经内窥镜鼓室牵引治疗猫耳部炎性息肉:37只猫的病例回顾 ...

王帆

Per-endoscopic trans-tympanic traction for the management of feline aural inflammatory polyps: a case review of 37 cats

经内窥镜鼓室牵引治疗猫耳部炎性息肉:37只猫的病例回顾

作者：Valentina Greci1, Erika Vernia2 and Carlo M Mortellaro

翻译：王帆

Abstract

摘要 

Feline aural inflammatory polyps are benign growths originating from the tympanic cavity or the Eustachian tube. They usually occur in young cats, which present either signs of otitis externa and otitis media, or respiratory signs, depending on the direction of polyp growth. Neurological signs are also reported. Simple traction and ventral bulla osteotomy (VBO) are the most common techniques used for treating this condition in cats; corticosteroids are recommended to reduce risk of recurrence given the inflammatory nature of the disease. The most common complications after treatment are Horner’s syndrome, polyp recurrence and facial nerve paralysis. The aim of this report is to describe the per-endoscopic trans-tympanic traction (PTT) technique for treating feline aural inflammatory polyps and to report the short- and long-term follow-up of this procedure. PTT allowed resolution of the aural inflammatory polyps in 94% of cats during a mean long-term outcome of 19 months. Three cats (8%) developed Horner’s syndrome immediately after the PTT procedure, which resolved within a few weeks, and five cats had polyp recurrence (13.5%). Only two cats had a poor outcome and were diagnosed with chronic otitis media at 22 months, and chronic otitis media and polyp recurrence at 46 months after the PTT procedure, respectively. PTT was shown to be an effective technique for treating aural inflammatory polyps and registered fewer neurological complications (8%) than VBO (57–81%) or simple traction (43%), and a recurrence percentage (13.5%) similar to VBO (0–33%) and much lower than traction alone (57%).

猫耳部炎性息肉是起源于鼓室或咽鼓管的良性增生。它们通常发生在年轻猫上，表现为外耳炎和中耳炎症状，或呼吸道症状，取决于息肉的生长方向。神经症状也有报道。简单牵引和腹侧鼓泡截骨术(VBO)是治疗猫的这种情况最常用的技术;考虑到疾病的炎性，建议使用皮质类固醇以降低复发风险。治疗后最常见的并发症是霍纳氏综合征、息肉复发和面神经麻痹。本报告的目的是描述经内窥镜鼓室牵引(PTT)技术治疗猫耳部炎性息肉，并报告该方法的短期和长期随访。在平均19个月的长期结果中，PTT使94%的猫的耳炎性息肉得到解决。3只猫(8%)在PTT手术后立即出现霍纳氏综合征，并在几周内痊愈，5只猫息肉复发(13.5%)。只有两只猫结果不好，在PTT手术后的22个月被诊断为慢性中耳炎，在46个月被诊断为慢性中耳炎和息肉复发。PTT是治疗耳部炎性息肉的有效方法，其神经系统并发症(8%)低于VBO(57-81%)或单纯牵引(43%)，复发率(13.5%)与VBO(0-33%)相似，远低于单纯牵引(57%)。

 

 

Introduction

介绍

Feline aural inflammatory polyps are the most common non-neoplastic pedunculated lesions that arise from the mucosa of either the tympanic cavity (aural inflammatory polyps) or the auditory tube (middle ear polyps). Polyps arising from the auditory tube can grow in both directions (middle ear and nasopharyngeal polyps). Feline inflammatory polyps usually occur in young cats, and they can cause either upper respiratory or aural clinical signs that do not resolve with a conservative medical regimen.

猫耳炎性息肉是最常见的非肿瘤性带蒂病变，起源于鼓室(耳炎性息肉)或耳道粘膜(中耳息肉)。从耳道产生的息肉可以向两个方向生长(中耳息肉和鼻咽息肉)。猫炎性息肉通常发生在年轻猫上，它们可以引起上呼吸道或耳部临床症状，使用保守的医疗方案无法解决。

 

Clinical signs observed in cats with inflammatory polyps are usually gradual in onset and chronic in nature, and depend on the definitive site of the polyp growth. Aural inflammatory polyps results in chronic otitis externa, with head-shaking and otorrhoea. Horner’s syndrome, head tilt, ataxia and facial paralysis may also be observed with middle and inner ear involvement. The most common clinical signs in cats with nasopharyngeal polyps are nasal discharge, stertorous breathing and sneezing.Dysphagia, megaesophagus, regurgitation, pulmonary hypertension and severe dyspnoea have been rarely reported.

在猫上观察到的炎性息肉的临床症状通常是渐进的和慢性的，并取决于息肉生长的确定位置。耳部炎性息肉可导致慢性外耳炎，并伴有甩头和耳分泌物。中耳和内耳患病也可见霍纳氏综合征、头倾斜、共济失调和面瘫。猫鼻咽息肉最常见的临床症状是流鼻涕、呼吸急促和打喷嚏。吞咽困难、巨食道、反流、肺动脉高压和严重呼吸困难罕有报道。

 

Both conventional and video-otoscopy can show a smooth pink-coloured mass arising in the ear canal or protruding from the middle ear cavity and occupying the ear canal, while rhinopharyngeal polyps can be confirmed on digital palpation, rostral traction of the soft palate or retrograde rhinoscopy, and they appear as smooth, pale pink, roundish lesions partially or totally occluding the rhinopharynx.

传统耳镜和视频耳镜均可发现一粉红色的光滑肿物，在耳道内隆起或从中耳腔突出并占据耳道，而鼻咽息肉可通过触诊、软腭吻侧牵引或逆行鼻镜检查确诊，表现为光滑、淡粉色、圆形病变，部分或全部阻塞鼻咽。

 

The aetiology of feline inflammatory polyps is unknown. It is unclear whether polyps are congenital in origin or a response to an inflammatory process from chronic viral infections, or a consequence of chronic upper respiratory or middle ear inflammation.

猫炎性息肉的病因尚不清楚。目前还不清楚息肉是先天的，还是慢性病毒感染引起的炎症反应，或者是慢性上呼吸道或中耳炎的结果。

 

Histopathologically, feline inflammatory polyps consist of well-vascularised fibrous connective tissue covered by stratified squamous or columnar epithelium; inflammatory cells, primarily lymphocytes, plasma cells and macrophages are present within the stroma and are especially dense in the submucosal areas of the tissue.

组织病理学上，猫炎性息肉由血管化良好的纤维结缔组织组成，覆盖层状鳞状上皮或柱状上皮;基质中有炎症细胞，主要是淋巴细胞、浆细胞和巨噬细胞，在组织的粘膜下区域尤其密集。

 

Methods used to remove aural inflammatory polyps are simple traction, ventral bulla osteotomy (VBO), traction after vertical ear canal incision and laser ablation. Total ear canal ablation with or without lateral bulla osteotomy has also been reported for aural polyp removal.

摘除耳炎性息肉的方法有单纯牵引、腹侧鼓泡截骨术(VBO)、耳道垂直切开牵引及激光消融。耳部息肉切除也报道过使用全耳道消融术加或不加外侧鼓泡截骨术治疗。

 

VBO has been suggested as the treatment of choice when involvement of the tympanic cavity is observed.

当观察到鼓室腔患病时，建议选择使用VBO治疗。

 

Regardless of the removal technique, postoperative complications such as Horner’s syndrome, vestibular syndrome, facial nerve paralysis, chronic otitis media and interna can occur; these complications can be temporary or permanent.

无论采用何种清除技术，术后均可出现霍纳氏综合征、前庭综合征、面神经麻痹、慢性中耳炎和内耳炎等并发症;这些并发症可以是暂时的，也可以是永久性的。

 

Use of corticosteroids after removal seems to reduce the risk of recurrence given the inflammatory origin of the feline inflammatory polyps.

考虑到猫炎性息肉的炎症起源，息肉去除后使用皮质类固醇似乎可以降低复发的风险。

 

The aim of this work was to evaluate the feasibility and the efficacy, and to report the short- and long-term outcome, of a minimally invasive technique for treating feline aural polyps called per-endoscopic trans-tympanic traction (PTT).

这项研究的目的是评估一种治疗猫耳部息肉的微创技术的可行性和有效性，并报告其短期和长期的结果。该技术被称为经内镜鼓室牵引(PTT)。

 

Materials and methods

材料和方法

Medical records of cats referred and diagnosed with aural polyps, presented between March 1999 and July 2010 at the School of Veterinary Medicine, University of Milan, Italy, were reviewed.

本文回顾了意大利米兰大学兽医学院1999年3月至2010年7月间收治并诊断为耳部息肉的猫的医疗记录。

 

Inclusion criteria were a complete medical record, including signalment, history and clinical signs, radiological findings, video-otoscopy, histological examination and a minimum follow-up of 6 months' duration. Thirty-seven cases fulfilled the inclusion criteria.

纳入标准为完整的医疗记录，包括特征、病史和临床症状、影像学检查结果、视频耳镜检查、组织学检查和至少6个月的随访。37例符合纳入标准。

 

Radiological scoring was established as follows: ‘normal’ when no changes were detected; ‘mild’ when an increased radiopacity in the horizontal canal and/or within the bulla was noted; ‘moderate’ when an increased radiopacity in the horizontal canal and/or within the bulla and/or thickening of the septum and/ or changes in the tympanic bulla contour (enlargement, thickening or irregularity) were noted; ‘severe’ when increased radiopacity in the horizontal canal and/or within the bulla, changes in the bulla contour and/or thickening of septum and/or alterations of the petrous bone were noted.

影像学评分如下:“正常”为未检测到变化;“轻度”是指水平耳道和/或鼓泡内的密度不透明增加;“中度”是指水平耳道和/或鼓泡内的密度增加和/或中隔增厚和/或鼓室大泡轮廓改变(增大、增厚或不规则);“严重”是指水平耳道和/或鼓泡内的密度增加，鼓泡轮廓改变和/或中隔增厚和/或颞骨岩改变。

 

The cases that presented with concurrent nasopharyngeal polyps were treated using the trans-oral tractionavulsion technique.

同时出现鼻咽息肉的病例均采用经口牵引撕脱术治疗。

 

PTT technique description

PTT技术描述

After cleaning and flushing the ear canal with a 0.9% saline solution and/or ceruminolytic agent (squalene), the cat was positioned in lateral recumbency with the affected side upper most.

用0.9%生理盐水溶液和/或耵聍溶解剂(角鲨烯)清洗和冲洗耳道后，猫置于侧卧位，患侧朝上。

 

Under endoscopic vision, the polyp was grasped with a curved mosquito forceps, then a traction–torsion manoeuvre was applied; when rupture of the polyp occurred the residual portion of the polyp was completely removed under endoscopic visualisation with the use of small biopsy forceps or Volkmann curettes. The dorsolateral compartment of the middle ear was curetted by means of an ear knife, an ear loop and small pinch biopsy forceps under direct visualisation. When necessary, the septum of the tympanic cavity was disrupted for better cleaning of the ventromedial compartment of the bulla. Local irrigations with refrigerated 0.9% saline solution were used to reduce and control the bleeding. All the procedures were carried out by CM.

在内窥镜下，用弯曲的蚊式钳抓住息肉，然后进行牵引-扭转操作;当息肉断裂时，在内镜下使用小活检钳或Volkmann刮胡器将息肉残留部分完全清除。在视频观察下，用耳刀、耳环和小捏活检钳刮中耳背外侧腔。必要时，破坏鼓室中隔，以便更好地清洁鼓泡腹侧腔。局部用0.9%冷冻盐水冲洗以减少和控制出血。所有程序均由CM进行。

 

All cats received methadone hydrochloride (Metadone Cloridrato; Molteni), 0.5–1.0 mg/kg intramuscularly before the procedure, but post-procedure pain medication was not necessary in any case. In all cases, the samples collected were submitted in buffered formalin 10% for histopathological evaluation.

所有猫均使用盐酸美沙酮，术前肌肉注射0.5-1.0 mg/kg，术后不需止痛药物。在所有病例中，收集的样本都用10%的缓冲福尔马林进行组织病理学评估。

 

Short-term outcome was assessed on clinical reexamination, conventional otoscopy or video-otoscopy between 1 and 2 months after the PTT procedure at the teaching hospital.

在教学医院进行PTT手术后1 - 2个月，通过临床复查、常规耳镜检查或视频耳镜检查评估短期结果。

 

Long-term outcome was assessed on clinical reexaminations, conventional otoscopy or video-otoscopy at the teaching hospital or at the referring veterinarian surgery and via telephone interviews.

通过临床复查、教学医院或转诊兽医外科的传统耳镜或视频耳镜以及电话采访评估长期结果。

 

The short- and long-term outcome was classified as follows: ‘excellent’ when normal clinical and otoscopic evaluation was obtained, ‘good’ when clinical and otoscopic signs of otitis externa and persistence of neurological signs detected at initial presentation were noted, and ‘poor’ when clinical and otoscopic signs of ongoing otitis media or recurrent polyp and persistence of neurological signs detected at initial presentation were observed.

短期和长期结果分为以下几类:“极好”当临床和耳镜评估正常时，“良好”当临床和耳镜症状发现外耳炎和神经症状持续存在时，“不佳”当临床和耳镜症状发现持续的中耳炎或复发性息肉和神经性症状持续存在时。

 

On telephone interviews, the persistence of neurological signs was not considered by the owners to be affecting the quality of life of their animals, but for us were considered to be affecting the clinical outcome.

在电话采访中，主人并不认为持续的神经症状会影响他们的动物的生活质量，但我们认为会影响临床结果。

 

The presence of an intact, but opaque, ear drum after PTT was considered to be a normal finding at re-examination because it is part of the healing process after rupture. The presence of stenotic ear canal was not considered a PTT sequela when already detectable during the initial video-otoscopy.

PTT后出现完整但不透明的鼓膜在复查时被认为是正常发现，因为它是破裂后愈合过程的一部分。当在最初的视频耳镜检查中发现耳道狭窄时，不认为是PTT后遗症。

 

Results

结果

Signalment and clinical signs

特征和临床症状

The study group was composed of 37 cats. The cats were aged between 5 and 192 months, with a mean age of 47.5 months. There were 17 males (10 intact and seven neutered) and 20 females (17 of which were spayed). Thirtyone cats were domestic shorthairs; the other cats belonged to different breeds (two Persian cats, one Devon Rex, one Norwegian, one Siamese and one Maine Coon).

研究小组由37只猫组成。这些猫的年龄在5到192个月之间，平均年龄为47.5个月。雄性17只(10只未去势，7只已去势)，雌性20只(17只已绝育)。31只猫是家养短毛猫;其他的猫属于不同的品种(两只波斯猫，一只德文卷毛猫，一只挪威猫，一只暹罗猫和一只缅因猫)。

 

The duration of clinical signs varied from 1 to 48 months, with a mean duration of 8.04 months. Prior to presentation, all cats had received different treatment, predominantly topical therapy, without success.

临床症状持续时间1 ~ 48个月，平均8.04个月。在此之前，所有的猫都接受了不同的治疗，主要是外部治疗，没有成功。

 

At admission, all but three cats had clinical signs of otitis externa, including otic discharge (purulent: 25 cats; ceruminous: seven cats; mixed: two cats), head-shaking (nine cats) and ear-scratching (six cats). During physical examination, standard otoscopy allowed visualisation of the mass in the horizontal portion of the ear canal in 13 cats. In four cats, the polyp was visible without the aid of the scope.

入院时，除3只猫外，其余猫均有外耳炎的临床症状，包括耳分泌物(化脓性:25只猫;耵聍性:7只猫;混合性状:2只猫)，甩头(9只猫)和抓耳(6只猫)。在体格检查中，标准耳镜检查可以看到13只猫水平耳道的肿块。在4只猫上，息肉在不用耳镜的情况下可见。

 

Neurological signs were identified in 11 cats. Head tilt was present in eight cats, ataxia in seven cats, Horner’s syndrome in four cats and facial nerve paralysis in three cats. One cat only had neurological signs at presentation, which consisted of left head tilt, Horner’s syndrome and ataxia. Another cat was reported to have had previous signs of vestibular syndrome, but these were not detectable at admission.

确定了11只猫的神经症状。8只猫出现头倾斜，7只猫出现共济失调，4只猫出现霍纳综合征，3只猫出现面神经麻痹。其中一只猫在表现时只有神经系统症状，包括左侧头倾斜、霍纳氏综合征和共济失调。据报道，另一只猫曾有前庭综合征的症状，但这些在入院时无法检测到。

 

Signs of obstructive upper airway disease were recorded in 10 cats, but only six cats were diagnosed with a concurrent nasopharyngeal polyp and one cat with concurrent idiopathic lymphoplasmacytic rhinitis based on histopathological examination of nasal biopsies. Eight cats presented nasal discharge (seven purulent, one serous), six cats stertorous breathing and three cats sneezing. In two cats a mass displacing the soft palate was detected on digital palpation. Two cats with aural and nasopharyngeal polyps had only upper respiratory signs at presentation.

10只猫记录了阻塞性上呼吸道疾病的症状，但根据鼻活检的组织病理学检查，只有6只猫被诊断为并发鼻咽息肉，1只猫被诊断为并发特发性淋巴浆细胞性鼻炎。8只猫出现鼻腔分泌物(7只脓性，1只浆液性)，6只猫呼吸急促，3只猫打喷嚏。在两只猫中，用手指触诊检测到软腭移位的肿块。两只猫的耳部和鼻咽息肉只有上呼吸道症状。

 

Dysphagia was present in four cats, and regurgitation and lingual dysfunction in one cat.

四只猫有吞咽困难，一只猫有反流和舌功能障碍。

 

Imaging findings

影像结果

Radiological changes of the bullae were present in 36 cats and absent in one. Three cats had bilateral involvement of the tympanic bullae; two cats were diagnosed with bilateral aural polyps and one cat with an aural polyp and contralateral otitis media.

36只猫有鼓泡的影像学改变，1只猫没有。3只猫双耳鼓泡患病;两只猫被诊断为双侧耳息肉，一只猫被诊断为耳息肉和对侧中耳炎。

 

Main radiological findings were cloudiness in the middle ear cavity (34), increase radiopacity of the horizontal ear canal (25), thickening of the tympanic wall (25), alterations of the petrous bone (12), enlargement of the bulla (11), thickening of the septum (seven), irregularity of the bulla wall (four) and thickening of the ear canal (two). According to the radiographic scoring, two cats were graded as ‘normal’, seven as ‘mild’, 16 as ‘moderate’ and 12 as ‘severe’ (Figure 1). All six cats with nasopharyngeal polyps showed increased radiopacity of the rhinopharynx.

主要影像学表现为中耳腔混浊(34)、水平耳道影像密度增加(25)、鼓室壁增厚(25)、颞骨岩改变(12)、鼓泡增大(11)、中隔增厚(7)、鼓泡壁不规则(4)、耳道增厚(2)。根据影像学评分，两只猫被评为“正常”，7只猫被评为“轻度”，16只猫被评为“中度”，12只猫被评为“严重”(图1)。所有6只患有鼻咽息肉的猫的鼻咽影像密度均增加。

 

 

Figure 1 Radiological scoring of feline aural inflammatory polyps (10° rostrocaudal ventrodorsal view of the tympanic cavity). (a) Note the increased radiopacity of the left ear canal (white arrow) and middle ear cavity (thick black arrow) (case classified as ‘mild’); (b) Note the increased radiopacity of the left ear canal (white arrow) and middle ear cavity (thick black arrow), and the thickening of the bulla contour (thin black arrow) (case classified as ‘moderate’); (c) Note the increased radiopacity of the right ear canal (white arrow) and middle ear cavity, the severe bulla enlargement, the thickening of the septum (thin black arrow), and remodelling and the petrous bone involvement (short black arrow) (case classified as ‘severe’). The contralateral ear in every image is normal (courtesy of M Di Giancamillo)

图1猫耳炎性息肉的影像学评分(鼓室10°头尾腹背侧影像)。(a)注意到左耳道(白色箭头)和中耳腔(黑色粗箭头)影像密度增加(病例分类为“轻度”);(b)注意左耳道(白色箭头)和中耳腔(黑色粗箭头)的影像学密度增加，鼓泡轮廓增厚(黑色细箭头)(病例分类“中度”);(c)注意右耳道(白色箭头)和中耳腔影像学密度增加，严重的鼓泡增大，鼻中隔增厚(黑色细箭头)和结构改变，以及颞骨岩部患病(黑色短箭头)(病例分类为“严重”)。每张图片中的对侧耳朵都是正常的(由M Di Giancamillo提供)

 

During video-otoscopy, the polyp stalk was visible within the middle ear cavity in six cats, five of which had a proliferated mucosa lining the middle ear cavity. Two cats had a stenotic horizontal ear canal. In three cats, otitis media was diagnosed in the contralateral ear.

在视频耳镜检查中，6只猫的中耳腔内可见息肉柄，其中5只猫的中耳腔内有增生的粘膜。两只猫的水平耳道狭窄。三只猫的对侧耳朵被诊断为中耳炎。

 

In all cats but one, a smooth pinkish to white in colour and rounded-to-oval mass was detected in the ear canal or the middle ear cavity. In the other cat, the mass did not have the typical appearance of a polyp and endoscopic biopsies were performed; in this cat, PTT was carried out after histopathological confirmation of an inflammatory polyp.

除了一只猫之外，所有猫的耳道或中耳腔都发现了光滑的粉红色到白色的肿块和圆形到椭圆形的肿块。在另一只猫中，肿块没有息肉的典型外观，并进行了内镜活检;在这只猫中，经组织病理学证实为炎性息肉后进行了PTT。

 

Post-PTT treatment and immediate complications

PTT后治疗和并发症

Thirty-nine PTT procedures were performed in 37 cats (39 ears) for removal of aural inflammatory polyps and in six cats PTT was combined with trans-oral traction avulsion of the concurrent nasopharyngeal polyp. The appearance of the middle ear cavity after the PTT procedure is shown in Figure 2.

对37只猫(39只耳朵)进行了39次PTT手术切除耳部炎性息肉，对6只猫进行了PTT联合经口牵引撕脱并发鼻咽息肉。PTT手术后的中耳腔外观如图2所示。

 

 

Figure 2 (a) Endoscopic appearance of a feline aural inflammatory polyp: note the presence of a pinkish round mass occluding the horizontal ear canal. (b) Free ear canal after per-endoscopic trans-tympanic traction and at the top of the image the white aspect of the tympanic cavity after curettage; a moderate quantity of blood is still notable around the tympanic cavity and along the ear canal. On the left side within the bulla there is an artefact from saline solution reflecting the light of the endoscope

图2 (a)猫耳炎性息肉的内镜外观:注意一个粉红色圆形肿块阻塞水平耳道。(b)经内窥镜经鼓室牵引后的自由耳道，图像顶部为刮除后的鼓室白色部分;鼓室周围和耳道沿岸仍有少量血。在左侧鼓泡内有一个由盐水溶液产生的人工制品，反射内窥镜的光线

 

All but two cats were given postoperative antibiotic treatment, with either amoxicillin/clavulanic acid 20 mg/kg q12h (Synulox; Pfizer) in 13 cats or enrofloxacin 5 mg/kg q24h (Baytril; Bayer) in 23 cats. The choice of antibiotic was based on real-time cytological swab of the ear canal: amoxicillin/clavulanic acid and enrofloxacin were chosen when cocci bacteria and rods bacteria, respectively, were identified.

除2只猫外，其余的23只猫术后均给予阿莫西林/克拉维酸20 mg/kg，每12小时一次或恩诺沙星5 mg/kg，每24小时一次。抗生素的选择基于耳道实时细胞学检查:当分别鉴定出球菌和杆菌时，分别选择阿莫西林/克拉维酸和恩诺沙星。

 

Twenty-one cats received concurrent corticosteroid treatment in the postoperative period with prednisolone (Vetsolone; Bayer) 1 mg/kg q12h tapered down over a 3 week period.

21只猫在术后接受了泼尼松龙1mg /kg，每12小时一次, 3周后逐渐下降。

 

Three cats developed Horner’s syndrome immediately after PPT, which resolved spontaneously within a few weeks postoperatively (2–6 weeks).

三只猫在产后立即出现霍纳综合征，术后数周(2-6周)内自行缓解。

 

Histopathology

组织病理学

In all cats, the histopathological examination was consistent with an inflammatory polyp.
所有猫的组织病理学检查均为炎性息肉。

 

Short- and long-term outcomes

短期和长期结果

Overall, five recurrences (13.5%) were recorded. Three recurrences occurred in the short-term outcome and the cats had normal, moderate and severe radiological scoring, respectively; the other two recurrences occurred in the long-term outcome, and both cats had a moderate radiological scoring. Of the five cats that had polyp recurrence, three were not discharged with corticosteroids. The recurrences were spread over the 11 years of the case series and therefore were not likely to be affected by the experience of the surgeon.

总的来说，有5例复发(13.5%)。在短期结果中发生了3次复发，猫的影像学评分分别为正常、中度和严重;另外两例复发发生在长期结果中，两只猫都有中度的影像学评分。在5只息肉复发的猫中，有3只出院后没有使用皮质类固醇。复发分布在11年的病例系列中，因此不太可能受到外科医生经验的影响。

 

The short-term outcome was considered ‘excellent’ in 11 cats, ‘good’ in 21 cats and ‘poor’ in five cats. In the cats with excellent short-term outcome, two had an opaque ear drum and the other nine had normal examination. In the cats with good short-term outcome ceruminous otorrhoea was found in 20 cats, an opaque ear drum in eight cats, head-shaking in three cats, ear-scratching in two cats, head tilt in three cats and partial stenosis of the horizontal canal in two cats.

短期结果显示，11只猫被认为“极好”，21只猫被认为“好”，5只猫被认为“不佳”。在短期结果良好的猫中，两只鼓膜不透明，其他9只检查正常。近期结果良好的猫有耵聍性耳分泌物20只，鼓膜不透明8只，甩头3只，抓耳2只，头倾斜3只，水平耳道部分狭窄2只。

 

In the five cats with a poor outcome, three cats had recurrent aural polyps 1.0, 1.5 and 2.0 months after the PTT procedure and were treated again with PTT; two cats had an excellent long-term outcome at 24 and 6 months after the first PTT, and one cat had a poor long-term outcome because of aural polyp recurrence and chronic otitis at 46 months after the first PTT procedure. The other two cats were diagnosed with otitis media at 1 and 2 months after the PTT procedure. Both cats were treated with antibiotics based on culture and sensitivity results and corticosteroids, with a good long-term outcome in one cat at 15 months after the PTT procedure and a poor long-term outcome in the other cat at 22 months because of the presence of chronic otitis media.

在结果不佳的5只猫中，3只猫在PTT术后1.0、1.5和2.0个月复发耳部息肉，再次接受PTT治疗;两只猫在第一次PTT术后24个月和6个月有良好的长期结果，而一只猫在第一次PTT术后46个月有较差的长期结果，因为耳息肉复发和慢性中耳炎。另外两只猫在PTT手术后1个月和2个月被诊断为中耳炎。根据细菌培养和药敏结果，两只猫都接受了抗生素和皮质类固醇治疗，其中一只猫在PTT手术后15个月的长期结果良好，另一只猫在22个月的长期结果不佳，因为存在慢性中耳炎。

 

The long-term outcome ranged from 6 to 60 months, for a median follow-up of 19.6 months. The outcome was considered ‘excellent’ in 20 cats, ‘good’ in 15 cats and ‘poor’ in two cats. In the cats with excellent long-term outcome, 14 had normal examination and six had an opaque ear drum. In the cats with good long-term outcome, nine showed ceruminous otorrhoea, four persistent head tilt, three occasional episodes of ataxia, two ear-scratching and one an opaque and thickened ear drum. The two cats with poor long-term outcome already had a poor outcome in the short-term outcome and showed signs of chronic otitis media at 22 months and chronic otitis media and polyp recurrence at 46 months after PTT, respectively.

长期结果范围6 ~ 60个月，中位时间19.6个月。结果为20只猫“极好”，15只猫“好”，两只猫“不佳”。在长期结果极好的猫中，14只检查正常，6只鼓膜不透明。在长期结果好的猫中，9只出现耵聍性耳分泌物，4只持续头倾斜，3只偶尔出现共济失调，2只抓耳，1只鼓膜不透明和增厚。两只长期结果不佳的猫在短期结果方面已经表现不佳，分别在PTT后22个月出现慢性中耳炎和46个月出现慢性中耳炎和息肉复发的症状。

 

Other occurrences during long-term follow-up were recurrent aural polyp in one cat 5 months after PTT that was treated again with PTT with an excellent outcome 9 months after the first PTT procedure; recurrent rhinopharyngeal polyp in one cat 4 months after PTT and traction avulsion procedures, which was again treated by a traction avulsion technique without further recurrences; diagnosis of contralateral aural polyp in one cat 13 months after the PTT procedure, which was treated by PTT with a good long-term outcome for both ears at 24 months after the first PTT; and ongoing otitis media in one cat 3 months after PTT, which was successfully treated with antibiotics based on culture and sensitivity results with a good long-term outcome at 60 months after PTT.

在长期随访中发生的其他事件有一只猫在PTT 5个月后复发耳部息肉，在第一次PTT手术9个月后再次接受PTT治疗并取得了极好的结果;1只猫在PTT和牵引撕脱术后4个月复发鼻咽息肉，再次采用牵引撕脱技术治疗，不再复发;其中一只猫在接受PTT手术后13个月诊断为对侧耳息肉，在第一次PTT手术后24个月接受PTT治疗，双耳长期结果良好;1只猫在PTT后3个月仍有中耳炎，根据细菌培养和药敏结果，在PTT后60个月使用抗生素成功治疗，并有良好的长期结果。

 

Of the five cats that had polyp recurrence, three were not discharged with corticosteroids. All the cats that were diagnosed with otitis media after PTT were discharged with corticosteroids. Both cats with poor shortand long-term outcomes had received corticosteroids.

在5只息肉复发的猫中，有3只出院后没有使用皮质类固醇。所有在PTT后被诊断为中耳炎的猫出院后都使用皮质类固醇。两只短期和长期结果不佳的猫都接受了皮质类固醇治疗。

 

Discussion

讨论

The aim of this study was to evaluate the feasibility, efficacy, and the short- and long-term outcomes of PTT as a minimally invasive technique for the treatment of aural inflammatory polyps in cats.

本研究的目的是评估PTT作为一种微创技术治疗猫耳炎性息肉的可行性、有效性和短期和长期结果。

 

In our case series, signalment with no gender predisposition, clinical findings, imaging findings and histopathological findings were similar to those that have been previously reported, but domestic shorthair cats were over-represented.

在我们的病例系列中，无性别易感性的特征、临床表现、影像学表现和组织病理学表现与先前报道的相似，但家养短毛猫的比例过高。

 

Only in one cat was histological examination of biopsy samples performed before proceeding with PTT because of an atypical appearance of the mass in the ear canal. Biopsy sampling and histological confirmation should be performed before traction or surgery when certainty of the presence of an aural polyp is not straightforward.

只有一只猫在进行PTT前对活检样本进行了组织学检查，因为在耳道出现了不典型的肿块。当不能直接确定耳息肉的存在时，应在牵引或手术前进行活检取样和组织学确认。

 

In this study, 94% (35/37) of cats were successfully treated with PTT. However, as reported in other studies, some clinical signs of ear disease, such as ceruminous otorrhoea, head-shaking, ear-scratching and the persistence of a degree of neurological signs in cats that were exhibiting neurological signs at presentation, were recorded during follow-up.

在这项研究中，94%(35/37)的猫成功地使用PTT治疗。然而，正如其他研究报道的那样，在随访中记录了一些耳部疾病的临床症状，如耵聍性分泌物、甩头、抓耳以及在出现神经症状时持续存在一定程度的神经症状。

 

One cat developed a contralateral polyp 13 months after PTT. This has only been reported once. The cat was successfully treated with PTT and had a good long-term outcome.

1只猫在PTT后13个月出现对侧息肉。这种情况只报道过一次。这只猫成功地接受了PTT治疗，并有一个良好的长期结果。

 

In the veterinary literature, traction alone and VBO are the most common used techniques for the treatment of aural inflammatory polyps. VBO has been recommended as the treatment of choice when middle or inner involvement is present. Short-term complications, such as Horner’s syndrome and polyp recurrence, are the most frequent complications, and Horner’s syndrome is usually temporary. Facial nerve paralysis and otitis interna have been rarely reported.

在兽医文献中，单纯牵引和VBO是治疗耳部炎性息肉最常用的技术。当出现中耳、内耳病变时，建议选择VBO作为治疗方法。短期并发症如霍纳氏综合征和息肉复发是最常见的并发症，而霍纳氏综合征通常是暂时的。面神经麻痹及内耳炎的病例罕有报道。

 

Immediate post-PTT procedure complications were temporary Horner’s syndrome in three cats (8%), and resolved a few weeks after the procedure. This percentage is lower than what has been reported for VBO (57–81%) or traction alone (43%) in other studies. None of the cats in this study developed temporary or permanent facial nerve paralysis after PTT.

PTT手术后立即出现的并发症是三只猫(8%)的暂时性霍纳氏综合征，并在手术后几周消失。这一比例低于其他研究中报道的VBO(57-81%)或单纯牵引(43%)。在这项研究中，没有猫在PTT后出现暂时性或永久性面神经麻痹。

 

In this study, three cats were diagnosed with otitis media within 3 months of the PTT procedure being performed (8%), but only two cats were diagnosed having chronic otitis media (2%) at 22 and 46 months on longterm outcome. To the best of our knowledge, chronic otitis media has been addressed in other studies as a possible long-term complication, but no percentages are available or deducible.

在本研究中，3只猫在PTT手术后的3个月内被诊断为中耳炎(8%)，但从长期结果来看，只有2只猫在22个月和46个月被诊断为慢性中耳炎(2%)。据我们所知，慢性中耳炎在其他研究中被认为是一种可能的长期并发症，但没有百分比可用或可推断。

 

Of the six cats that had concurrent nasopharyngeal polyps, one cat that did not received corticosteroids had a recurrent nasopharyngeal polyp 4 months after traction and was again treated with traction with no further recurrence. These findings are in agreement with what has been previously reported.

在6只同时患有鼻咽息肉的猫中，有一只猫没有接受皮质类固醇治疗，在牵引4个月后鼻咽息肉复发，再次进行牵引治疗，没有再复发。这些发现与以前的报道一致。

 

Overall in this study, recurrence of an aural inflammatory polyp after PTT occurred in five cats (13.5%), and three cats had recurrence in the short-term outcome and two cats in the long-term outcome at 5 and 46 months, respectively, after PTT. This last cat was considered to have a poor outcome according to the outcome assessment, but had a normal follow-up up to 40 months after PTT, and for us it is questionable whether a diagnosis of an aural polyp after 4 years should be considered a recurrence or a new polyp. Two recurrences occurred in two cats that received corticosteroids and two in cats that had not received corticosteroids. These results are in agreement with what has been reported previously.

在本研究中，有5只猫(13.5%)在PTT后再次出现耳部炎性息肉，3只猫在PTT后5个月和46个月分别出现短期复发和长期复发。根据结果评估，最后一只猫的结果不佳，但在PTT后的40个月随访正常，对我们来说，4年后诊断为耳部息肉是复发还是新的息肉是值得怀疑的。在两只接受皮质类固醇治疗的猫和两只未接受皮质类固醇治疗的猫中出现了两次复发。这些结果与以前报道的结果一致。

 

The percentage of recurrence for PTT (13.5%) is lower than that reported for traction alone (57%) and similar to the percentages reported for VBO (0–33%). VBO offers surgical exposure of the bulla, which allows extirpation of the mucosal lining the tympanic cavity. PTT allowed visualisation of the stalk in six cats and curettage of the bulla in all cases thus increasing the success rate of the single traction procedure.

PTT的复发率(13.5%)低于单纯牵引的复发率(57%)，与VBO的复发率(0-33%)相似。VBO外科暴露鼓泡，可以清除鼓膜腔内衬黏膜上皮。PTT可以看到6只猫的息肉柄部，并且所有病例都刮鼓泡，从而提高了单次牵引手术的成功率。

 

In this study, it was not possible to trace all the anaesthesia records to evaluate the mean duration of PTT, but the minimum duration time available was 45 mins and the maximum was 2.5 h. Although minimally invasive and effective, PTT can be time-consuming.

在本研究中，无法通过追踪所有的麻醉记录来评估PTT的平均持续时间，但最小持续时间为45分钟，最大持续时间为2.5小时。虽然微创和有效，但PTT可能很耗时。

 

Conclusions

结论

PTT is an effective and minimally invasive technique for the treatment of aural inflammatory polyps in cats. PTT should be performed after a learning curve has been accomplished and by an experienced endoscopist because it allows visualisation and cleaning of the dorsolateral compartment of the bulla, which contains important neurological structures that should not be damaged.

PTT是治疗猫耳炎性息肉的一种有效的微创技术。PTT应在完成学习曲线后由经验丰富的内窥镜医生进行，因为可以可视化到和清理包含不应被破坏的重要神经结构的鼓泡背外侧腔。

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