Ear diseases CY

Question 1

With the PPSP classification of ear disease, what is a Primary cause? And name 3

Answer 1

Create disease in normal ear

Allergy, autoimmune (BP, EB, LE, PF), Endocrine (esp hypoT), Foreign bodies (plant awns), Epithelial disorders (idiopathic seborrhea, vit A responsive dermatosis), Immune mediated (drug reactions, EM, vasculitis), dermatophytes, parasites (otodectes, Otobius, chiggers)

Question 2

What is a secondary cause (PPSP)? Name 3 for ear disease

Answer 2

= create disease in an abnormal ear

Bacteria, fungal (aspergillus), medication reaction (propylene glycol), overcleaning (moisture and maceration), yeast

Question 3

What is a Predisposing factor (PPSP) in ear disease? Name 3

Answer 3

= present prior to ear disease development

Conformation (excess hair growth, stenosis), moisture (grooming), obstructive ear disease (feline cystamatosis), PSOM, OM d/t neoplasia

Question 4

What are perpetuating factors (PPSP) in ear disease?

Name 3

Answer 4

= occur as a result of otic inflammation

Failure of epithelial migration, oedema, proliferative changes, ruptured TM, sebaceous hyperplasia, apocrine dilation, calcification, OM

Question 5

A 4 year old DSH presented to you with this

It’s bilateral, affected concave pinna and external orifice

What is your top ddx?

Answer 5

Feline proliferative and necrotizing otitis externa

Question 6

What is the aetiology of feline proliferative and necrotizing otitis externa?

Answer 6

Unknown aetiology

a/c with T cell induced caspase-positive epidermal keratinocyte apoptosis (like EM)

Question 7

In chronic otitis, where does the calcification of the ear canal occur?

Answer 7

In the connective tissue OUTSIDE Of the auricular or annular cartilage

Question 8

What is p53 tumor suppressor?

Why is this important in SCC?

Answer 8

Protects the body from DNA damage and cancer

Mutations of p53 can be seen with SCC

Question 9

Name 2 dog breeds that have been reported to have Primary secretory otitis media

Answer 9

CKCS, Boxers

Question 10

What am I?

Non-neoplastic mass of epithelial tissue, fibroblasts, macrophages, lymphocytes, plasma cells, neutrophils

Often arise from the mucosa of the middle ear or auditory tube

Answer 10

Feline inflammatory polyps

Question 11

What am I?

Multiple blue-fluid filled cystic masses of concave pinna

Non-neoplastic disorder; Persians over represented

Common predisposing factor; may be asymptomatic

Answer 11

Ceruminous cystamatosis

Question 12

What is a rare fatal complication of bacterial OM in dogs and cats?

Answer 12

Meningoencephalitis

Question 13

What breed is primarily affected in Idiopathic inflammatory or hyperplastic otitis externa?

Answer 13

Young cocker spaniels

Question 14

What is idiopathic inflammatory or hyperplastic otitis externa?

Answer 14

Possible primary glandular disorder, can lead to calcified ear canals

Question 15

What changes can occur in dogs ears with HypoT and sex hormone imbalances?

Answer 15

Chronic ceruminous otitis externa from altered keratinization and glandular function

Question 16

Ear mites can induce what type of hypersensitive reaction?

Answer 16

Ear mites can induce Arthrus-type and immediate hypersensitive reactions

Question 17

Cat ear, what is this?

Answer 17

Mammomonogamus auris: middle ear of cats of Northwest Pacific

Question 18

What otitis externa disease is a/c with T cell induced caspase-positive epidermal keratinocyte apoptosis (like EM)?

Answer 18

Feline proliferative and necrotizing otitis externa

Question 19

True/False

Pinnal squamous cell carcinoma has a relatively high metastasis rate

Answer 19

False

Pinnal SCC has relatively low mets rate

Question 20

Give 7 ddxs (cat pinnal lesions)

Answer 20

SCC, dermatophytosis, notoedric mange, fight wounds, vasculitis, frostbite/cryoglobulinemia, DLE/SLE, PF

Question 21

What ear disease is the most common cause of peripheral vestibular signs in both dogs and cats?

Answer 21

Otitis interna

Question 22

On clinical exam, a patient presented with a head tilt and nystagmus. They are ataxic, but no weakness detected or proprioceptive deficits. Is this peripheral or central vestibular disease?

Answer 22

Peripheral vestibular disease

Question 23

List clinical signs of PSOM

Answer 23

Hearing loss, neurological signs (facial nerve paralysis, head tilt, ataxia), head and neck scratching, otic pruritus, excessive or abnormal yawning, yelping, head shaking, neck pain, painful ears

Question 24

What are theories for pathophysiology of PSOM?

Answer 24

increased production of viscous mucus in middle ear

decreased drainage of middle ear through auditory tube

or both

Question 25

How to perform a myringotomy?

Answer 25

Passing a sterile 5-French polypropylene urinary catheter cut to approximately 30 cm in length, attached to a 12-cc syringe through the port of the video otoscopic otoendo- scope. The 5-French catheter was used to make the myringotomy incision in the caudoventral quadrant of the pars tensa. One mL of warm isotonic irrigation saline was flushed into the middle ear cavity through the 5-French catheter in order to retropulse the mucus from the ME into the EEC. The mucus was then suctioned from the EEC and collected into a sterile 30 mL polypropylene conical tube.

Question 26

In Cole et al, 2019, bacteriology and cytology of otic exdudates of PSOM dogs, how many cultured positive and which strain of bacteria was predominant?

Answer 26

1/3 of 69 middle ear exudates of 41 CKCS with PSOM were culture positive

of 49 bacterial isolates, most common bacterial species was coagulase-negative staphylococci (60% from external ear canal, 59% from middle ear) - 5/15 from external ear were MRS, 11/34 from middle ear were MRS)

Question 27

The normal canine middle ear has been shown to harbor low numbers of bacterial organisms, including _____, as well as ___, ___and __

Answer 27

The normal canine middle ear has been shown to harbor low numbers of bacterial organisms, including Staphylococcus, as well as E. coli, yeast, and Morazellaceae

Question 28

What is another name for aural cholesteatoma?

Answer 28

Tympanokeratoma

Question 29

What is an aural cholesteatoma?

Answer 29

destructive expansile growths of keratinizing epithelium that develops in the middle ear.

Epidermoid cyst that develops in the middle ear, composed of keratin debris surrounded by keratinizing stratified squamous epithelium…“skin growing in the wrong place”

misplaced keratinizing epithelium constantly sheds keratin debris –> gradual enlargement of cyst and eventual destruction of adjacent tissue due to increasing pressure and osteoclastic bone resorption activated by inflammatory cytokines.

Regarded as severe complication of OM.

Question 30

T/F: Otitis externa always precedes choleasteatoma in all dogs

Answer 30

F; does not always precede cholesteatoma

Question 31

T/F: Neuro signs are never seen with cholesteatomas.

Answer 31

F, neuro signs may occur.

Clincial signs include non-specific ones, but include otic discharge, head shaking, rubbing, otic pain +/ - nasopharyngeal and/or neuro signs

Question 32

What is the treatment of cholesteatomas?

Answer 32

only curative tx is TECABO, with primary objective being removal of all keratinous debris and stratified squamous epithelium.

Recurrence is common post-sx.

Question 33

What is the auricular projection also called?

Answer 33

Dorsal fold; represents a landmark that separates vertical and horizontal ear canals

=cartilaginous ridge

Question 34

Imai et al. 2018 found doliocephalic/brachycephalic breeds to be overrepresented in their retrospective study on cholesteatomas.

Answer 34

brachycephalic

Question 35

What are perceived predisposing factors for developing primary acquired cholesteatoma? Is this more or less common than the secondary acquired form?

Answer 35

Previous reports documented that dysfunction of the auditory tube and the narrow nasopharynx could be predisposing factors for developing primary acquired cholesteatoma

hypertrophic bulla walls and stenotic bony parts of the horizontal ear canals also could predispose brachycephalic breeds to secondary acquired cholesteatoma

primary acquired cholesteatoma is considred less common than the secondary acquired form

Question 36

CT is an important part of assessing dogs with middle ear disease. What are CT findings likely suggestive of cholesteatomas?

Answer 36

nonenhancing but expansile lesion, which is hyper-attenuating to brain, is likely to be a cholesteatoma, +/- expansion of bullae

54% of ears in Imai et al. vet derm 2018 had expansile bullae with 75 % of the brachycephalic breeds with expansile bullae also having lysis of bullae

Question 37

How do polyps and cholesteatomas differ histopathologically?

Answer 37

Polyp: Presence of ciliated columnar epithelial cells is a prerequisite

Cholesteatoma: protruding nodule consisting of fibrous connective tissue surrounded by squamous epithelium

Question 38

surgical treatment is curative in only ___% of cases of canine cholesteatoma

Answer 38

50%