Otitis

Question 1

Indications

Answer 1

Microbial overgrowth
Immunomodulation
Pruritus
Skin barrier production
Hormone Management
Nutrition deficiency
Parasitic management

Question 2

Microbial infection

Answer 2

Confirm presence of infection (cytology)
Determine level of infection
-Surface/superficial/deep
Choose therapy
Management to prevent recurrence

Question 3

Surface pyotraumatic dermatitis

Answer 3

Clip (norm sedation)
Clean
Daily topical antiseptic/antimicrobial
Anti-inflammatory - preds
Analgesia - paracetamol
Manage primary disease

Question 4

Intertrigo (skin fold dermatitis)

Answer 4

As for pyotraumatic dermatitis
Look for underlying cause
Consider Sx
Can progress to deep infections

Question 5

Pyoderma/ folliculitis

Answer 5

Topical antiseptics (2-3/wk)
Systemic AM not normally needed unless widespread
Manage underlying cause

Question 6

Deep pyoderma

Answer 6

Local- topical
Widespread - systemic AM

Question 7

Topical antiseptic

Answer 7

No other choice for multi-resistant infections
Sole therapy for surface Dz-
-otitis externa, surface pyo
Chlorhexidine

Question 8

Duration of Tx

Answer 8

Superficial
-2-3wks clinical and cytological cure
Deep
-4+wks palpable, clinical and cytological cure

Question 9

Otitis general

Answer 9

Inflammation of ear canal
Otitis externa - external ear canal
Otitismedia - middle ear
Otitis interna - inner ear
Pinna can also be affected
Common 1st opinion problem

Question 10

Otic anatomy

Answer 10

Facial nerve
Tympanic bulla
Tympanic membrane
- Pars flaccida, Stria mallearis, Pars tensa

Question 11

Otic histology

Answer 11

Ear canal lined with modified skin
-small hair, ceruminous glands, sebaceous glands
Middle ear lined by modified respiratory epithelium
-simple squamous, few ciliated cells, goblet cells

Question 12

Otic physiology

Answer 12

Self cleaning
-Cerumen- catches material and has AM peptides and Igs
-Epithelial migration-carry cerumen out of canal
Mid ear clean
-goblet mucus drained via eustachian tubes (nasopharynx)
Flora
-G+ve cocci
-Malassezia

Question 13

Pathogenesis

Answer 13

1°- Otodectes, demodex, allergy, FB
(Foreign body, Allery, Bug) (FAB)
Cats 1°-viral (FCV), para, allergy

Question 14

Allergic otitis

Answer 14

OE- manifestation of allerigc Dz
Pruritus, normally bilateral

Question 15

FB otitis

Answer 15

Unilateral
Grass seed
Acute and severe onset
Painful

Question 16

Otodectes cynotis

Answer 16

Dark coffe colour wax
Hyper sensitivity reaction to mites
Pruritis
Ectopic dz
Mites are photophobic (indirect smear in paraffin)

Question 17

Predisposition

Answer 17

Hairy canal (poodle)
Narrow canal (shar pei)
Waxy canals (cockers)
Pendulous pinnae
Water (swimmers)
Hot and humid
Neoplasia and polyps (also 1° Dz)

Question 18

Progressive pathological changes

Answer 18

Failure of epithelial migration
Progressive epithelial hyperplasia, oedema, fibrosis
Glandular dilation and hyperplasia
Canal stenosis
Rupture of tympanum
Calcification of pericartilaginous tissue
Osteomyelitis
Para-aural abscessation

Question 19

Otitis Dx

Answer 19

Check both ears
Assess and palpate pinnae and external ear canal
Otoscopy (sedation if painful)
Imaging - if OM/ OI
-radiography, CT, MRI

Question 20

CS Otitis externa

Answer 20

Otic pruritis - scratching, head shake
Pain
Discharge (otorrhea), malodour
Deafness
Pinna- erythema, lichenification
Otoscopy- epithelial erythema, ulceration

Question 21

CS progression

Answer 21

Secondary causes & perpetuating factors develop due to 1°
Allergic otitis>Malassezia overgrowth
Change in Env. due to inflammation and high humidit
Chr Pseudomonas OE progress to OM

Question 22

Ear cleaning

Answer 22

Most otitis cases can be help with cleaning
Removal of debris
Visualisation of TM
Enhance topical therapies
Ac, no pain, minimal debris
-conscious, proprietary cleaner
Chr, copious discharge
-GA, saline lavage (till TM seen)
-Analgesia (paracetamol), Preflush preds

Question 23

Anti inflammatory Tx

Answer 23

Resolve progressive pathological changes
Epithelial and glandular hyperplasia and stenosis
Glucocorticoids
-anti-pruritic, less secretion, systemic/ topical prednisolone
Long term- ciclosporin

Question 24

Cytology

Answer 24

Cheap, low risk
Dx of infection
Differentiate sterile/ infectious otitis
Informs empirical topical therapy
Assess therapy response
Indirect smear with cotton bud
NO overgrowth> Anflamms
Yeast> topical antiseptic/ fungal
Bacteria> topical antiseptic/ antibiotic

Question 25

AM spectrum of activitu

Answer 25

Chlorhexidine> G+ cocci, G- rods, Malassezia
Florfenicol> G+ cocci
Gentamycin> G+ cocci, G- rods
Miconazole> Malassezia
Not licensed if TM ruptured
-Sys prednisolone, clean (GA)
-water based products (otodine)
-low [] chlorhexidine

Question 26

Long term management

Answer 26

Therapeutic plan for 1° cause
Address predispositions
Regular ear cleaning

Question 27

Hypersensitivity atopic otitis

Answer 27

Common manifestation of OE
Tx allergic inflammation to prevent recurrence
Cortisol licensed 2wks Tx
Nothing licensed long term

Question 28

Pathogenesis of OM and OI

Answer 28

Extension of chronic OE
-norm. canine bacterial Dz
1° OM
- not always clear PthG
-cats ET inflammation, obstruction
-dog ET dysfunction, abnormal conformation

Question 29

Primary secretory otitis media

Answer 29

PSOM
CKCS/ brachycephalics
Mucus build up in middle ear (sterile)
Present as deaf and painful, incidental on CT/MRI
Bulging TM on otoscopy
Myringotomy to sample for cytology
Repeated flushing with sterile water to liberate mucoid plug

Question 30

OM and OI CS

Answer 30

+/- OE CS
Pain
Horners syndrome
Loss of hearing
Vestibular Dz