Defense & Barriers: Otitis 2

Question 1

we should only ____ daily but not ____ daily, why?

Answer 1

TREAT daily but NOT CLEAN

can cause MACERATION or DESTRUCTION OF EPITHELIAL LINING OF EAR CANAL

Question 2

SECONDARY infections to otitis…
why must they be addressed?
3 microorganisms?

Answer 2

must be addressed TO FIX PRURITUS

3 organisms?
1. COCCI = STAPH PSEUD/SCHLEIFERI, STAPH AUREUS MORE COMMON IN CATS
2. RODS = PSEUDOMONAS AERUGINOSA
3. YEAST = MALASSEZIA PACHYDERM

Question 3

3 clinical signs for PSEUDOMONAS AERUGINOSA infection?

Answer 3

1. CHRONIC otitis
2. MALODOROUS, SEPTIC-TANK like odor
3. SUPPURATIVE EXUDATE (yellow or green)

Question 4

DEAFNESS is associated with what infection?

Answer 4

OTITIS MEDIA

Question 5

FACIAL NERVE PARALYSIS is associated with what infection?
what reflex is slowed?

Answer 5

OTITIS MEDIA (facial nerve runs close to middle ear)

slow PALPEBRAL reflex

Question 6

head tilt/nystagmus are signs of WHAT?

Answer 6

NEUROLOGIC VESTIBULAR signs due to SECONDARY INFECTION to OTITIS

Question 7

the majority of ___ ___ cases will also have ____ ___

Answer 7

OTITIS MEDIA –> OTITIS EXTERNA

Question 8

why is an ORAL exam important in DOGS & CATS?

Answer 8

CATS = can have INFLAMMATORY POLYPS in NASOPHARYNGEAL region

DOGS = have PAIN when OPENING MOUTH due to OM because middle ear NEAR TMJ

Question 9

4 important things to do for exam for OTITIS?

Answer 9

1. PHYSICAL EXAM & HISTORY
2. PALPATE EARS
3. perform NEUROLOGIC exam
4. perform ORAL EXAM

Question 10

identify genus/species

Answer 10

PSEUDOMONAS AERUGINOSA

Question 11

identify organism (type)

Answer 11

EAR MITES

Question 12

PERIORAL HYPERPIGMENTATION/ALOPECIA indicates what 2 diseases?

Answer 12

ALLERGY, ATOPY

Question 13

OTOSCOPIC exam…
3 goals?
how to perform? (+what are we straightening out?)

Answer 13

3 goals?
1. appreciate AMOUNT and CHARACTER of CERUMEN
2. appreciate TYMPANIC MEMBRANE INTEGRITY
3. evaluate ENTIRE EAR CANAL

how to perform?
PULL PINNA UP AND AWAY FROM HEAD to STRAIGHTEN EAR CANAL
+straightening out CARTILAGINOUS RIDGE

Question 14

EAR CYTOLOGY…
when do we perform this? (2)
in context of secondary infections? (1)
3 pieces of equipment needed?
2 steps to do to complete? (1 is something NOT to do, 1 is what tool we use to see it)

Answer 14

when do we perform this?
1. EVERY CASE OF OTITIS
2. as the FIRST DIAGNOSTIC

2nd-ary infections?
1. QUICKEST/MOST DIAGNOSTIC METHOD

3 pieces of equipment needed?
1. COTTON SWABS
2. MINERAL OIL
3. GLASS SLIDES

2 steps for completion?
1. **DO NOT HEAT FIX
2. use DIRECT MICROSCOPY

Question 15

EAR BACTERIAL CULTURE & SENSITIVITY…
3 indications? (include 2 organisms for second, last one has 3 subs)
limitation? (long explanation)
techniques? (2)
how to sample for MIDDLE EAR? + how it’s done

Answer 15

indications?
1. CHRONIC/RECURRENT bacterial OE that FAILS TO RESPOND TO APPROPRIATE empirical therapy
2. Can be due to RESISTANCE, especially true for STAPH & PSEUDOMONAS
3. For systemic therapy treatment choices, which is needed for…
–> OTITIS MEDIA!! NUMBER ONE INDICATION FOR SYSTEMICS
–> Extensive ulceration
–> Severe stenosis

limitation?
NOT A GOOD INDICATOR for TOPICAL therapy because results based on SERUM CONCENTRATION, and though systemics can reach it, CANNOT PENETRATE EAR CANAL as well as topicals!

techniques?
1. sample JUNCTION between HORIZONTAL/VERTICAL canal
2. ALWAYS SAMPLE BOTH EARS!!

how to sample for middle ear = MYRINGOTOMY
–> done via INCISION in PARS TENSA of TYMPANUM for selecting SYSTEMIC MEDICATION

Question 16

CT/MRI for otitis…
indications? (3)
which is usually BETTER?
when to use the OTHER ONE?

Answer 16

indications? –> suspect…
1. INFLAMMATORY POLYPS
2. BONY CHANGES
3. possibility of OM

usually CT is better because BETTER VISUALIZATION OF TYMPANIC BULLA

MRI good for NEUROLOGIC signs!

Question 17

4 ways to manage CHRONIC otitis externa?

Answer 17

1. Resolve/minimize PREDISPOSING FACTORS
2. REDUCE INFLAMMATION (topical steroid)
3. Identify & resolve SECONDARY infections via CYTOLOGY!
4. Look for UNDERLYING/PRIMARY disease!

Question 18

TOPICAL treatment options for OTITIS EXTERNA…
usually the ___ treatment option
how do we choose which treatment?
what 3 active ingredients are in most topical otic medications?

Answer 18

BEST treatment option!

choose treatment based on CYTOLOGY

3 active ingredients?
1. antiBACTERIAL
2. antiFUNGAL
3. anti-INFLAMMATORY

Question 19

identify GENUS/SPECIES

Answer 19

STAPHYLOCOCCUS SCHLEIFERI (more common) or PSEUDINTERMEDIUS

Question 20

identify GENUS/SPECIES

Answer 20

PSEUDOMONAS AERUGINOSA

Question 21

treatment options for COCCI in OTITIS EXTERNA…
FIRST line? (2, + what 2 ingredients they have + a risk!)
second line? (mention, FYI)

Answer 21

FIRST LINE = NEOMYCIN or GENTAMICIN (aminoglycosides)
–> These medications ALSO HAVE ANTIFUNGAL & STEROIDAL properties!
**For dogs with ruptured eardrums, MORE LIKELY FOR OTOTOXICITY!

SECOND LINE = Amikacin (aminoglycoside), Polymixin B/Miconazole (antibiotic + antifungal)
–> Polymixin/miconazole are a good choice for STAPH

Question 22

treatment options for RODS in OTITIS EXTERNA? (3, how to formulate second)

Answer 22

1. GENTAMICIN (aminoglycoside)
2. SILVER SULFADIAZINE, usually need to mix sterile water & powder
3. POLYMIXIN B/surolan

Question 23

treatment options for YEAST in OTITIS EXTERNA? (2)
if there’s ONLY yeast in ear canals, WHAT SHOULD WE USE? (2 options)

Answer 23

1. AZOLES
   (1) MICONAZOLE
   –> + POLYMIXIN B in SUROLAN
   (2) CLOTRIMAZOLE
   –> + GENTAMICIN in MOMETAMAX/OTOMAX
2. TERBINAFINE
   –> + FLORFENICOL in OSURNIA/CLARO

**If ONLY YEAST in ear canals, then MICONAZOLE or CLOTRIMAZOLE ALONE!!

Question 24

treatment options for EAR MITES in OTITIS EXTERNA?
overall, how many options?
what kind of coverage should we provide + 4 examples?
if there’s a SECONDARY bacterial infection, treat with what drug/brand?

Answer 24

MANY options!

Ear mites DO NOT STAY IN EAR CANAL, so good to provide SYSTEMIC COVERAGE with…
1. SELAMECTIN
2. AFOXALANER (Nexgard)
3. FLURALANER (Bravecto)
4. LOTILANER

If SECONDARY BACTERIAL INFECTION, use THIABENDAZOLE (Tresaderm) because it treats secondary infections + mites!