Ventral Bulla Osteotomy

Polyps that extend from the middle ear into the ear canal or pharynx (back of the throat) may be grabbed and pulled out during an examination, but if the root of the polyp remains inside the bulla, regrowth rates approach 50 percent or higher. VBO gives the surgeon direct access to the entire bulla, allowing complete removal of the polyp's attachment site and a thorough clean-out of the chamber — dramatically reducing the chance of recurrence. For middle-ear infections, cholesteatomas, or tumors where medical management has failed, VBO is often the only approach that can clear the disease and restore comfort and hearing-related function.

VBO is performed under general anesthesia with the pet positioned on its back. The surgical steps include:

• A small incision is made on the underside of the jaw/neck directly over the tympanic bulla
• Careful dissection through soft tissue to reach the bony bulla — avoiding the major blood vessels and nerves in the region
• An opening is created in the bulla wall using a bone curette or drill, giving the surgeon direct view inside the chamber
• Abnormal tissue (polyp, debris, infected material, or tumor) is removed thoroughly, including the attachment stalk in the case of polyps
• The chamber is flushed copiously with sterile saline
• The wound is closed in layers; the bulla opening is generally left to drain naturally

CT imaging before surgery is strongly recommended to map the extent of disease within the bulla and plan the approach.

Pre-operative evaluation typically includes:

• CT scan of the skull to characterize the bulla contents and confirm which side (or both) is affected
• Ear examination under sedation or anesthesia to assess the external and middle ear
• Pre-anesthetic bloodwork and assessment of overall health
• Discussion of expected findings and any concurrent procedures planned (for example, simultaneous removal of a pharyngeal polyp)
• Food withheld the night before; water restrictions per the surgical team's guidance

Most cats and dogs are discharged within 24 hours of surgery. Home care priorities include:

• Week 1: keep the incision clean and dry; monitor for swelling, discharge, or changes in head posture
• Horner's syndrome (a drooping upper eyelid, small pupil, and sunken eye on the operated side) is a common temporary complication — it typically resolves within four to six weeks and requires no specific treatment
• Head tilt may be present for days to weeks if the inner ear was affected or manipulated; most animals compensate fully over time
• Antibiotics and pain medication are prescribed for the first one to two weeks
• Recheck examination at two weeks to evaluate healing and neurologic signs

VBO is a technically demanding procedure with several possible complications that owners should understand before proceeding:

• Horner's syndrome: the most common short-term complication, caused by nerve proximity; usually resolves within weeks to months
• Head tilt / vestibular signs: inner-ear involvement or surgical proximity to the inner ear can produce head tilt and wobbling; compensation occurs gradually
• Facial nerve injury: uncommon, but possible; may cause temporary or (rarely) permanent drooping of the lip or eyelid on the operated side
• Recurrence: thorough polyp removal at the attachment site substantially reduces recurrence, though it can still occur
• Infection: managed with antibiotics; rare after thorough flushing

Despite these risks, VBO offers most patients lasting relief and a significantly improved quality of life compared with repeated medical management alone.