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Dermatology > Ear Diseases > Flashcards

Ear Diseases Flashcards

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Dermatology Board Prep flashcards
1
Q

When looking in the ear where to you insert the otoscope?

A

Into the intertragic incisure

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2
Q

Anatomy of tempanic membrane

A 
Pars flaccida (vessels here)
Stria mallearis (C shaped bone)
Pars tensa (semi-transparent)
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3
Q

What is Otitis Externa

A

Inflammation of the ear canal

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4
Q

Otitis Causes (3 broad -Ps-)

A

Primary (allergies)
Predisposing (swimming)
Perpetuating

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5
Q

Otitis: Primary Causes

A 
Parasites:
Otodectes 
Otobius
Demodex
Sarcoptes/notoedres

Allergies

Foreign bodies

Disorders of keratinization

Neoplasia

Autoimmune

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6
Q

Otodectes cynotis

A

Primary cause of otitis

Dogs and cats
Coffee ground appearance
Ears can be normal
Can be visualized

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7
Q

Demodex

A

Primary cause of otitis
uncommon

canis
injai
cati

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8
Q

Sarcoptes

A

Primary cause of otitis
Scabies!
Dogs

Zoonotic

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9
Q

Notoedres

A

Primary cause of otitis
Feline

Otitis externa

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10
Q

Allergies (3 kinds)

A

Most common primary cause of otitis

Atopy: pruritus on face, paws, axiallae, inguinal

Food: +/- pruritus

Contact hypersensitivity: propylene glycol

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11
Q

Swimming lab DfDx for Otitis

A

Yeast

However, if this keeps happening might actually be allergies!

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12
Q

Foregin bodies

A

Primary cause of otitis

Grass awns
Medications

Usually unilateral

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13
Q

Disorders of keratinization

Causes

A

Primary cause of otitis

Primary seborrhea
Sebaceous adenitis
Hypothyroidism
Cushing’s disease?

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14
Q

Otitis think…

A

Allergies

Endocrine

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15
Q

Pyoderma think…

A

Allergies

Endocrine

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16
Q

Neoplasia

A

Primary cause of otitis

Inflammatory polyps (usually due to chronic issues)
Benign and malignant types:
Adenoma
Cysts (apocrine)
Apocrine gland carcinoma
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17
Q

Autoimmune

A

Primary cause of otitis

Pemphigus foliaceus
Caseous like material
Eyes, nose, ears

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18
Q

Predisposing Causes of Otitis (Anatomy)

A

Pendulous pinnae
Stenotic ear canal (brachycephalic breeds)
Increased hair in ears

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19
Q

Predisposing Causes of Otitis (Lifestyle)

A

Swimming
Grooming (plucking; causes inflammation)
Overzealous cleaning

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20
Q

Perpetuating Causes of Otitis

A

Yeast
Bacteria
Chronic changes
Otitis media

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21
Q

Clinical Signs of Acute Otitits

A 
Head shaking
Ear scratching
Head carriage
Erythema
Facial trauma
Aural hematoma (blood vessels rupturing from shaking head)
Mal-odor
Debris
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22
Q

Clinical Signs of Chronic Otitits

A

Lichenification
Thickening of ear canal cartilage (end stage)
Stenotic ear canal (can’t get the ear swab in)
Ceruminal gland hyperplasia

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23
Q

Pseudomonas otitis

Clinical Signs

A

Perpetuating cause of otitis

Mal-odor
Fluid on palpation
Purulent discharge
Ulcerated ear canal
Pain
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24
Q

Diagnosis of Otitis

History

A 
Age of onset
Recurrence?
Pruritus?
History of skin infections?
Swimming?
Bathing?
Hiking?
Hunting?
Treatments already done
25
Q

Diagnosis of Otitis

Broad

A

PE:
Observe gait and mentation (head tilt; think interna)
Palpate ear canals
Open mouth (painful suggests middle ear infection)
Skin and paws (allergies)

26
Q

Diagnosis of Otitis

Specific exam…

A

Otoscopic Exam
Look at both ears (less affected one first)
Understand anatomy
Need to see the TM (must be in-tact for certain treatments; mainly important for patients with head tilt/suspected rupture-otitis interna-)
Head being held out straight is most helpful

27
Q

Why would you not be able to see the TM?

A

Inadequate restraint
Painful
Waxy material blocking TM
Severe stenosis (calcification, chronic issue)

Not 100% necessary unless head tilt/suspected rupture

28
Q

Diagnostics -main-

A

Ear cytology!

Always address underlying cause

29
Q

Diagnostics Additional

A

Culture?
When suspecting pseudomonas
Infection is persisting in face of appropriate treatment
PMNs with no apparent bacteria

Note: stenotic ears are most likely not receiving all the necessary antibiotic

30
Q

Diagnostics: what advanced imaging is the best

A

Mainly for otitis media
CT

Can also use:
MRI or ultrasound

31
Q

Management of Otitis (4 steps)

A
  1. Look for primary cause
  2. Address predisposing causes
  3. Reduce inflammation (steroid)
  4. Treat secondary infections
32
Q

When prescribing ear meds what is important

examples

A

Volume!
Not enough volume than will not be cured

Toy breeds/cats: 0.25 cc
Small/medium: 0.5 cc
Large: 1 cc

Twice daily for 14 days

33
Q

Neurologic deficits/Ruptured TM

Meds

A

Safe:
Enrofloxacin
Miconazole
Dexamethasone

Avoid:
Aminoglycosides
Chlorhexidine

34
Q

Ear Cleaners

Properties

A

Ceruminolytic
Drying agents
Antimicrobial

Can be ototoxic

35
Q

Ear Cleaners

Procedure

A

Must flood ear canal and message for 30 seconds

Use soft gauze to clean out (external portion)

Do not have to use cotton swabs the ear cleaner should debride what is necessary

36
Q

Ear Cleaners

Ruptured TM

A

Saline
Squalene
TrizEDTA; good for pseudomonas

37
Q

Oral Antibiotics for Otitis Externa

A

Debatable

Oral antibiotics most likely will not reach externa

Needed for otitis media/interna; 6-8 weeks

38
Q

Anti-inflammatory

A

Corticosteroids:
Topical
Oral = most helpful

NSAIDs NOT useful

39
Q

How to treat a chronic endstage diseased ear

A

Very stenotic so cannot get meds in

Will have to do Sx (Total ear canal ablation; TECABO)

40
Q

Key to Successful Treatment

5 Components

A

Look for primary/predisposing causes

Good communication

Open ear canal; steroids, decrease inflammation and secretions from sebaceous glands

Use large volumes

Re-checks

41
Q

Ear Mites

Treatment (2)

A

Topical:
Pyrethrin
Thiabendazole
Milbemite

Systemic:
Revolution (3x: 1 treatment every 2 weeks)
Isoxazolines (Bravecto, Nexgard, Simparica)

42
Q

Malasezzia Otitis

A

Common organism

Look for primary/predisposing causes

Smell test not accurate; cytology

Treatment; azoles
Stenotic? use liquid not ointment

43
Q

Bacterial Otitis

Types (non-pseudomonas)

A

Cocci:
Staph

Rods:
E. coli
Proteus
Kelbsiella
Corynebacterium
44
Q

Bacterial Otitis

Treatment (non-pseudomonas)

A

Aminoglycosides (as long as TM is in-tact)
Florfenicol
Polymixin B

Note momentamax is ineffective against pseudomonas

45
Q

Bacterial Otitis
Recurrent
What to consider

A

Allergies!

Endocrine; hypothyroidism

46
Q

Pseudomonas Otitis

Characteristics

A

History of chronicity

Tends to be resistant

47
Q

Pseudomonas Otitis

Diagnosis

A

Suspect with history and PE (purulent debri)

Cytology:
PMNs with a lot of rods; should be the only bacteria type

Culture: ID

48
Q

Pseudomonas Otitis

Treatment

A 
TrizEDTA: punches holes in bacteria wall
Enrofloxacin
Tobramycin 
Silver sulfadiazine 
Ticracillin
Polymixin B

Corticosteroids (decrease inflammation and ulceration)

49
Q

Components of middle ear

A 
TM
Tympanic bulla
Auditory (Eustachian) tube
Auditory ossicles
Facial nerve (inner ear only)
50
Q

Otitis Media

Pathogenesis

A

Chronic OE usually

TM is composed of collagens (type 1 and 2) which weaken with infection

51
Q

Otitis Media

Infectious organisms

A 
Staph
Streptococcus
Pseudomonas
E. coli
Proteus

Otitis externa can be due to different bacteria

52
Q

Otitis Media

Other causes

A

Fungal
Foreign bodies
Masses

53
Q

Otitis Media

Clinical Signs

A

History of chronicity

Pain on opening mouth

Neurologic deficits:
head tilt, facial paralysis, Horner’s syndrome

54
Q

Otitis Media

Diagnosis

A

History:
Chronicity
Poor response to treatment

PE

Otoscopic exam:
Mass
TM: ruptured, bulging, color

55
Q

Otitis Media
Diagnosis
Myringotomy

A

Referal procedure

Have to rupture the TM

Fluid/material collection from middle ear
Send out for C/S

Flush ear

56
Q

How long does it take for a ruptured TM to heal?

A

2-4 weeks

57
Q

Otitis Media

Treatment

A

Systemic antimicrobial:
6-8 weeks

Topical treatment:
TrizEDTA
Saline
Squalene
Baytril
Miconazole
58
Q

Systemic antibiotics for generalized pyoderma

How long?

A

3-4 weeks

59
Q

Otitis Media

Prognosis

A

Gaurded
Recurrences possible
VBO may need to occur

Always look for primary cause

Dermatology (13 decks)

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