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Dermatology > Otitis > Flashcards

Otitis Flashcards

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1
Q

What is the number one cause of ear infections

A

allergies

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2
Q

T/F: inflammation cause otitis and not infection

A

True

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3
Q

What is the pathogenesis of otitis externa

A

1) Primary cause
2) Inflammation
3) then infection

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4
Q

when examining ears, you need to be

A

parallel to the ear canal

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5
Q

What is lowest point in the external ear canal

A

intertragic incisure

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6
Q

What is the goal of ear visualization

A

see the tympanic membrane

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7
Q

What do you do for aural hematomas

A

1 mg/kg pred PO q24h for 1-2 weeks
50% success rate with this strategy, without scarring

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8
Q

What is the starting point of otoscopic examination

A

intertragic incisure

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9
Q

How do you get around the transition between the horizontal canal and the vertical canal (luminal

A

pull the ear out towards you

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10
Q

How do you get proper visualization of ear canal

A

-Extend ear
-Head down and rostral
-Table top recommendended

-assistant hold

if ear pain, avoid the luminal fold

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11
Q

What might cause opaque tympanic membrane

A

ear inflammation

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12
Q

Do you pluck ear hairs?

A

no- do not pluck hair
causes inflammation

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13
Q

What are the different otoscopes

A

Operating scope
Pneumatic Scope
video otoscopy

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14
Q

T/F: if a patient has a dilated pars flaccida you dont have to be concerned

A

true

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15
Q

T/F: visible wax accumulation in ear is normal

A

False- sign of inflammation

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16
Q

What type of glands produce ear wax

A

modified apocrine glands

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17
Q

concretions of wax and debris that fill the horizontal canal, in front of the tympanum.

A

ceruminolith

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18
Q

What is the key to treatment, prevention, and control of otitis

A

inflammation

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19
Q

a single episode of otitis is likely a

A

flare of secondary infection resulting from ongoing primary inflammation, and is likely to recur

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20
Q

Acutely treating otitis will result in

A

temporary improvement, but further episodes in the future

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21
Q

What are the 4 causes of Otitis *

A

1) Allergy
2) Something in the ear (foreign body, mass, ectoparasite)
3) Endocrinology
4) Immune disease

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22
Q

T/F: conformation causes ear disease

A

False

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23
Q

T/F: hair causes otitis

A

False

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24
Q

T/F: swimming causes otitis

A

False

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25
Q

“It cant be allergies because otitis is unilateral”

A

False

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26
Q

Primary otitis inflammation is often complicated by

A

secondary infection (yeast/bacteria)

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27
Q

What does ear cytology tell you

A

1) Organism population- greater or fewer
2) Changing organisms? rods? cocci? yeast?
3) Dying organisms- yeast will break down or you can assess for yeast resistance
4) No organisms- drug reaction? inflammation
5) Pairing with culture

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28
Q

What are indications for otitis culture

A

1) Otitis media/interna (bc its 8-12 week tx)
2) Cant medicate topically (compliance)
3) Rods (Pseudomonas aerginosa)
4) Topical medications ineffection
-Breakpoints designed for systemic antibiotics
may not be accurate for topicals
5) Middle ear vs external ear canal sample?
6) Cytology usually sifficient for initial cases

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29
Q

What should do you prior to treating otitis media/interna

A

culture because the treatment is 8-12 weeks

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30
Q

If you see rods on ear cytology, what should you do?

A

culture! - likely Pseudomonas otitis

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31
Q

How does Pseudomonas otitis rupture the tympanum

A

they are ulcerative (produce proteolytic enzymes)

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32
Q

Why should you never empirically treat Pseudomonas otitis

A

because they are typically multi-drug resistant
Fluoroquinolones or aminoglycosides are empric choices

do cultures because it makes biofilms

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33
Q

any group of microorganisms in which cells stick to each other and often these cells adhere to a surface

A

biofilm

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34
Q

How long does Claro last

A

4 weeks

make sure to flush debris prior and then put claro in it

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35
Q

T/F: there is no reliable treatment for otitis biofilms

A

True- hard to break up

36
Q

1ml of ear medication is about ______ drops

A

20 drops

37
Q

What can a ruptured tympanic membrane cause

A

harder for the ear to clean itself
might need to flush more often

38
Q

T/F: most prescription commercial topicals will resolve acute cases of otitis

A

True

39
Q

What medication has no effect for ear inflammation

A

NSAIDs (steroids work better)

40
Q

What medications are commonly implicated to cause ototoxicity

A

Gentamicin, chlorhexidine

but it is idiosyncratic- fast and irreversible

41
Q

Is cochlear or vestibular ototoxicity more common?

A

Cochlear (hearing loss) is more common by far

42
Q

What products are safe for the ears

A

-Enrofloxacin:Dexamethason SP 1:3
-Miconazole:Dexamethasone SP 1:1
-Enrofloxacin:Miconazole: Dexamethasone SP 1:2:1
-Silver sulfadiazine:saline 1:9
-Cerumene
-Tris-EDTA
-DMSO-Flucinoline (Synotic)
-EpiOtic Advanced

43
Q

What soften and dissolve cerument to facilitate cleaning

A

Ceruminolytics

44
Q

What dries the ear canal surface, preventing maceration

A

astringents

45
Q

What are routine ingredients in topical ear medications

A

1) Ceruminolytics: soften and dissolve cerumen to facilitate cleaning
2) Surfactants emulsify debris, breaking it up and keeping it in solution
3) Astringents dry the ear canal surface, preventing maceration
4) Anti-microbial and anti-inflammatories to control infection/inflammation
5) Non-irritants

good for mild infection or excessive wax accumulation
have little to no anti-inflammatory activity

46
Q

a small, hammer-shaped bone in the middle ear that plays a key role in hearing

A

malleus

47
Q

What makes the tympanic membrane rupture

A

1) Trauma (CTA, mass polyp) *
2) Pseudomonas (protelytic enzymes)
3) Chronic (proliferative) otitis
4) Otitis media

48
Q

What is the most common cause of tympanic membrane rupture

A

Trauma (CTA, mass polyp)

49
Q

How long does it take to grow a tympanum

A

30 days

50
Q

How does the ear clean itself

A

lateral epithelial migration
moves the epidermal cells (exfoliation) and wav from the inside of the canal to the outside

might stop if masses, inflammation, infection

51
Q

Accumulations of wax are an indicator of

A

primary pathology (inflammation, endocrine, etc)

52
Q

What is an end-stage ear

A

ear that is refractory to treatment, has perpetuating factors
-Stenosis
-Calcinosis
-Otitis media
-physical obstruction of the canal
-hyperplasia
-fibrosis

swelling can be reverse with steroids but mineralization cannot be removed

53
Q

How might you fix end-stage ears

A

1) Rescue medically- takes months and might not work
or
2) Surgically- expensive, invasive, complications

54
Q

How do you open the ear in complicated ear infections

A

Steroids
-Oral: pred, dexamethasone, triamcinolone
-Topical (Synotic, dexamethasone SP)
-Injectable?

once daily typically suffices

but if it doesnt resolve in 2 weeks, might need to look at surgical options

55
Q

Very potent steroids that can be used to open the ear canal in complicated otitis

A

Synotic

56
Q

Deep ear cleanings

A

always recommended
must open the ear first
sedated doesnt work
remove debris (and masses)
better visualization
middle ear cultures
fancy equipment not needed
pressure is needed

CT? for middle and inner ear
biofilms

57
Q

What is the only way to visualize the middle and inner ear

A

CT

58
Q

How do you prevent against otitis

A

Dirty ears do not exist- find the underlying cause
-address primary cause and secondary infections
-control inflammation
-allergy medications?
-routine treatment with preemptive therapy
-steroids?

in many cases, otitis externa require weekly to monthly maintenance therapy to prevent recurrence

59
Q

What kind of tissue is the middle ear

A

ciliated respiratory epithelium

why chronic respiratory disease causes otitis media- sterile fluid build up in the middle ear (bulla)

60
Q

What are the clinical signs of otitis media

A

1) Unilateral Xeromycteria (parasympathetic)
2) Horner’s Syndrome (sympathetic)
3) Facial paresis, paralysis (no blink, lip drooping) from facial nerve

61
Q

What are the clinical signs of otitis interna

A

-Head tilt
-asymmetrical ataxia
-circling to the side of the lesion
-torticollis
-horizontal or rotatory nystagmus- quick phase from the side of the lesion
-positional ventral strabismus
-deafness

62
Q

What drugs reverse the signs of vestibular disease

A

steroids
anti-emetic
Meclizine

63
Q

What causes otitis media/interna

A

1) ascending infection from otitis externa
2) abnormal drainage from auditory tube (brachycephalics, PSOM- cavaliers, chronic respiratory cats)
3) Ototoxicity (meds)
4) Neoplasia- adenomas/sarcomas most common, please biopsy

64
Q

How do you treat otitis media/interna

A

-Systemic and topical therapy
-Culture (middle ear preferred)- Myringotomy
-Deep (anesthetized) ear cleaning
-8 weeks (deep pyoderma)
-Nerve damage may be permanent

-Vestibular (interna):
1 mg/kg prednislone
Meclizine
Maropitant
Antihistamines?
Benzodiazepines?

65
Q

How do you treat the vestibular issues with otitis interna

A

1 mg/kg prednislone
Meclizine
Maropitant
Antihistamines?
Benzodiazepines?

66
Q

a surgical procedure that involves making an incision in the eardrum to access the middle ear

A

myringotomy

67
Q

how do you sample the middle ear

A

myringotomy
use 5Fr tomcat catheter and sample through the caudal ventral aspect of tensa
push until you hit bone (bulla)
good for biopsy/culture
requires anestesia

68
Q

How long does it take for the myringotomy perforation to heal

A

2-4 weeks

69
Q

non-neoplastic inflammatory, pedunculated masses that arise from the auditory tube or middle ear in cats

A

feline inflammatory polyps

70
Q

What is the most common external ear canal mass in the feline patient

A

Feline inflammatory polyps

71
Q

the cats middle ear is split into

A

ventromedial and dorsolateral compartments

dorsolateral connects to the auditory canal

72
Q

The dorsolateral compartments connects to the _________ which connects to the ________

A

The dorsolateral compartments connects to the auditory canal which connects to the nasopharynx

73
Q

Feline inflammatory polyps have what appearance on histopathology

A

-stratified squamous to ciliated, columnar epithelium
-fibrovascular tissue
-mixed inflammation

74
Q

What causes Feline inflammatory polyps

A

Unknown
1) Infectious
-Viral: calicivirus, herpesvirus-1
-Bacterial: mycoplasam, chlamydophilis felis, bartonella
2) Chronic inflammation - persistence of epithelial hypertrophy and submucosal proliferation following inflmmation
3) Congenital/Anatomic: aberrant growths from remnants of branchial arches

75
Q

What is the typical signalment of Feline inflammatory polyps

A

no breed or sex predilection
-abyssinian?
any age can be presented but typically <2years

76
Q

What is the clinical presentation of Feline inflammatory polyps

A

Variable depending on path of growth
1) Pharyngeal: nasal discharge, sneezing, dyspnea, stridor, dysphagia, stertorous, breathing, phonation change ; possible: cyanosis, syncope

2) Aural: otitis interna, media, externa
interna: head tilt (persistent), nystagmus, ataxia hearing loss
media: horner’s syndrome, facial nerve paralysis
externa: otorrhea, headshaking
secondary infection

77
Q

What are the signs of Feline inflammatory polyps with growth into the nasopharynx

A

nasal discharge, sneezing, dyspnea, stridor, dysphagia, stertorous, breathing, phonation change ; possible: cyanosis, syncope

78
Q

What are the signs of Feline inflammatory polyps with growth into otitis media

A

Horner’s syndrome
facial nerve paralysis

79
Q

What are the signs of Feline inflammatory polyps with growth into otitis externa

A

otorrhea
head shaking

80
Q

What are differentials for Feline inflammatory polyps

A

-Upper respiratory tract infections (can be ascending)
-Foreign body
-Neoplasia (adenomas, carcinomas, lymphomas)
-Mycotic disease (cryptococcus)
-Cysts

81
Q

How do you diagnose Feline inflammatory polyps

A

1) Visual examination
-Otoscopy
-Endoscopy
-Spay hook retraction
2) Imaging
-Radiography
-CT
-MR
3) Biopsy (otic masses look similar)

82
Q

T/F: rads are good for diagnosing Feline inflammatory polyps

A

False

83
Q

How do you treat Feline inflammatory polyps

A

1) Surgery -removes all affected tissues
Ventral Bulla Osteotomy (VBO)
-Total ear canal ablation (TECA)
-Lateral ear canal resection

2) Traction-Avulsion/Excision

3) Medical
Antibiotics
Glucocorticoids

84
Q

What are complications of surgery for Feline inflammatory polyps

A

Horner’s syndrome (most common)
facial nerve paralysis
hypoglossal nerve damage
ataxia
hearing loss

85
Q

Ventral Bulla Osteotomy (VBO) is recommended in all cases of

A

middle ear involvement

86
Q

What should you do after traction/avulsion

A

steroids- has recurrence rates similar to VBO (95% success)

Dermatology (10 decks)

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