to dissect, ablate, and sculpt the hyperplastic tissue. The procedure was finished when each ear had near-normal anatomy. Postoperative care included oral cyclosporine, topical silver sulfadiazine, and oral analgesics (eg, tramadol, meloxicam) as needed. Surgical sites were generally healed 3 weeks postoperatively. 

A good to excellent response was seen in 24 dogs, and 33 ears had an excellent response after a single laser treatment. Repeat laser treatment was needed in 3 dogs. Overall, 4 dogs also underwent TECABO. Of these, 2 dogs were initially thought to have an excellent response, but recurrent otitis externa occurred despite no recurrence of the hyperplastic tissue. 

Dogs with a good to excellent response were maintained on a steroid-containing topical product (eg, hydrocortisone aceponate or dexamethasone-fortified ear cleaner).

The Takeaways …

Key pearls to put into practice:

• Chronic otitis externa can be difficult to manage because ongoing treatment is usually needed to prevent infection. Topical steroids may be needed to prevent recurrence of otitis, even after laser ablation of hyperplastic tissue. This is a cornerstone of treatment for recurrent otitis externa and should always be considered for these patients.

• Carbon dioxide laser ablation is valuable in dogs with hyperplasia of the tissue surrounding the ear canal opening. Chronic pathologic changes typically require TECABO. A less-invasive option (eg, carbon dioxide laser ablation) may be appealing to clinicians and owners of dogs with chronic otitis.

• Carbon dioxide laser ablation would not be useful in dogs with hyperplastic tissue of the vertical and horizontal canals, as laser ablation is more challenging in these regions. The procedure described here is most useful in dogs with normal horizontal and vertical canals.