If you have a young cat who suffers from chronic ear infections or recurrent upper respiratory symptoms, it might be time to look for an underlying cause. An ear polyp, also known as aural polyp, inflammatory polyp, or nasopharyngeal polyp, just might be the culprit.
Ear polyps in cats are benign, smooth, reddish pink, soft tissue growths that typically grow from a stalk originating deep in the ear cavity. They can get as big as a large blueberry or small grape. They usually occur in one ear, but they can occur in both. If your kitty has a polyp that is properly diagnosed and treated, his or her nagging, recurring signs and symptoms will often become a thing of the past.
“I’ve seen unilateral and bilateral ear polyps,” says James Flanders, DVM, DACVS, emeritus 
associate professor, section of Small Animal Surgery, at Cornell University’s College of Veterinary Medicine. “When they’re bilateral, they cause a very severe obstruction. The poor cats can barely breathe because of the occlusion of their nasal passages.”
Popping Through the Ear Drum
Sometimes inflammatory polyps grow outward, popping through the ear drum into the external ear canal. When this happens, chronic recurring external ear infections are common. Associated signs include frequent head shaking, scratching or rubbing the ears, visible discharge from ears, and odor.
If these cases go untreated long enough, an affected cat may develop inflammation or infection in the middle ear, with associated signs including Horner’s syndrome and facial nerve paralysis (see sidebars), or even inflammation/infection in the inner ear with signs including head tilt, unusual back-and-forth jerking eye movements (nystagmus), loss of balance, and even deafness. From the inner ear, inflammation/infection can spread to the brain, so it is important to get on top of things before this happens.
Sometimes, ear polyps grow inward through the eustachian tube that connects the ear cavity to the back of the throat. When this happens, upper respiratory signs are common and include sneezing, nasal discharge, loud breathing, trouble breathing and/or swallowing, change in voice, and weight loss.
Causes Aren’t Clear
The cause of feline aural polyps is currently unknown. They are more common in young cats, suggesting a potential congenital predisposition; and because they sometimes occur in multiple kittens from the same litter, a genetic component is suspected. Finally, because they are inflammatory, they are thought to possibly occur secondary to chronic upper respiratory infections.
Diagnosis
Diagnosis starts with a physical exam. With otoscopic examination, your veterinarian may be able to see an ear polyp that has broken through the ear drum. Sometimes, nasopharyngeal polyps cause a bulging of the soft palate your veterinarian may see during oral examination. The next diagnostic step is skull X-rays taken under general anesthesia.
The X-rays may show soft tissue density within the ear cavity where air is normally seen or thickening or abnormalities of the tympanic bulla (the bony structure that houses the middle and inner ear). Unfortunately, X-rays will sometimes appear normal even if there is a polyp. The next step for these cats is advanced imaging such as CT or MRI.
Surgery
The definitive treatment for most cases of ear polyps in cats is surgical removal. The approach depends upon whether the polyp has grown inward (nasopharyngeal) or outward (ear) and whether the cat has any signs of middle or inner ear disease. The simplest approach, and the one that is usually tried first for nasopharyngeal polyps specifically, is removal by traction.
With the cat under general anesthesia, the surgeon will identify the polyp behind or under the soft palate, grab it with a clamp, and apply gentle, steady traction until it gives. There is usually a little bleeding with this technique, but it is the least invasive for the cat, and complications are not common. The biggest drawback is a higher likelihood of recurrence since it’s possible the entire stalk may not be fully retrieved.
“I consider it sort of a semi surgical disease, because to treat the polyps, you need to anesthetize the cat and then yank the polyp out of the nasopharynx through the cat’s mouth. I usually followed up the extraction with a two-week course of oral steroids just to reduce the inflammation,” says Dr. Flanders.
The other surgical approach is called ventral bulla osteotomy (VBO). With this approach, the surgeon cuts into the tympanic bulla, identifies the origin of the polyp, and removes it. With this surgery, there is a much lower rate of recurrence, as the entire lining of the tympanic cavity is visualized and debrided, ensuring complete removal of all polyp tissue. This surgery is, however, more invasive, and post-op complications are more likely.
Almost all cats undergoing VBO will wake up with Horner’s syndrome and sometimes even facial nerve paralysis. Fortunately, these complications are typically transient.
VBO is usually the best option for ear polyps, as traction is more difficult in the ear and often a waste of time. VBO is the best option for cats showing signs of middle or inner ear disease, as it allows for assessment, lavage, and culture of the tympanic cavity. If the polyp cannot be visualized in the external ear canal or nasopharynx, VBO becomes the only option. All tissue removed, whether by traction or VBO, should be submitted for biopsy. “Some surgeons recommend ventral bulla osteotomy to prevent recurrence, but I have not seen that to be necessary,” says Dr. Flanders. In his experience, “Very few of them occurred after extraction and steroid treatment.”
Prognosis
The prognosis for cats with successful removal of nasopharyngeal or ear polyps is good. So, while there may be a few bumps along the way, if your young cat suffers from chronic ear infections or has chronic upper respiratory symptoms, it is well worth pursuing the possibility of an underlying inflammatory polyp, giving your cat a happy, comfortable future.
