ear exam Flashcards
Common complaints for ear exams
Scratching at ears
* Wounds, redness, discharge, strong smell
* Masses/growths
* Swollen ear
* Head shaking
* Head tilt
* Loss of balance
* Horner’s syndrome (dropped ear, dropped eyelid, raised 3rd eyelid, miosis – all on one side of the face)
* Loss of hearing
Basic equipment for an ear exam
Otoscope
* 2 clean, appropriate sized otoscope cones (ONE PER EAR)
* Swabs
* Slides
* Quick stain (e.g. DiffQuik)
* Microscope
* Ear cleaning solution
* Gauze/cotton wipes
Otoscope cleaning
Cleaning barrel and lens
* Clean the lens & inside of head
* Use clean dry lens paper or optical grade cloth
* Never submerge the head
* Outside can be cleaned with an isopropyl alcohol disinfectant wipe or a cloth dampened with 1:10 bleach solution
Otoscope ear tip cleaning
Ear tips are single use only
* Use 1 tip per ear – to prevent cross contamination
* Tips must be cleaned and disinfected after each use
* Wash with soap and water to remove biofilm
* Scrub inside with a soft bristle brush to remove secretions/wax/discharge
* Disinfect after washing:
* At minimum, soak in disinfectant (ex. Accel, 70% alcohol) for minimum of 20 minutes, rinse, let dry
* Better if sterilized - Cold sterilant solution or autoclave
Steps to basic ear exam
- History
- Distance exam – balance, hearing
- Systemic exam
- Focused exam
- Head
- Pinnae
- Opening of canal
- Otoscopic exam of canals and tympanic membrane
- Diagnostics
- Treatment
History for an ear exam
- How long the issue has been occurring
- Which ear(s)
- Has it happened before, how frequently, which ear(s), prior treatment (YOU should also check prior record)
- Has the owner put anything (meds, cleaners, home- remedies, etc.) into the ear
- Current diet and any diet changes
- Environment/lifestyle – swimming, groomer, baths
- Are other pets in the home also affected
- Ask if they have been head shaking, scratching, head tilting, or incoordination
- Loss of hearing
What to observe in the distance ear exam
Head tilt
Balance
Response to sound
Exam of head during ear exam
Look for:
Injuries
Head tilt, asymmetry
Horners syndrome
Horners syndrome is
A collection of changes caused by damage to the sympathetic nerves feeding the ear, eye, face
* Lots of different causes including lesions in the middle ear
Pineal exam
Common conditions
* Frostbite
* Infection, wounds
* Hematoma = bursting of capillaries in the pinnae causing bleeding under the skin (same day emergency)
Exam of the opening and canal
- Naked eye can only visualize the opening and distal vertical canal (not definitive)
- Must use otoscope to visualize deep vertical and horizontal canals, and tympanic membrane (TM)
- Never place solution/medication in the ear until an intact TM is confirmed
Stenotic
- Swollen, excessive tissue
- Canal may be closed off
Otoscope exam
- To visualize vertical and horizontal ear canal and TM
- Must be familiar with the ear anatomy to evaluate
properly - If ear is stenotic or very painful, vet may opt to delay examining/treating the canal until some of the inflammation can be controlled
- Only rule: Animal can’t move
- Gently restrain by chin or muzzle to prevent lateral movement
Accessing the ear canal
- Direction is very important
- Pulling gently on pinnae will elongate the canal
- Avoid “into the head”
- Direct “towards the cheek”
- Make sure head does not move
Cotton tipped applicator used when
- Clean, but not sterile
- Swabs for cytology
- Cleaning around opening
Sterile culture used when
- For culture and sensitivity
- Swab is stored/shipped in transport media
- One per affected ear
Ear swan is taken when
- Take sterile cotton swab and roll it along affected parts of the ear to collect discharge
- If ear is dry, may need to moisten with sterile isotonic saline
- Wetting the swab reduces cell damage during collection and smear preparation
What to do with the ear swab after collection
- After collecting the sample, gently roll along the flat surface of a glass slide
- If multiple parts of the ear are affected, swab separately.
Cytology for bacteria/yeast
- Heat fix
- Stain (Simple stain, DiffQuick, Gram)
- Hint for waxy ears and DiffQuik:
- Leave longer in #3 (1 min final dip)
- Evaluate under oil field and record:
- Epithelials (+/-)
- Bacteria (cocci/rods, approx #/oil)
- Yeast (budding or not, approx #/oil)
- WBCs (+/-)
- If rods or recurrent otitis, check if sterile swab for culture and sensitivity is requested before cleaning
Cytology for ear mites steps
- More common in cats
- Collect discharge from the inside of the vertical canal by gently wiping a cotton swab along the wall of the canal
- Place a drop of mineral oil on a glass slide
- Roll the sample along the glass slide in the oil
- Evaluate under the microscope under low power (10x objective)
- Otodectes cynotis mites may be seen at various life stages including the egg stage
- Occasionally can be seen with otoscope as very small white flecks moving over discharge in the ear
- Always check if there are other cats in household
- ALL cats in a household must be treated to control an infection
Reasons for ear cleaning
- Important part of managing otitis externa
- Indicated when there is discharge in the ear canal
- Facilitates exam of ear canal
- Removes microbes, material that harbours microbes, small foreign bodies
- Exposes lining of the ear to topical therapy
- Prevents inactivation of topical therapy
general rules for ear cleaning and medication
- Make sure all exam and diagnostic testing is completed before cleaning
- Must confirm an intact tympanic membrane
- Never clean with alcohol or antiseptics
- Some cats are very sensitive to chemicals in the ear
- Higher degree of drug absorption through the skin
- Location of cranial nerve near TM
- Purulent discharge can inactivate drug so ears must be cleaned out before medicating
- Medication must reach the site of infection
- Ears that are very painful or stenotic may require systemic treatment before any topical treatment
Steps to clean ears
- Make sure animal is restrained to a degree
- If itchy, rubbing the ear will increase tolerance
* Rub at the cheek (over horizontal canal) - Gently extend pinnae
* Place dispenser close to opening.
* Do NOT touch container to ear or will contaminate bottle.
* Do not release pressure on container until away from ear.
* Fill canal to “brim” with cleaner4. Massage along length of ear canal for 30-60 seconds
* Below the opening, along the “groove in the cheek”
* This agitates the fluid to break down discharge - Let patient shake
* Stand back or hold towel over head
* Repeat once if required - Wipe excess cleaner from ear opening and pinnae with
gauze/cotton/tissue - Can use cotton swabs around opening only
- Allow 15 minutes to “dry” before medicating
Using a Q-tip
- Do not go further than you can see
- Recommend owners not to use Q-tips
- Wet gauze or tissue can be as effective for cleaning around opening
- Can pack debris into the ear canal
- Risk of perforating the tympanic membrane
- Exception: can be handy to remove ear mites during cleaning process in very infected cats
