Ocular Examinations are Important in Animals Undergoing Aural Surgeries

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When your pet needs ear surgery, their eyes might be the last thing on your mind. Yet Dr. Bianca Hartrum's pioneering research reveals a critical connection between ear procedures and vision health that veterinary professionals and pet owners can no longer afford to ignore.

Dr. Hartrum's study examines ocular examinations before and after total ear canal ablation and bulla osteotomy (TECALBO) procedures in cats and dogs. The findings are striking: a staggering 90.9% of cats developed Horner's syndrome following surgery—far higher than previously documented rates. Additionally, 20% of patients already had eye disease related to their ear condition before surgery, while another 30% had unrelated ocular issues discovered during comprehensive exams.

The research originated from a troubling case early in Dr. Hartrum's residency—a dog with a severe melting corneal ulcer and facial nerve paralysis following ear surgery. This prompted her deep dive into existing literature, where she found only passing mentions of neuro-ophthalmic complications without detailed analysis. Her study fills this critical knowledge gap with ophthalmologic expertise and data-driven recommendations that are already transforming clinical practice.

The take-home message is clear and actionable: thorough eye examinations should be standard before and after ear surgeries. Dr. Hartrum recommends Schirmer tear tests, fluorescein staining, and post-operative topical lubricants as minimum protective measures. These simple steps can prevent potentially devastating vision complications. These findings can lead to new collaborative care protocols incorporating pre- and post-operative eye exams into surgical costs.

Has your veterinarian discussed potential eye complications before your pet's ear surgery? Share your experience and help spread awareness about this important connection between ear and eye health in our beloved companions.

JAVMA article: https://doi.org/10.2460/javma.24.08.0533

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Episode Transcript

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well-being together with theirpet.

Sarah Wright (00:31):
You're listening to Veterinary Vertex, a podcast
that AVMA journals.
In this episode we chat abouthow ocular examinations before
and after total ear canalablation and bula osteotomy can
help recognize and preventpotential vision-threatening
abnormalities in cats and dogs,with our guest, Bianca Hartrum.

Lisa Fortier (00:51):
Welcome to Veterinary Vertex.
I'm Editor-in-Chief LisaFortier, and I'm joined by
Associate Editor Sarah Wright.
Today, we have Bianca joiningus.
Hey, Bianca, thank you so muchfor being here with us today.

Bianca Hartrum (01:02):
Thanks for having me.
I'm excited to be on here andtalk about the paper.

Sarah Wright (01:07):
All right, let's dive right in.
So, Bianca, your JAVMA articlediscusses how ocular
examinations before and aftertotal ear canal ablation and
volosteotomy can help recognizeand prevent potential
vision-threatening abnormalitiesin cats and dogs.
Please share with our listenersthe background on this article
abnormalities in cats and dogs.

(01:27):
Please share with our listenersthe background on this article.

Bianca Hartrum (01:30):
So this is my residency study that I completed
at my residency at MedVet inOhio State.
In the study we performedocular examination in dogs and
cats before and after total earcanal ablation and
bolo-osteotomy and then alsoafter our VBOs in cats, just to
kind of get a whole compilationof the different ear surgeries.
So the idea for the study wassparked actually from a case

(01:52):
very early in my residency.
We were choosing what do I wantto study?
What do I want to invest allthis time in a residency project
in?
And this dog came in with areally severe melting corneal
ulcer and facial nerve paralysisafter a recent teakaboo.
So we're wondering, you know,how long has this issue been
going on before we saw this dog?

(02:13):
Did the dog have eye diseasebefore it had ear surgery?
And how many cats and dogs dohave eye disease either as a
result of their ear disease orfollowing their ear surgery?
So afterwards I dove into abunch of publications just
trying to figure out is this aviable study?
And from everything I learned,every study mentions

(02:34):
neuro-ophthalmic complications.
There's several that mentioneye complications but really
don't dive into the details andnone of those studies had any
ophthalmologists involved.
So we thought it would be areally great study to look into.
Do these animals have eyeproblems and what can we do to
prevent eye problems that theydid occur?

Sarah Wright (02:55):
Yeah, very useful and very clinically applicable
too.
So, what are some of theimportant take-home messages
from this JAVMA article?

Bianca Hartrum (03:04):
Biggest take-home message it is, I would
say, is that patients shouldhave eye exams.
There were so many patientsthat developed eye complications
and all of our findings weremore than in previous studies, I
think, because we did havepeople paying really close
attention to their eyes.
So patients should have eyeexams before and after ear
surgery because the ocular andneuro-ophthalmic complications

(03:27):
were so high.
At minimum they should haveShermer tear tests to make sure
that they don't have dry eye.
They should have topicallubricants afterwards to protect
their eyes, because manydevelop facial nerve paralysis
and then, no matter what, weshould be fluorescing and saving
these patients.
It doesn't take very long, justto make sure that they don't
have a corneal ulcer, becausethat can lead to blinding

(03:48):
complications in them.

Lisa Fortier (03:51):
Fabulous.
So, you might know, Bianca, I'man equine orthopedic surgeon,
but if I had to do it over again, I would do ophthalmology.
I think it's just, it'sfascinating.
So, I'm living vicariouslythrough you right now.
Okay, what sparked your?

Bianca Hartrum (04:08):
So, I always wanted to be a vet, just like
many of us.
I think most of us kind of sayyou know, we always wanted to be
a veterinarian because we loveanimals.
But really uniquely, it wasgeneral physics class.
I was working as a veterinaryassistant at a general practice
in my college town and was in ageneral physics class just
learning about optics, lenses,how the eye worked, and I
thought it was so fascinating.

(04:30):
So, I worked at a veterinarian,Heather Vanderbrink, and I
mentioned to her hey, it is socool how the eye works and
everything, and she's like youknow, you can be an
ophthalmologist and aveterinarian at the same time.
And that was the first time Ilearned that I could do that and
kind of just.
All the rest is history.

Lisa Fortier (04:49):
That's amazing.
Mentorship is alive and well,and I also.
Physics was probably myfavorite class.
So there you go.
What do an equine surgeon andophthalmologist have in common?
I really like also what yousaid about you know people
mentioned this problem before,but then you did a deep dive
into all the literature thatexisted and then formulated a

(05:11):
question.
I think that's an amazing giftto have.
It's a natural gift to have,especially at a resident stage.
So congratulations.
That'll take you a long waywhen you do studies like this.
Sarah asked you earlier whatwere some of the most important
findings, but there's alwaysthings that surprise us.
What things surprised you bydoing this study?

Bianca Hartrum (05:34):
I think it was the sheer amount of cats
affected, so almost all cats.
It was actually 90.9% developedHorner's syndrome.
So it was such a high numberthat it was very surprising to
us because all the previousliterature said it was only up
to 58%.
So it was just very surprisingthat the complication was so

(05:55):
high.

Sarah Wright (05:58):
Yeah, I think cats often get overlooked sometimes,
especially when we're lookingat both like cats and dogs as
far as companion animals go.
So kudos to you too for lookingat the cats in the study.

Bianca Hartrum (06:07):
It was important to me to do that.
I made sure I did a study whereit included cats.

Sarah Wright (06:12):
So what are next steps for research in this topic
?

Bianca Hartrum (06:16):
So we don't currently have any future
research planned on this topic.
But I think the biggest kind ofthing with this, it has changed
the way that things work in ourhospital and it's improved our
collaborative care at MedVet.
So we created a new standard ofcare that includes pre and
post-op exams included in thesurgical cost for any patient

(06:37):
undergoing ear surgery.
So we have handouts oncollaborative care for our
clients when they first come in.
All the estimates include allthe eye exams they can
communicate with us.
So it really has kind ofchanged the way we approach ear
surgery and we are payingattention early now to eye
problems and we encourage otherMerkle specialty hospitals to do

(06:57):
the same.
It's really been great, youknow.
It's improved everyone workingtogether in the hospital and I
think it's really increased thecare for these patients.

Sarah Wright (07:08):
Great to hear about that collaboration.
It's to see, too, you puttinglike like the findings from your
study into action at yourpractice.

Bianca Hartrum (07:15):
Yeah, it's been great.

Sarah Wright (07:17):
So emerging technology is a very hot topic
right now.
Do you see a role for AI inthis area of research?

Bianca Hartrum (07:24):
I think that's hard to say now.
I think the use of AI is goingto be relevant in a lot of
veterinary fields in the future.
We're already seeing severalstudies for AI in ophthalmology
as a successful tool to increasethe accuracy of diagnosis.
So, a lot of machine learning,showing them photos, saying is
this a problem, is it not aproblem?

(07:45):
So that could be used in thefuture, I believe.
I think it's just we.
It's really dependent on howmuch data we collect and how
good that data is, cause you canonly the models are only as
good as we train them to be.
So, I think it's possible.
It's going to be some time, butI think it could be a good

(08:05):
thing in addition to all theexpertise we have, just to
improve our accuracy.

Sarah Wright (08:12):
I think you could say the same thing for medical
records.
Garbage in, garbage out, right.
That's why it's so important tohave them be accurate and
detailed.

Bianca Hartrum (08:18):
Absolutely so.
That would be important, orelse they're not going to be as
usual as we'd like them to be.

Sarah Wright (08:24):
And for those of you just joining us, we're
discussing how ocularexaminations before and after
total ear canal ablation andbulla osteotomy can help
recognize and prevent potentialvision-threatening abnormalities
in cats and dogs, with ourguest Bianca.

Lisa Fortier (08:39):
Yeah, again, congratulations, Bianca, on
getting all the way across thefinish line of Resident Project.
How has your residency,training or any other previous
work prepared you to write thisarticle?

Bianca Hartrum (08:52):
I've been thinking about this a lot.
It's a hard question so I thinkjust the way the veterinary
field works, you know a lot ofus have all of us have it going
into specialty, having to do arotating internship and really
learning at that stagecollaboration between services,
and a lot of us are fortunate toend up in hospitals where we do
get to see such greatcollaborative care.

(09:13):
So I think my training atVirginia Tech helps me with that
.
I did several specialtyinternships after that, before a
residency, and I think thatreally helped.
You know, being in differentplaces and being in different
hospitals and seeing how theycollaborated, and I think a lot
of those places really did showthat it is possible.

(09:34):
You know ophthalmology works somuch with surgery, with
dermatology, with anesthesia, soI feel like that did really
help me in preparation for thisarticle.
And I completed my residency atOhio State and MedVet and both
those places had really greatcollaborative care and I got
kind of a combination ofacademic and private practice

(09:54):
and that that and it reallyhelped me with this article.
Yeah.

Lisa Fortier (10:01):
Very good.
Do you know about our residentawards?

Bianca Hartrum (10:04):
I do.

Lisa Fortier (10:05):
All right, I've heard of it, so yeah, you can
self-nominate.
It's a rolling nomination onthe JAVMA and AJVR website, so
we hope to see your articlethere.

Sarah Wright (10:16):
Yeah, and to our listeners too, don't forget if
you have a student, resident orintern author.
It is rolling, but we'relooking right now for articles
published in 2024.
And we'll be looking to haveall of those captured by March,
so be sure to get yournominations in if you're tuning
in.
So, Bianca, this next set ofquestions is going to be really
important for our listeners, andthe first one is going to be

(10:36):
dealing with the veterinarian'sperspective.
So what is one piece ofinformation the veterinarian
should know about?
Ocular examinations before andafter a cheek of bow and VBOs in
cats and dogs?

Bianca Hartrum (10:49):
before and after chikabo, and vbos and cats and
dogs.
So if I had to narrow it downto one piece of advice, it would
be do eye exams.
So many people overlook theeyes.
We learned so much from thisarticle that there were a lot of
patients with eye disease 20%beforehand had ear disease
related to or eye diseaserelated to their ear disease,
and then 30% had unrelated eyedisease.

(11:11):
So I think the biggest thing isjust do eye exams.
A lot of times you can findstuff either related to the
condition you're looking at forthe animal or even unrelated.

Sarah Wright (11:21):
So then, on the other side of the relationship,
what's one thing that clientsshould know about ocular
examinations before and afterear surgeries?

Bianca Hartrum (11:29):
I think it's that eye disease isn't uncommon
in these pets and it's importantthat they're aware of that,
because clients are less upsetabout a complication if they're
warned out of time.
They know what to watch out for.
They know it can happen, so ifit does, they're prepared for
that.

Lisa Fortier (11:49):
And it's not a shock to them.
Well, thank you again for beingwith us, Bianca.
This is really transformativeinformation for veterinarians
and for clients, and that's ahuge accomplishment, so
congratulations.
As we close down, we love toask a fun question, and for you,
what is your favorite animalfact?

Bianca Hartrum (12:12):
My favorite animal fact of course it has to
advise.
So, cats can only blink one, orcats only blink one to five
times per minute, so you'reprobably always going to lose a
staring contest if you try topick one with them okay, I
definitely have tried thatbefore.

Sarah Wright (12:23):
I have two cats that will start now.
Look how, oh, that's crazy.
Thank you, it makes sense, I'mdefinitely going to go Okay?

Lisa Fortier (12:33):
A naive question Is that with our third eyelid,
or like a true blink, true blink?

Sarah Wright (12:38):
Okay, the default question, though.
Well, thank you so much forbeing here, Bianca, and for
sharing your knowledge ofophthalmology with us, and our
listeners too.

Bianca Hartrum (12:48):
Thank you, thanks for having me.

Sarah Wright (12:50):
And to our listeners.
You can read Bianca's articleon JAVMA.
I'm Sarah Wright with LisaFortier.
Be on the lookout for nextweek's episode and don't forget
to leave us a rating and reviewon Apple Podcasts or whatever
platform you listen to.