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Integumentary (Exam3) > Module 6: Otitis Externa and Media (Week 7) > Flashcards

Module 6: Otitis Externa and Media (Week 7) Flashcards

1
Q

Definition:
Is cone-shaped and articulates with the chain of three bones called the auditory ossicles

A

Tympanic Membrane

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2
Q

Definition:
- Acute or chronic inflammation of the external ear canal
- May involve the pinna

A

Otitis externa

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3
Q

Definition:
Inflammation of the middle ear

A

Otitis media

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4
Q

What is the most common ear disease in dogs and cats?

A

Otitis externa
- 10 to 20% dog
- 2 to 10% cat

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5
Q

Functions:
- Collect sound waves
- Conduct sound waves to the tympanic membrane
- Determine the origin of the sound waves

A

External Ear Functions

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6
Q

(T/F) Both ears have to function to know the direction of sound

A

True

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7
Q

External Ear Canals: Composed of 2 Elastic Cartilage
- Expands to form pinna, funnel-shaped

A

Auricular

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8
Q

External Ear Canals: Composed of 2 Elastic Cartilage
- Fits within base of auricular, overlaps osseous external auditory meatus; flexibility

A

Annular
- dogs can move their pinna

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9
Q

External Ear Canal:
What is the notch between the Tragus laterally and Antitragus causally called?

A

Intertragic incisure
- This is the perfect place to place your otoscope for looking at the ear

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10
Q

(T/F) The external ear canals have microbiome

A

True
- Bacteria
- Staphylococci
- Micrococcus spp. (the only normal one)
- Beta-streptococcus
- Corynebacterium spp.
can also become pathogens
- Malassezia pachydermatis

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11
Q

External Ear Canals:
- Superficial
- Ducts open into the hair follicle

A

Sebaceous glands

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12
Q

External Ear Canal:
- Simple, coiled tubular glands
- Modified apocrine glands
- Located in the deeper dermis below the sebaceous glands
- Ducts open into either the hair follicle or onto the surface of the external ear canal

A

Ceruminous glands

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13
Q

External Ear Canals:
- Emulsion that coats the ear canal
- Desquamated keratinized epithelial cells, glandular secretions
- Removal by epithelial migration

A

Cerumen

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14
Q
  • Tympanic membrane
  • Auditory ossicles (3)
  • Tympanic cavity
  • Eustachian tube (auditory tube) (equalize pressure)
A

The Middle Ear

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15
Q
  • Histologically:
    • Outer and inner epithelium
    • Core of collagen
    • Hairless, glandless
  • 45 angle to center
  • Pars flaccid (dorsal part)
  • Pars tensa (ventral part)
    • Semitransparent
    • Stria mallearis
    • Concave due to tension
A

Tympanic Membrane

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16
Q

(T/F) Bulging pars flaccida indicates otitis media

A

False, it does NOT indicate otitis media except in CKCS dogs

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17
Q
  • Epitympanic recess
  • Ventral tympanic cavity
  • Tympanic cavity proper
  • Round window
  • Oval window
  • Eustachian Tube
A

Tympanic Cavity

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18
Q
  • Microbiome
    • Negative ear cultures in 50% of the ear swabs
    • Organisms isolated in positive ear cultures
      • yeast, E. coli, Staphylococcus spp., Corynebacterium spp, Streptococcus sp.
A

Middle Ear

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19
Q
  • Divided by a septum into 2 separate tympanic cavities; connected through a foramen between the septum and petrous bone
  • Dorsolateral (smaller of the two)
    • Auditory ossicles, ostium of auditory tube, tympanic membrane
  • Ventromedial
    • Air-filled tympanic bulla
A

Feline Middle Ear

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20
Q

Middle Ear:
Incomplete bulla septum

A

Dog

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21
Q

Middle Ear:
Complete bulla septum

A

Cat

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22
Q
  • Housed in a bony labyrinth
  • Vestibule
  • Semicircular canals
  • Cochlea
  • Bony surrounds membranous labyrinth
A

Inner Ear

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23
Q

Inner ear:
- Housed in the petrous temporal bone
- Bony labyrinth
- “Snail shell”
- Oval and round windows

A

Cochlea

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24
Q

Inner Ear: Cochlea
- Follows shape of the bony labyrinth
- Three ducts:
- Scala vestibulisuperior
- Scala media (cochlear duct) - medial
- Scala tympani-inferior

A

Membranous labyrinth
important for exam

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25
Q

List the Cochlea Membranes:

A
  • Reissner’s membrane
    • Floor of scala vestibuli
    • Roof of scala media (cochlear duct)
  • Basilar membrane
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26
Q

List the TWO fluids of the Cochlea:

A
  1. Perilymph
    • Scala vestibuli
    • Scala tympani
  2. Endolymph
    • Scala media
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27
Q

Inner ear: Cochlea
- Stria vascularis
- Blood vessels
- Endolymph

A

Spiral ligament-outer wall

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28
Q
  • Tectorial Membrane
  • Reticular lamina
  • Hair cells
    • Inner hair cells (1 row)
    • Outer hair cells (3 rows)
  • Supporting cells
    • Stereocilia
    • Tectorial membrane
  • Basilar membrane
A

Organ of Corti

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29
Q

Hair Cells:
- Actual receptor cells for hearing

A

Inner Hair Cells (IHC)

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30
Q

Hair cells:
- Important role in adjusting the tuning and sensitivity of the IHC

A

OHCs
- most susceptible to damage

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31
Q

Auditory System:
- Determined by rate of action potentials firing

A

Intensity

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32
Q

Auditory System:
- Determined by part of the Organ of Corti that is stimulated

A

Frequency

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33
Q

Auditory System:
- Determined by higher central auditory nervous centers comparing sounds from both ears

A

Location

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34
Q
  • Connects cochlea with brainstem
  • Relay information about the intensity, frequency, and timing of a sound
  • Part of CN VIII (vestibulocochlear nerve)
  • Course from the cochlea through a small canal in petrous temporal bone: internal auditory meatus (IAM)
A

Auditory Nerve

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35
Q
  • CANS (central auditory nervous system)
    • Cochlear nucleus (CN)
      • Connects to SOC
    • Superior Olivary Complex (SOC)
      • Connects to IC thru LL
    • Lateral Lemniscus (LL)
    • Inferior Colliculus (IC)
      • Connects to medial geniculate body
    • Medial Geniculate Body (MGB)
      • Connects to auditory cortex
    • Auditory Cortex
A

Auditory System

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36
Q

Hearing Loss:
- Wax accumulation/Stenosis/Hyperplasia (otitis externa)
- Infectious otitis media, PSOM
- Medications (ointments, packing)
- Mass/polyp

A

Conductive

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37
Q

Hearing Loss:
- Congenital hereditary deafness
- Dalmatians
- Drugs
- Noise-induced hearing loss
- Presbycusis

A

Sensorineural

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38
Q

Which hair cell is the actual receptor cell for hearing?

A

Inner hair cells (IHC)

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39
Q

Etiology of Otitis - The Three P’s

A

Etiology of Otitis - The Three P’s

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40
Q
  • Facilitate the inflammation by permitting alteration of normal microenvironment
  • Establishment of secondary infections
A

Predisposing Factors for Otitis Externa

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41
Q

List the Conformation predisposing factors for otitis externa:

A
  • Stenotic ear canals
    - Chinese Shar Pei
    - Overgrowth of bacteria, yeast
    - Inhibit proper cleaning of ear
  • Hair in the canal
    - Impair ventilation
    - Impair clearance
    - Routine removal is not recommended
  • Pendulous pinnae
    - Restrict airflow
    - Higher risk for the development of OE
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42
Q

List the predisposing factors for Otitis externa:

A
  • Conformation
  • Moisture
    - Maceration of stratum corneum
    - Secondary infection
    - Swimming, bathing
  • Inappropriate Therapy
    - Cotton Swabs (Q-tips)
    - Plucking hair
    - Irritant ear-cleaning solution
    - Improper topical antibiotic usage
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43
Q
  • Conditions or disorders that initiate the inflammatory process
  • Epithelium of the ear canal is just an extension of the rest of the body
  • Most cases of otitis are associated with an underlying dermatologic condition
A

Primary Causes of Otitis Externa

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44
Q

List the Primary causes of Otitis Externa:

A
  • Otodectes cynotis
    • Most common parasite
    • Life cycle completed on host
    • Irritate ceruminous glands
    • Diagnosis
  • Demodicosis
    • Demodex canis/Demodex cati
    • Infrequent cause of otitis external
    • Ceruminous otitis externa
  • Foreign Bodies
    • Plant material
    • Acute
    • Unilateral
    • Painful
    • Perforation of tympanic membrane
  • Atopic Dermatitis
    • Bilateral pruritic otitis externa
    • Otitis may be the only clinical sign in 10% of atopic dogs
    • Early: pinna
    • Later: erythema, infections
  • Cutaneous adverse food reactions
    • Bilateral pruritic otitis externa
    • Otitis may be the only presenting sign in 25% of food allergic dogs
    • Clinical signs similar to atopic
    • History, steroid response, age
  • Contact allergy
    • Rare
    • Non-haired portion of skin
    • May be caused by topical medications
    • Should be suspected if otitis fails to respond or worsens
  • Autoimmune Diseases (less common)
    • Pemphigus foliaceus
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45
Q

Primary Causes of Otitis Externa:
What is the most common cause of recurrent otitis externa in the dog?

A

Allergic Diseases (>90%)

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46
Q

Puppies: Primary Causes of Otitis Externa
- Affects puppies 3-16 weeks old
- Etiology unknown
- Papules, pustules, alopecia, swelling
- Submandibular lymphadenopathy
- Systemic illness

A

Juvenile Cellulitis

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47
Q

Primary Causes of Otitis:
Sebaceous adenitis is a disorder of ______________

A

keratinization

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48
Q

Primary Causes of Otitis Externa:
What are endocrine disorders that we see?

A
  • Hypothyroidism
  • Hyperadrenocorticism
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49
Q

Primary Causes of Otitis Externa:
What are the most common cases of ear tumors?

A
  • Ceruminal gland adenoma
  • Adenocarcinoma
    • More common in dog
    • Felines are usually malignant
      unilateral most common
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50
Q

Primary Causes of Otitis Externa:
Polyps …

A
  • Feline nasopharyngeal polyps
    - Common
    - Purulent, ceruminous OE
    - Dysphagia, sinusitis
  • Inflammatory aural polyps – Canine
    - Rare
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51
Q

Tips for Work-up of Primary Causes:

A
  • Age of onset
    • Young animal: might be ear mites
    • Older animal: Neoplasia
  • Species:
    • Dog: CAFR, AD
    • Cat: Otodectes, polyp, allergic disease
  • Additional body affected
    • CAFR, AD
    • Hypothyroidism, hyperadrenocorticism
    • Juvenile cellulitis
    • Autoimmune diseases
    • Keratinization disorders
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52
Q

Tips for Work-up of Primary Causes:
- Otodectes
- CAFR, AD
- Foreign body
- Tumor/polyp

A

Ears only

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53
Q

Tips for Work-up of Primary Causes:
- Foreign body
- Tumor/polyp
- CAFR, AD

A

Unilateral

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54
Q
  • Sustain and aggravate the inflammatory process
  • Prevents resolution or worsens an already present otitis externa
A

Perpetuating Factors of Otitis Externa

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55
Q

List the Perpetuating Factors of Otitis externa:

A
  • Bacteria
    • Coccoid bacteria
      • Staphylococcus pseudintermedius
    • Rod bacteria
      • Pseudomonas aeruginosa
    • > 4 cocci/OIF considered abnormal
    • ALL rod bacteria considered abnormal
  • Yeast
    • Malassezia pachydermatis
    • Candida spp.
    • > 4/OIF considered abnormal
  • Progressive pathologic changes (end-stage ear)
    • Edema
    • Stenosis
    • Epidermal hyperplasia
    • Fibrosis
    • Calcification
    • TOTAL EAR CANAL ABLATION
  • Otitis media
    • Route of infection:
      • A direct extension of otitis externa through a ruptured tympanic membrane
        - Intact tympanic membrane does not rule out
      • Through Eustachian tube
56
Q
  • Dogs with chronic recurrent otitis externa
    - *89% had otitis media *
    - Intact tympanic membrane 73%
  • Dogs with acute otitis externa
    - 16% had otitis media
A

Otitis Media
- Bacteria
- Staphylococcus pseudintermedius, Pseudomonas aeruginosa (rod)
- Yeast alone isolated in 23.7% of ears
- Trauma, polyps, neoplasms, foreign bodies

57
Q

Primary Secretory Otitis Media (PSOM)
- Cavalier King Charles Spaniels
- Head and neck scratching, neurological signs, hearing loss
- Intact tympanic membrane, mucoid exudate

A

Non-Infectious Otitis Media

58
Q

Clinical signs & Diagnosis

A

Clinical signs & Diagnosis

59
Q

What is the most common clinical sign for infectious otitis media?

A

Recurrent Otitis Externa

60
Q

List other Clinical signs for Otitis Media:

A
  • Facial Nerve Paralysis
  • Drooping of ear/lip
  • Drooling saliva
  • Absent palpebral reflex
  • Keratoconjuctivitis sicca
61
Q

Clinical sign for Otitis Media:
- Injury to sympathetic nerve
- Ptosis
- Drooping of the upper lid
- Miosis
- Contraction of pupil
- Enophthalmos
- Backward displacement of eyeball into the orbit
- Protrusion of nictitating membrane

A

Horner’s Syndrome

62
Q

List the clinical signs for Otitis Interna:

A
  • Horizontal nystagmus away from the lesion
  • Head tilt, falling, rolling to the affected side
  • Asymmetric ataxia
63
Q

How would you want to place the dog for an ear x-ray (views)?

A
  • Rostralventral-caudodorsal
  • Lateral Oblique (L&R)
  • Dorsoventral
64
Q
  • Imaging method that uses x-rays to create pictures of cross-sections of body
  • Better for bone
  • Accuracy of CT and radiographs for diagnosis of otitis media are similar
  • CT appears to be more sensitive indicator
A

Computed Tomography (CT)
- prefered for middle ear disease

65
Q
  • Allows distinction of soft-tissue components
  • Normal bulla: signal void
  • Fluid in bulla:
    • Hyperintense of T2-weighted
A

Magnetic Resonance Imaging (MRI)

66
Q

Definition:
Far-field recording of neuroelectrical activity of the auditory nerve and BS pathways in response to a sound stimulus

A

Brain-stem Auditory Evoked (BAER) Testing

67
Q

Generator Sites:
Distal auditory nerve

A

Wave I

68
Q

Generator Sites:
Proximal auditory nerve

A

Wave II

69
Q

Generator Sites:
Cochlear nucleus

A

Wave III

70
Q

Generator Sites:
Nucleus of the lateral lemniscus (LL)

A

Wave IV

71
Q

Generator Sites:
Inferior colliculus (IC)

A

Wave V

72
Q

What is a Site-of-Lesion diagnostic Toll?

A

BAER Applications
- Example: Neural lesions of CN VIII, Brainstem (Wave III)

73
Q

Otic exam and flush

A

Otic exam and flush

74
Q

Otic exam

A

Otic Exam

75
Q

The pars flaccida is located …

A

dorsally

76
Q

What occupies the remainder of the membrane and has radiating strands ?

A

Pars tensa

77
Q
  • Elbow shape structure
A

Stria mallearis

78
Q

Otic Flushing: In Hospital
How will you prepare ear for cleaning?

A
  • Topical and/or systemic glucocorticoids if stenotic, hyperplastic, ulcerated
    - 2 to 3 weeks
    - 1 mg/kg q 24h, then taper after the flush
    - Bloodwork
  • Schedule ear flush
79
Q
  • General anesthesia, endotracheal tube
  • Radiographic imaging - CT
  • Cytology, culture
  • Ten minute soak with ceruminolytic agent
  • Flush using saline (warm) and bulb syringe
  • Final flush with saline, 8 Fr urinary catheter or red rubber feeding tube, 12 cc syringe, through otoscope
  • Visualization of tympanic membrane
  • Samples from middle ear for bacterial C/S and cytology if tympanic membrane is ruptured
  • Final flush with saline, Tom cat catheter/5French catheter, 12 cc syringe
  • If tympanic membrane intact, but abnormal, decision to perform myringotomy
    - not all patients get myringotomy
A

Otic Flushing: In hospital

80
Q

List the Purpose/indication of a Myringotomy procedure:

A
  • Samples
  • Remove exudates
  • Drain middle ear
  • Treat middle ear
81
Q
  • Visualization of the tympanic membrane
  • Incision made into the caudoventral quadrant
  • Cytology, C/S
  • Flush middle ear
A

Myringotomy procedure

82
Q

Otic Flushing: In hospital
List the possible complications (cats vs. dogs) for a Myringotomy:

A
  • Facial nerve paralysis
  • Horner’s Syndrome
  • Vestibular disturbances
  • Deafness
    (very rare in dogs, common in cats)
  • Healing of tympanic membrane
    - 21 to 35 days
83
Q

Otic Treatments: Part 1

A

Otic Treatments: Part 1

84
Q

What is the treatment of Otitis?
Infection:
- Otitis externa
- Otitis media = NO OITMENTS/NO SUSPENSIONS
- Panolog oitment
- Otomax
- No ear Packs

A

Topical therapy (antimicrobial agents)
- Appropriate volume; frequency important

85
Q

What is the treatment of Otitis?
Infection:
- Otitis media
- Severe otitis externa
- also in the tissue of the ear canal

A

Systemic therapy (antimicrobial agents)

86
Q

What is the treatment of Otitis?
- Inflammation, proliferation, stenosis

A

Topical steroids

87
Q

List the Topical therapy otic treatments:

A
  • Ceruminolytic agents
  • Cleaning and drying agents
  • Glucocorticoids
  • Antiseptics
  • Antimicrobial agents
  • Antiparasiticidal agents
88
Q

List the Systemic therapy otic treatments:

A
  • GC
  • Antibiotics
  • Antifungals
  • Antiparasiticidals
89
Q

Treatment of Otitis:
- Apply 10 minutes prior to cleaning
- Contraindicates with ruptured tympanic membrane
- Most are ototoxic

A

Ceruminolytic Agents

90
Q

Ceruminolytic Agent:
- Vetoquinol
- 25% Squalene
- No hearing loss, inflammation when injected into middle ear

A

Cerumene
- Treatment of choice when doing a flush
- Can be sent home with client

91
Q

Ceruminolytic Agent:
- Dechra
- 22% Squalene

A

KlearOtic

92
Q

Treatment of Otitis:
- Applied after cleaning with ceruminolytic agent
- Prophylactic treatment of swimmer’s ear
- Maintenance ear program to keep infections from recurring or just normal maintenance

A

Cleaning and Drying Agents

93
Q

List the Ear cleaning/drying agents:

A
  • Douxo micellar Solution, Ceva
  • EpiOtic Advanced, Virbac
  • Malacetic Otic, Dchra
  • Vet solutions Ear Cleaning Solution
  • Gent-L-Clens, Merck
  • Oti-Clens, Zoetis
  • OtoCetic solution, Vedco
94
Q

Treatment of Otitis:
Usually contain combinations of antibiotics, antifungals, +/- glucocorticoids

A

Topical

95
Q

Topical therapy:
- Antipruritic, anti-inflammatory, antiproliferative
- Decrease sebaceous and apocrine secretions
- Even topical glucocorticoids (dexamethasone, triamcinolone) may cause adrenal suppression

A

Glucocorticoids

96
Q

Topical therapy:
- Antipruritic, anti-inflammatory, antiproliferative
- Decrease sebaceous and apocrine secretions
- Even topical glucocorticoids (dexamethasone, triamcinolone) may cause adrenal suppression

A

Glucocorticoids

97
Q

Topical Glucocorticoids:
- Vedco
- Burow’s solution, 1% hydrocortisone
- Dries the ear

A

Cort/Astrin

98
Q

Topical Glucocorticoids:
- Zoetis
- 0.01% fluocinolone acetonide, DMSO (helps w/ absorbption)
- low percentage

A

Synotic

99
Q

Topical Antibiotics:
- Good activity against most otic pathogens
- Gram positive
- Gram negative (not efficaceous against chronic P. aeruginosa)
- Ototoxicity is a concern in humans
- Inactivated in purulent debris

A

Aminoglycosides
- Neomycin sulfate
- Combination
- Solution
- Tresaderm
- Merial
- Thiabendazole, dexamethasone

100
Q

Aminoglycosides:
- Neomycine sulfate
- Gentamicin sulfate

A

1st Line

101
Q

Aminoglycoside:
- Combination
- Solution
- Tresaderm
- Merial
- Thiabendazole, dexamethasone

A

Neomycin sulfate

102
Q

Aminoglycoside:
- Combination
- Ointment
- Panolog
- Zoetis
- Nystatin, thiostrepton, triamcinolone acetonide

A

Neomycin sulfate
- Quadruple

103
Q

Aminoglycoside:
- Combination
- Ointment
- Otomax
- Merck
- Clotrimazole, Betamethasone valerate

A

Gentamicin sulfate

104
Q

Aminoglycoside:
- Combination
- Suspension
- Mometamax
- Merck
- Once daily application
- Clotrimazole, mometasone furoate

A

Gentamicin sulfate

105
Q

Aminoglycoside:
- Combination
- Suspension
- easOtic
- Virbac Animal Health
- Once daily application
- Micanazole, Hydrocortisone aceponate (HCA) (soft steroid)

A

Gentamicin sulfate

106
Q

Topical Antibiotic:
- Good activity against gram-positive and gram-negative organisms
- Esp useful for Pseudomonas aeruginosa
- Also E. coli, enterobacter, Klebsiella
- NOT EFFECTIVE against Proteus
- Inactivated in purulent debris
- Synergistic effects when combined with miconazole against gram-negative (E. coli, PA) and Malassezia pachydermatis

A

Polymyxin B

107
Q

List 2nd line of Topical Antibiotics:

A
  • Polymyxin B
108
Q

Topical Antibiotics:
- Combination
- Suspension
- Surolan
- Elanco
- Miconazole, prednisolone

A

Polymyxin B

109
Q

Topical Antibiotic:
- Good activity against Staphylococcus pseudintermedius and E. coli
- NOT EFFECTIVE against Pseudomonas aeruginosa

A

Florfenicol (1st line)

110
Q

Topical Antibiotics:
- Combination
- Otic gel
- Osurnia
- Elanco
- Terbinafine, betamethasone acetate
- 2 doses - 45 days
- NOT an ear pack

A

Florfenicol

111
Q

Topical Antibiotic:
- Combination
- Otic Solution
- Bayer
- Terbinafine, mometasone furoate
- 1 dose - 30 days
- NOT an ear pack
- Not refrigerated

A

Florfenicol - Claro

112
Q

Topical Antibiotics:
- Bactericidal
- Gram-positive and gram-negative aerobes
- Staphylococcus pseudintermedius
- E. coli, Proteus spp,. Enterobacter spp., Klebsiella spp.
- Pseudomonas aeruginosa
- Little or no efficacy:
- Streptococcus spp., enterococcus spp.
- Anaerobes
- Reserve infections resistant to other antimicrobial agents and susceptible Pseudomonas aeruginosa

A

Fluroquinolones

113
Q

Topical Antibiotics: 2nd Line
- Fluroquinolone
- Enrofloxacin
- Combination
- Emulsion
- Bayer Animal Health
- Silver sulfadiazine

A

Baytril Otic
- lacking GC (can always be added on)

114
Q

Topical Antibiotics: 2nd Line
- Fluroquinolone
- Orbifloxacin
- Combination
- Suspension
- Merck
- Once daily application
- Posaconazole, mometasone

A

Posatex

115
Q

Topical Antibiotics: 2nd Line
- Fluoroquinolone
- Enrofloxacin
- Extra-label
- Bayer Animal Health
- 1:4 with vehicle
- CortAstrin, Synotic
- Saline
- 1:1:1 with
- 2mg/mL inject dexamethasone
- 1% miconazole

A

Baytril
- we don’t know stability
- after one month, need to be discarded

116
Q
  • Cell surface of gram-negative bacteria are damaged by exposure of cells to EDTA
  • Leakage of cellular compinents, permeability of antibiotics
  • Tromethamine enhances the effect of EDTA
A

Tris-EDTA

117
Q

Topical Antibacterial:
- Chlorhexidine

A

Antiseptics

118
Q

(T/F) If you want to use a Chlorhexidine product in the ears use Nolvasan Otic

A

False

119
Q

Topical Antibacterial:
- Malaseb Flush, Bayer Animal Health
- Chlorhexidine
- Miconazole (ant-yeast)

A

Chlorhexidine

120
Q

Topical Therapy:
- Thiabendazole
- Clotrimazole
- Nystatin
- Terbinafine
- Ketoconazole
- Miconazole

A

Antifungals

121
Q
  • Lanolin-based otic – Oily, waxy substance
  • Compounded
  • Liquid at room temp, thick goopy oil in ear
  • Applied in-office – last for 10-14 days – convenience for owner
  • ISSUES:
    • Conductive hearing loss
    • NO Solvent to remove
      - can’t be removed, will go away on its own
    • Ototoxic
  • What to use instead for cocci/yeast?
    - Claro or Osurnia
A

Otic “Packs”

122
Q

Topical Parasiticidals:
The following are going to be used for …
- Thiabendazole (Tresaderm)
- Ivermectin (Acarexx)
- Milbemycin (Milbemite)

A

Ear mites

123
Q

Definition:
Semipermeable barrier that serves as a physiological barrier from external agents including bacteria, fungi, and chemicals while preventing the loss of fluids and solutes from the internal environment

A

stratum corneum

124
Q

Otic Treatments: Part 2

A

Otic Treatments: Part 2

125
Q

Systemic Antibiotics: Cephalosporins (cocci)
- Cephalexin
- Generics
- Rilexine, Virbac
- Cefadroxil: Cefa-drops

A

First generation
- we prefer this generation

126
Q

Systemic Antibiotics: Cephalosporins (cocci)
- Cefpodoxime: Simplecef, Zoetis generics

A

Third generation

127
Q

Systemic Antibiotics:
- Amoxicillin trihydrate-clavulanate potassium
- Zoetis
- 14 to 22 mg/kg q12h

A

Clavamox
- expensive option
- Cocci

128
Q

Systemic Antibiotics: Fluoroquinolones (Rods)
List them:

A
  • Baytril (enrofloxacin)
    - 5 to 20 mg/kg q24h
  • Zeniquin (marbofloxacin)
    - 2.75 to 5.5 mg/kg q24h
  • Ciprofloxacin
    - Inconsistent absorption – Canine
    - may not work
129
Q

List the Systemic Antifungals:

A
  • Ketoconazole
    - Nizoral, Janssen; generics
  • Itraconazole
    - It is rare to fing yeast otitis media in a cat, but if found use this
130
Q

List Systemic Antiparasiticide:

A
  • Ivermectin
    • ear mites
    • Extra - label usage
    • Caution
  • Selamectin
    • Revolution, Revolution Plas (cats)
  • Imidacloprid + moxidectin
    • Advantage Multi
      • Labeled for cats: ear mites
      • Bayer Animal Health
  • Isoxazoline
    • Off-label for ear mites
    • Simparica (Sarolaner [dogs])
    • Nexgard
    • Bravecto
131
Q

List Systemic Glucocorticoids:

A
  • Prednisone
    • Stenosis, edema, hyperplasia
    • otic exam, cleaning
    • decrease to alternate dose
132
Q

When is maintenance ear therapy useful?

A
  • Chronic recurrent otitis externa
    - Probably lost the ability to self clean
  • Previous Pseudomonas otitis infection
  • While diagnosing primary disease
133
Q

What does an “Maintenance ear Therapy” include?

A
  • Ear cleaning and drying agent
  • TrisEDTA
  • +/- Glucocorticoid (mostly used when still trying (diagnose primary disease)
134
Q

How long do we moitor?

A
  • Every 2 to 4 weeks
    • Otoscopic/video otoscopic exam
    • Cytology
135
Q

What is the surgery of choice?

A

Total ear canal ablation/bulla osteotomy (TECABO)

Integumentary (Exam3) (3 decks)

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