1. Treatment of Otitis Externa - MemberClicks

LET¡¯S BREAK DOWN

COMMON QUESTIONS

TREATMENT OF OTITIS

EXTERNA

? What ear drops do I use to treat this case?

Cynthia Bauer DVM, MS, Dipl. ACVD

? Many factors decide this answer.

? Usually not one good answer.

? Can I ever cure otitis?

? More art

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UNDERSTANDING THE EXTERNAL EAR

CANAL

CONSULTS?

? Formed by rolled annular

cartilage

? greenville@

? 864-385-6565

? Lined by skin

?

? Secretions are protective

? Bacteria and yeast normal

? Epithelial migration

? TM?external orifice

Tabacca NE; Epithelial migration on the canine tympanic membrane, Veterinary Dermatology

Volume 22, Issue 6, pages 502¨C510, December 2011

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UNDERSTANDING THE EXTERNAL EAR

CANAL

UNDERSTANDING THE EXTERNAL EAR

CANAL

? Vertical canal

? Horizontal Canal

? External orifice

? *Tragus,

? Bends off medially from vertical canal

? Pretragic incisure and

? Tympanic Membrane

? Intertragic incisure

? Lumen ridge

? Rostral?Ventral

? Picture courtesy of Dr L.K. Cole and Mr T. Vojt, College of Veterinary Medicine, The Ohio State University, Columbus, OH..

From Njaa, B. L. Practical Otic Anatomy and Physiology of the Dog and Cat. Vet Clin Small Anim 42 (2012) 1109¨C1126

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OVERVIEW OF OTITIS

UNDERSTANDING THE EXTERNAL EAR

CANAL

? Common and Frustrating

? Tympanic Membrane- epithelial structure

? Pars flacida

? Inflammation of the ear

? Causes and Factors

? Vascular, Buldges

? Pars Tensa

? Translucent

? Manubrium of malleous

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CLASSIFICATION SYSTEM

PRESENTING COMPLAINT

? Foul odor from ear

? Rubbing head

? Shaking head

? Hearing loss

? Scratching at ear

? Behavioral changes

? Aural Hematoma

? Alopecia of pinnae

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Causes

? Primary

? Secondary

Factors

? Perpetuating

? Predisposing

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PRIMARY CAUSES

? Foreign body

? Epithelialization

? Parasites

? Metabolic

? Atopic disease

? Glandular disorder

? Food allergy

? Immune mediated

SECONDARY CAUSES

Bacterial infections

Malassezia sp. Yeast

Drug eruption

Over cleaning

? Endocrine

¡°Easy¡±

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PREDISPOSING FACTORS

PERPETUATING FACTORS

? Prior factors that alone do not cause otitis

? Conformation

? Moisture

HFOC

? Obstructive

? Systemic disease

? Tx effects

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?

?

?

?

Altered migration

Edema

Proliferation

Hidradenitis

?

?

?

?

Calcification

OM

Cholesteatoma

Osteomyelitis

Tx continued until resolution

Months, Life long, Surgical solution

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OTITIS SUCCESS

? Adept at detailing factors and causes

IF OTITIS IS SO COMPLEX HOW

DO I TREAT CASES SUCCESSFULLY?

? Formulate a plan

? Client Education IS KEY

? Reasonable expectations

? Prognosis

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OTHER QUESTIONS

HOW TO BEGIN

? Complete and thorough history

? Did you get a cytology?

?

?

?

?

?

?

?

? What is the best way to take and prepare a

cytology?

? I have culture results, now what?

? Is the culture accurate? Useful?

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Onset

Seasonality

Tx-outcome, side effects

Diets/treats

Concurrent diseases

Preventive tx

Other pets/people with issues

¡°HOW DO YOU DO

YOUR CYTOLOGIES?¡±

DIAGNOSTICS

? Cytology

? Culture

? Biopsy

? Imaging

? Myringotomy

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CYTOLOGY

CYTOLOGY

? No statistically significant differences were observed in the

numbers of keratinocytes, yeast, bacteria, or neutrophils among the

4 staining techniques.

? Roll onto slide

? Heat fixing?

? TOMA S., et al. Comparison of 4 fixation and staining methods for the cytologic evaluation of ear

canals with clinical evidence of ceruminous otitis externa. Veterinary Clinical Pathology 35, 2008,194¨C

198.

? Other authors feel heat fixation does help fix ceruminous debris to

the slide

? C Mendelsohn, W Rosenkrantz, CE Griffin Practical Cytology For Inflammatory Skin Diseases, Clinical Techniques

in Small Animal Practice, Volume 21, Issue 3, August 2006, Pages 117-127

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READING THE SAMPLE

CYTOLOGY

? Scan on 10x

? Staining

? Examine areas of

interest under oil

immersion

? Examine approx. 10

fields

? Average reading

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WHEN DO I CULTURE?

? Otitis Media

CULTURING

? Myringotomy

? PSOM

? Flush

Caudo-Ventral

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WHAT ORGANISMS ARE COMMON IN

DOGS WITH OM?

IS MYRINGOTOMY SAFE

? Side effects

? Horner¡¯s

? Facial nerve paralysis

? Vestibular

disturbances

? Deafness

? drooping of the upper eyelid on the affected side

(ptosis)

? Pseudomonas aeruginosa

? Staphylococcus intermedius

? the pupil of the eye on the affected will be

constricted (miosis)

? Proteus

? Klebsiella

? Escherichia coli

? the eye on the affected side often appears sunken

(enophthalmos)

? Anaerobes

? the third eyelid of the affected side may appear

red and raised (prolapse of the third

eyelid, conjunctival hyperemia)

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WHAT ORGANISMS ARE COMMON IN

CATS WITH OM?

? Staphylococcus intermedius

I DID A CULTURE, NOW WHAT?

? Resistance rarely an issue in OM cases

? Otitis media

? Polyps

? Pseudomonas

? Bordetella

? Bacteroides

? Fusobacterium

? Mycoplasma

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? Streptococcus

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