Veterinary Vertex
Veterinary Vertex is a weekly podcast that takes you behind the scenes of the clinical and research discoveries published in the Journal of the American Veterinary Medical Association (JAVMA) and the American Journal of Veterinary Research (AJVR). Tune in to learn about cutting-edge veterinary research and gain in-depth insights you won’t find anywhere else. Come away with knowledge you can put to use in your own practice – along with a healthy dose of inspiration to remind you what you love about veterinary medicine.
Veterinary Vertex
Ocular Examinations are Important in Animals Undergoing Aural Surgeries
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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Sarah Wright:You're listening to Veterinary Vertex, a podcast that AVMA journals. In this episode we chat about how ocular examinations before and after total ear canal ablation and bula osteotomy can help recognize and prevent potential vision-threatening abnormalities in cats and dogs, with our guest, Bianca Hartrum.
Lisa Fortier:Welcome to Veterinary Vertex. I'm Editor-in-Chief Lisa Fortier, and I'm joined by Associate Editor Sarah Wright. Today, we have Bianca joining us. Hey, Bianca, thank you so much for being here with us today.
Bianca Hartrum:Thanks for having me.
Bianca Hartrum:I'm excited to be on here and talk about the paper.
Sarah Wright:All right, let's dive right in. So, Bianca, your JAVMA article discusses how ocular examinations before and after total ear canal ablation and volosteotomy can help recognize and prevent potential vision-threatening abnormalities in cats and dogs. Please share with our listeners the background on this article abnormalities in cats and dogs.
Sarah Wright:Please share with our listeners the background on this article.
Bianca Hartrum:So this is my residency study that I completed at my residency at MedVet in Ohio State. In the study we performed ocular examination in dogs and cats before and after total ear canal ablation and bolo-osteotomy and then also after our VBOs in cats, just to kind of get a whole compilation of the different ear surgeries. So the idea for the study was sparked actually from a case very early in my residency. We were choosing what do I want to study? What do I want to invest all this time in a residency project in?
Bianca Hartrum:And this dog came in with a really severe melting corneal ulcer and facial nerve paralysis after a recent teakaboo. So we're wondering, you know, how long has this issue been going on before we saw this dog? Did the dog have eye disease before it had ear surgery? And how many cats and dogs do have eye disease either as a result of their ear disease or following their ear surgery? So afterwards I dove into a bunch of publications just trying to figure out is this a viable study? And from everything I learned, every study mentions neuro-ophthalmic complications. There's several that mention eye complications but really don't dive into the details and none of those studies had any ophthalmologists involved. So we thought it would be a really great study to look into. Do these animals have eye problems and what can we do to prevent eye problems that they did occur?
Sarah Wright:Yeah, very useful and very clinically applicable too. So, what are some of the important take-home messages from this JAVMA article?
Bianca Hartrum:Biggest take-home message it is, I would say, is that patients should have eye exams. There were so many patients that developed eye complications and all of our findings were more than in previous studies, I think, because we did have people paying really close attention to their eyes. So patients should have eye exams before and after ear surgery because the ocular and neuro-ophthalmic complications were so high. At minimum they should have Shermer tear tests to make sure that they don't have dry eye. They should have topical lubricants afterwards to protect their eyes, because many develop facial nerve paralysis and then, no matter what, we should be fluorescing and saving these patients. It doesn't take very long, just to make sure that they don't have a corneal ulcer, because that can lead to blinding complications in them.
Lisa Fortier:Fabulous. So, you might know, Bianca, I'm an equine orthopedic surgeon, but if I had to do it over again, I would do ophthalmology. I think it's just, it's fascinating. So, I'm living vicariously through you right now. Okay, what sparked your?
Bianca Hartrum:So, I always wanted to be a vet, just like many of us. I think most of us kind of say you know, we always wanted to be a veterinarian because we love animals. But really uniquely, it was general physics class. I was working as a veterinary assistant at a general practice in my college town and was in a general physics class just learning about optics, lenses, how the eye worked, and I thought it was so fascinating. So, I worked at a veterinarian, Heather Vanderbrink, and I mentioned to her hey, it is so cool how the eye works and everything, and she's like you know, you can be an ophthalmologist and a veterinarian at the same time. And that was the first time I learned that I could do that and kind of just. All the rest is history.
Lisa Fortier:That's amazing. Mentorship is alive and well, and I also. Physics was probably my favorite class. So there you go. What do an equine surgeon and ophthalmologist have in common? I really like also what you said about you know people mentioned this problem before, but then you did a deep dive into all the literature that existed and then formulated a question. I think that's an amazing gift to have. It's a natural gift to have, especially at a resident stage. So congratulations. That'll take you a long way when you do studies like this. Sarah asked you earlier what were some of the most important findings, but there's always things that surprise us. What things surprised you by doing this study?
Bianca Hartrum:I think it was the sheer amount of cats affected, so almost all cats. It was actually 90.9% developed Horner's syndrome. So it was such a high number that it was very surprising to us because all the previous literature said it was only up to 58%. So it was just very surprising that the complication was so high.
Sarah Wright:Yeah, I think cats often get overlooked sometimes, especially when we're looking at both like cats and dogs as far as companion animals go. So kudos to you too for looking at the cats in the study.
Bianca Hartrum:It was important to me to do that. I made sure I did a study where it included cats.
Sarah Wright:So what are next steps for research in this topic?
Bianca Hartrum:So we don't currently have any future research planned on this topic. But I think the biggest kind of thing with this, it has changed the way that things work in our hospital and it's improved our collaborative care at MedVet. So we created a new standard of care that includes pre and post-op exams included in the surgical cost for any patient undergoing ear surgery. So we have handouts on collaborative care for our clients when they first come in. All the estimates include all the eye exams they can communicate with us. So it really has kind of changed the way we approach ear surgery and we are paying attention early now to eye problems and we encourage other Merkle specialty hospitals to do the same. It's really been great, you know. It's improved everyone working together in the hospital and I think it's really increased the care for these patients.
Sarah Wright:Great to hear about that collaboration. It's to see, too, you putting like like the findings from your study into action at your practice.
Bianca Hartrum:Yeah, it's been great.
Sarah Wright:So emerging technology is a very hot topic right now. Do you see a role for AI in this area of research?
Bianca Hartrum:I think that's hard to say now. I think the use of AI is going to be relevant in a lot of veterinary fields in the future. We're already seeing several studies for AI in ophthalmology as a successful tool to increase the accuracy of diagnosis. So, a lot of machine learning, showing them photos, saying is this a problem, is it not a problem? So that could be used in the future, I believe. I think it's just we. It's really dependent on how much data we collect and how good that data is, cause you can only 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, but I think it could be a good thing in addition to all the expertise we have, just to improve our accuracy.
Sarah Wright:I think you could say the same thing for medical records. Garbage in, garbage out, right. That's why it's so important to have them be accurate and detailed.
Bianca Hartrum:Absolutely so. That would be important, or else they're not going to be as usual as we'd like them to be.
Sarah Wright:And for those of you just joining us, we're discussing how ocular examinations before and after total ear canal ablation and bulla osteotomy can help recognize and prevent potential vision-threatening abnormalities in cats and dogs, with our guest Bianca.
Lisa Fortier:Yeah, again, congratulations, Bianca, on getting all the way across the finish line of Resident Project. How has your residency, training or any other previous work prepared you to write this article?
Bianca Hartrum:I've been thinking about this a lot.
Bianca Hartrum:It's a hard question so I think just the way the veterinary field works, you know a lot of us have all of us have it going into specialty, having to do a rotating internship and really learning at that stage collaboration between services, and a lot of us are fortunate to end up in hospitals where we do get to see such great collaborative care. So I think my training at Virginia Tech helps me with that. I did several specialty internships after that, before a residency, and I think that really helped. You know, being in different places and being in different hospitals and seeing how they collaborated, and I think a lot of those places really did show that it is possible. You know ophthalmology works so much with surgery, with dermatology, with anesthesia, so I feel like that did really help me in preparation for this article. And I completed my residency at Ohio State and MedVet and both those places had really great collaborative care and I got kind of a combination of academic and private practice and that that and it really helped me with this article. Yeah.
Lisa Fortier:Very good. Do you know about our resident awards?
Bianca Hartrum:I do.
Lisa Fortier:All right, I've heard of it, so yeah, you can self-nominate. It's a rolling nomination on the JAVMA and AJVR website, so we hope to see your article there.
Sarah Wright:Yeah, and to our listeners too, don't forget if you have a student, resident or intern author. It is rolling, but we're looking right now for articles published in 2024. And we'll be looking to have all of those captured by March, so be sure to get your nominations in if you're tuning in. So, Bianca, this next set of questions is going to be really important for our listeners, and the first one is going to be dealing with the veterinarian's perspective. So what is one piece of information the veterinarian should know about? Ocular examinations before and after a cheek of bow and VBOs in cats and dogs?
Bianca Hartrum:before and after chikabo, and vbos and cats and dogs. So if I had to narrow it down to one piece of advice, it would be do eye exams. So many people overlook the eyes. We learned so much from this article that there were a lot of patients with eye disease 20% beforehand had ear disease related to or eye disease related to their ear disease, and then 30% had unrelated eye disease. So I think the biggest thing is just do eye exams. A lot of times you can find stuff either related to the condition you're looking at for the animal or even unrelated.
Sarah Wright:So then, on the other side of the relationship, what's one thing that clients should know about ocular examinations before and after ear surgeries?
Bianca Hartrum:I think it's that eye disease isn't uncommon in these pets and it's important that they're aware of that, because clients are less upset about a complication if they're warned out of time. They know what to watch out for. They know it can happen, so if it does, they're prepared for that.
Lisa Fortier:And it's not a shock to them. Well, thank you again for being with us, Bianca. This is really transformative information for veterinarians and for clients, and that's a huge accomplishment, so congratulations. As we close down, we love to ask a fun question, and for you, what is your favorite animal fact?
Bianca Hartrum:My favorite animal fact of course it has to advise. So, cats can only blink one, or cats only blink one to five times per minute, so you're probably always going to lose a staring contest if you try to pick one with them okay, I definitely have tried that before.
Sarah Wright:I have two cats that will start now. Look how, oh, that's crazy. Thank you, it makes sense, I'm definitely going to go Okay?
Lisa Fortier:A naive question Is that with our third eyelid, or like a true blink, true blink?
Sarah Wright:Okay, the default question, though. Well, thank you so much for being here, Bianca, and for sharing your knowledge of ophthalmology with us, and our listeners too.
Bianca Hartrum:Thank you, thanks for having me.
Sarah Wright:And to our listeners. You can read Bianca's article on JAVMA. I'm Sarah Wright with Lisa Fortier. Be on the lookout for next week's episode and don't forget to leave us a rating and review on Apple Podcasts or whatever platform you listen to.
