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

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.