Defense & Barriers: Otitis 2 Flashcards
we should only ____ daily but not ____ daily, why?
TREAT daily but NOT CLEAN
can cause MACERATION or DESTRUCTION OF EPITHELIAL LINING OF EAR CANAL
SECONDARY infections to otitis…
why must they be addressed?
3 microorganisms?
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
3 clinical signs for PSEUDOMONAS AERUGINOSA infection?
- CHRONIC otitis
- MALODOROUS, SEPTIC-TANK like odor
- SUPPURATIVE EXUDATE (yellow or green)
DEAFNESS is associated with what infection?
OTITIS MEDIA
FACIAL NERVE PARALYSIS is associated with what infection?
what reflex is slowed?
OTITIS MEDIA (facial nerve runs close to middle ear)
slow PALPEBRAL reflex
head tilt/nystagmus are signs of WHAT?
NEUROLOGIC VESTIBULAR signs due to SECONDARY INFECTION to OTITIS
the majority of ___ ___ cases will also have ____ ___
OTITIS MEDIA –> OTITIS EXTERNA
why is an ORAL exam important in DOGS & CATS?
CATS = can have INFLAMMATORY POLYPS in NASOPHARYNGEAL region
DOGS = have PAIN when OPENING MOUTH due to OM because middle ear NEAR TMJ
4 important things to do for exam for OTITIS?
- PHYSICAL EXAM & HISTORY
- PALPATE EARS
- perform NEUROLOGIC exam
- perform ORAL EXAM
identify genus/species
PSEUDOMONAS AERUGINOSA
identify organism (type)
EAR MITES
PERIORAL HYPERPIGMENTATION/ALOPECIA indicates what 2 diseases?
ALLERGY, ATOPY
OTOSCOPIC exam…
3 goals?
how to perform? (+what are we straightening out?)
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
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)
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
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
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
CT/MRI for otitis…
indications? (3)
which is usually BETTER?
when to use the OTHER ONE?
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!
4 ways to manage CHRONIC otitis externa?
- Resolve/minimize PREDISPOSING FACTORS
- REDUCE INFLAMMATION (topical steroid)
- Identify & resolve SECONDARY infections via CYTOLOGY!
- Look for UNDERLYING/PRIMARY disease!
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?
BEST treatment option!
choose treatment based on CYTOLOGY
3 active ingredients?
1. antiBACTERIAL
2. antiFUNGAL
3. anti-INFLAMMATORY
identify GENUS/SPECIES
STAPHYLOCOCCUS SCHLEIFERI (more common) or PSEUDINTERMEDIUS
identify GENUS/SPECIES
PSEUDOMONAS AERUGINOSA
treatment options for COCCI in OTITIS EXTERNA…
FIRST line? (2, + what 2 ingredients they have + a risk!)
second line? (mention, FYI)
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
treatment options for RODS in OTITIS EXTERNA? (3, how to formulate second)
- GENTAMICIN (aminoglycoside)
- SILVER SULFADIAZINE, usually need to mix sterile water & powder
- POLYMIXIN B/surolan
treatment options for YEAST in OTITIS EXTERNA? (2)
if there’s ONLY yeast in ear canals, WHAT SHOULD WE USE? (2 options)
- AZOLES
(1) MICONAZOLE
–> + POLYMIXIN B in SUROLAN
(2) CLOTRIMAZOLE
–> + GENTAMICIN in MOMETAMAX/OTOMAX - TERBINAFINE
–> + FLORFENICOL in OSURNIA/CLARO
**If ONLY YEAST in ear canals, then MICONAZOLE or CLOTRIMAZOLE ALONE!!
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?
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!
