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SA DX & TX II > Exam 2 - Otitis Externa > Flashcards

Exam 2 - Otitis Externa Flashcards

1
Q

what is cerumen?

A

waxy secretion formed by sebaceous & ceruminous glands that contains immunoglobulins, & coats the epithelial lining trapping debris/desquamated cells/hair/micro-organisms

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2
Q

T/F: otitis is a form of skin disease & may be the only sign of dermatological disease going on in an animal

A

true

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3
Q

what is the most common reason we see otitis media?

A

extension of chronic otitis externa into the bulla/tympanic cavity

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4
Q

how is otic disease classified?

A

anatomical classification

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5
Q

what is otitis externa?

A

external vertical and/or horizontal canal that is inflammed/diseased

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6
Q

what are some signs that indicate otitis externa?

A

otic odor, head shaking/pawing/rubbing at ear, altered ear carriage, ipsilateral head tilt that isn’t neurologic, otic discharge, aural hematomas, etc

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7
Q

what is otitis media?

A

media - middle ear (bulla) is inflammed/diseased

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8
Q

what are some notable exceptions of when we see otitis media in companion animals?

A

feline inflammatory polyps originating in the bulla or eustachian tube

primary secretory otitis media in cavalier king charles spaniels

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9
Q

what is otitis interna?

A

inner ear is inflamed/diseased

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10
Q

what is the most common reason we see otitis interna in companion animals?

A

most often due to the extension of otitis media into the inner ear structures within the petrous temporal bone of the skull

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11
Q

extension of otitis media into otitis interna is a very common cause of what neurological disease?

A

peripheral vestibular disease

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12
Q

what is a primary cause of otitis externa in companion animals?

A

companion animal food reaction/allergy

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13
Q

what are some clinical signs seen in animals with otitis media/interna?

A

otitis externa signs, head & neck pain, difficulty opening the mouth, horner’s syndrome, facial nerve paralysis, peripheral vestibular disease, & deafness

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14
Q

what are some pathological changes seen in the ear due to chronic otitis externa?

A

edema, glandular hyperplasia, folding, stenosis, fibrosis, calcification, & failure of epithelial migration

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15
Q

what are some examples of primary causes of otitis externa?

A

parasites, allergy, cornification, endocrine problems, immune-mediated/autoimmune disease, trauma, FB, & mass

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16
Q

what are some predisposing factors that contribute to otitis externa?

A

animal conformation, excess moisture, iatrogenic, & owner error

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17
Q

what are some sequela of otitis externa?

A

infection, ongoing pathology, & otitis media

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18
Q

what therapy can be utilized to reduce predisposing risk factors for otitis externa?

A

reduce moisture in the ears, reduce cerumen, remove hair, reassess owner compliance, & reassess your treatment plan

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19
Q

what therapy can be utilized to reduce primary causes for otitis externa?

A

often neglected part of therapy - failure to ID & treat a primary cause is a common reason for failure, need to ID & treat the cause

therapy is more than just a topical commercial product

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20
Q

what therapy can be utilized to reduce the common sequela of otitis externa?

A

remove otic discharge, improve drainage of the ear, ID & eliminate infection, & halt the progression of the disease

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21
Q

before treating otitis externa in cats, what must be ruled out first?

A

otodectes

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22
Q

what is the purpose of using systemic glucocorticoids for an animal with otitis externa?

A

reduce pain, edema, cerumen, hyperplasia

& improve visualization & flushing

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23
Q

at what point would TECABO be recommended for a patient with otic disease?

A

animal has:

ossified canals

stenosis in the canal is unaffected by steroids

patient intolerance to other therapies/owner can’t effectively treat the pet

monetary concern over time

patients with otitis media/interna

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24
Q

what are some dog breeds that have normally narrowed ear canals making them predisposed to developing otitis externa?

A

shar pei, chow chow, & english bull dog

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25
Q

why does poor confirmation predispose an animal to otitis externa?

A

they have poor aeration of the canal, increased temperature in the ear, & increased humidity in the canal

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26
Q

why does increased moisture in the ear predispose an animal to otitis externa?

A

maceration of the epithelium & excessive moisture removes the protective cerumen

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27
Q

what are some examples of iatrogenic/owner errors that may predispose an animal to otitis externa?

A

inappropriate treatment, excessive ear flushing, over or under treating, & trauma from cotton swabs

removing healthy cerumen, infection is gone but owner continues treatment

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28
Q

what is the most common cause of otitis externa in cats?

A

otodectes cynotis - ear mites

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29
Q

what is an example of an endocrinopathy that causes otitis externa?

A

hypothyroidism - ceruminous otitis

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30
Q

what mass commonly causes otitis externa in cats?

A

inflammatory polyp - usually unilateral otitis where the mass arises from the bulla, eustachian tube, or nasopharynx

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31
Q

what is primary secretory otitis media?

A

disease seen in cavies where excessive mucus production in the bulla can rupture through the tympanic membrane & drain into the ear canal with many signs overlapping with chiari-like malformation & syringomyelia

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32
Q

what cocci are commonly involved in otitis externa?

A

staph, strep, & enterococcus

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33
Q

what rods are commonly involved in otitis externa?

A

pseudomonas, proteus, e. coli, & cornyebacterium

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34
Q

what yeast is commonly identified in otitis externa?

A

malassezia

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35
Q

what is the treatment for end-stage otitis?

A

canal removal

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36
Q

T/F: at least 70% of the time in otitis media, the tympanum is intact

A

true

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37
Q

what is likely present if an animal has had otitis externa for more than 6 months?

A

otitis media

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38
Q

what pathological feature is seen that indicates acute inflammation in the ear canal?

A

edema

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39
Q

what pathological feature is seen that indicates chronic inflammation in the ear canal?

A

glandular hyperplasia, stenosis, & folding

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40
Q

what is a ceruminolith?

A

solid accumulation of cerumen - wax plug/ball

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41
Q

if bloody discharge is seen in an ear canal, what is likely present?

A

an otic mass

42
Q

what kind of otic discharge may indicate over treatment?

A

white, creamy, odor-free discharge

43
Q

what is otoscopy used for?

A

to visualize the health of the otic canal & look for pathology

44
Q

what treatment can you do for an animal that has severely inflamed/proliferative ears to help you better visualize the canal & treat their discomfort?

A

7-14 days of anti-inflammatory dose of oral steroids or topical steroids to reduce pain, edema, & glandular secretions to then be able to properly visualize the ear canal

45
Q

if you see that the tympanic membrane looks ruptured/bulging/thickened/absent, what are you concerned for the presence of?

A

otitis media

46
Q

what does cerumen discharge look like?

A

gray to brown/black material that is adhered to the canal wall that may be dry or moist & has a yeasty odor

47
Q

when may you use a video otoscope?

A

performing a myringotomy for a ruptured tympanum, collecting bulla contents, flushing the bulla, & getting a of biopsy any mass

48
Q

what are the goals of otic cytology?

A

identifying/characterizing an infection & perpetuators of disease & better assisting in therapeutic intervention selection

49
Q

if you see rods on an ear cytology, what agent do you think is present?

A

pseudomonas

50
Q

what is the most common agent seen in yeast infections in the ears?

A

malassezia pachydermatitis

51
Q

T/F: it is normal to find inflammatory cells in a normal ear canal

A

false

52
Q

T/F: an otic culture is very helpful in diagnosing otic disease

A

false - rarely adds to any info obtained through otoscopy & otic canal cytology

53
Q

______ ________ is an indication for bulla culture

A

otitis media

54
Q

T/F: topical antibiotics can achieve a much higher concentration in the ear canal

A

true

55
Q

what happens if you fail to identify & treat the primary cause of otitis externa?

A

lead to more frequent/chronic & resistant infections & continuing pathological changes in the ear canal resulting in an end-stage ear that is beyond medical intervention

56
Q

for all cases of chronic/proliferative otitis & otitis media, what therapy is recommended in the hospital?

A

deep otic flushing under general anesthesia - collect bulla contents for culture prior to aggressive cleaning measures

57
Q

what is always safe to use in flushing out an ear? when would you use it?

A

warm saline!

worried about tympanum/otic toxicity

58
Q

what drug can be used in the hospital for breaking up wax in the ear canal?

A

dioctyl sulfosuccinate (surfactant) must flush out well

59
Q

why should you be careful with how much pressure you apply when flushing an ear?

A

too much pressure can rupture the tympanic membrane

60
Q

what is considered to be a ‘liquid q-tip’ for at home treatment?

A

ear flush

61
Q

how should you show the client to use the proper amount of flush at home? how often do you instruct them to use it?

A

fill up the canal with otic flush - let them see it

don’t use more frequently than every 48 hours during initial therapy & use prophylactically after that

62
Q

T/F: any product/ingredient has the potential to be ototoxic & may manifest as an idiosyncratic reaction for any given patient

A

true

63
Q

how should you show the owner to properly dispense medications into the ear?

A

place a thin volume of medication to where it lines the canal & treat twice daily

64
Q

ototoxicity is reported most commonly with what drug class?

A

aminoglycosides

65
Q

how long should topical treatment be prescribed for otitis externa?

A

2 weeks & then reassess clinically & cytologically - need to continue 1-2 weeks past clinical & cytological resolution

66
Q

what are the benefits of using systemic steroids for a patient with otitis externa?

A

reduce pain - allows client to instill topicals

reduce edema - allows for better topical penetration & reduces humidity

reduces cerumen production - less debris inactivating topicals

reduce glandular & epithelial hyperplasia - slows the progression of pathological changes & dilates the canal

67
Q

when should you consider prescribing systemic steroids for a patient with otitis externa?

A

otic canals are too painful/proliferative to assess

topical drugs are ineffective or deemed inappropriate

when trying to assess if proliferation/stenosis are reversible & therefore amenable to continue medical management

if steroids don’t open the canal, total ear canal ablation & bulla osteotomy is likely indicated

68
Q

what diagnostic tool should you use on every case of otitis?

A

cytology

69
Q

T/F: often, enough volume of topical products are not administered in the otic canal

A

true

70
Q

why do we see animals needing TECABO?

A

many cases of otitis are needlessly/unsuccessfully managed medically & lead to the continued pain/discomfort to the patient & inappropriate cost to the client

71
Q

what are the goals of managing an ear with otitis at home?

A

dry, acidify, neutralize, antiseptic, & remove cerumen

72
Q

what cases do you reserve otic canal culture for?

A

when you see neutrophils cytologically & appropriate empirical therapy fails

73
Q

T/F: pseudomonas species are becoming increasingly resistant to fluoroquinolones

A

true

74
Q

are topicals going to work well in a patient that has ongoing canal pathology due to otitis externa?

A

nope

75
Q

what is the most common benign neoplasia seen in the ears of dogs?

A

ceruminous adenoma

76
Q

what is the most common malignant neoplasia seen in the ears of cats?

A

ceruminous adenocarcinoma & SCC

77
Q

what dog breeds are predisposed to cornification defects leading to ceruminous otitis?

A

cocker spaniels!!!!!!

78
Q

T/F: canine allergic food reactions & atopy are common allergic disorders that cause otitis

A

true

79
Q

what does a ‘predisposing factor for otitis externa’ mean?

A

in & of themselves not able to cause otitis but make an individual more susceptible to otitis when a primary cause arises

80
Q

what does it mean to be a ‘primary cause’ of otitis externa?

A

conditions/diseases that result directly in otitis

81
Q

what does it mean to be ‘perpetuating sequelae of otitis externa’?

A

secondary conditions resulting from primary causes that contribute to disease progression & hinder resolution even if the primary cause & predisposing factors have been managed or resolved

82
Q

what are the canals that make up the companion animal’s ear?

A

vertical canal & horizontal canal

why we don’t use q-tips & instead use flush to avoid pushing gunk further into the ear

83
Q

what is the function of the ear canal?

A

directs sound waves to the tympanic membrane

84
Q

what are the 2 parts that make up the tympanic membrane?

A

pars tensa & parsa flaccida

85
Q

what is the pars tensa?

A

thin semitransparent membrane continuous with the otic canal lining on the lateral side & bulla lining on the medial side

86
Q

what is the pars flaccida?

A

dorsal opaque rim of the ear drum with well-vascularized tissue - don’t confuse with it being a mass

87
Q

what is the function of the pars tensa & pars flaccida?

A

tensa - transmits sound waves to the auditory ossicles

flaccida - provides bloody supply to the tensa

88
Q

what is inside of the tympanic cavity?

A

auditory ossicles (malleus, incus, stapes), eustachian tube, & nerves)

disruption of postganglionic sympathetic fibers leads to horner’s syndrome

89
Q

the tympanic cavity is lined with upper respiratory epithelium (ciliated columnar epithelium) - do feline respiratory viruses cause or favor inflammatory polyps?

A

favor - may play a role in the development of them by triggering inflammation

90
Q

what is the function of the tympanic cavity/bullae?

A

transmit sound vibrations through auditory ossicles to the oval/vestibular window of the inner ear

91
Q

what is included in the inner ear?

A

cochlea & semicircular canals

vestibule is the common entrance into the cochlea & semicircular canals

92
Q

what is the function of the inner ear?

A

cochlea - hearing

semicircular canals - balance

93
Q

in regards to otic anatomy, what is the manubrium? why is it important?

A

manubrium of the malleus inserts within the pars tensa & is visible on the otoscope as a finger-like projection

it is the region that contains germinal cells of the tympanum, so if it is ruptured, this is what allows for healing to occur

94
Q

what is epithelial migration?

A

normal cleaning process of the ear - pulling out squames, cerumen, hair, microbes, & medication

germinal center cells of the pars tensa migrate outwards & travel up & out of the ear

95
Q

what are some examples of in-hospital topical cleaners used for otitis externa?

A

bulb syringe/water pick/catheter & syring

dioctyl sodium sulfosuccinate

96
Q

what are some examples of at-home topical cleaners used for otitis externa?

A

cerumenolytics, pH adjusters, antimicrobials, & otic barrier repair

97
Q

what active ingredient would you prescribe if you saw cocci bacteria on cytology of an ear?

A

a. gentamicin
b. neomycin
c. florfenicol
d. ssd
e. polymixin b

98
Q

what active ingredient would you prescribe if you saw rod bacteria on cytology of an ear?

A

a. gentamicin
b. neomycin
c. enrofloxacin
d. orbifloxacin
e. ssd
f. polymixin b

99
Q

what active ingredient would you prescribe if you saw yeast organisms on cytology of an ear?

A

a. miconazole
b. clotrimazole
c. posaconazole
d. terbinafine

100
Q

what pathology is seen in the photo?

A

glandular hyperplasia

SA DX & TX II (62 decks)

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