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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