Otitis Flashcards
Primary factors of OE
systemic disease
- enough for inflammation (FB, allergy, autoimmune, endocrinopathy, parasitic)
Parasites as primary factors of OE
- otodectes cynotis (ear mite) nonburrowing obligate parasite
*50% of OE in cats, 10% in dogs. feed on lymph and blood (especially <1 yr animals) - otobius megnini (spinous ear tick) more common in SW US/Large animal, larval infection
- E. alfreddugesi (chiggers) seasonal(fall) see red/orange dots around ear canal
- Demodex. in cats suspect FeLV, FIV, neoplasm.
- Scabies (scabiei - dogs) usually isnt in the ear, associated with a lot of pruritis, thick crusts
(notoedres cati - cats) face, pinna not in ear canal as much, also severe pruritis.
one of most pruritic diseases
scabies
Which parasite isn’t ruled out just because you can’t see it on the scrape?
scabies
FB otitis
unilateral! with acute pain
(plant awns, insect, sand, dry meds)
remove and use topical abx
intraluminal tumor causing otitis externa
relatively uncommon
ulceration and necrosis
often more malignant in cats than dogs (**ceruminous gland adenocarcinoma, squamous cell carcinoma, mast cell)
Nasopharyngeal polyp
- etiology can be congenital, bacterial or calicivirus.
- chronic uni/bilateral otitis, mass in canal, head tilt
- tx with surgery
apocrine cystomatosis
sitting on pinna, start small.
sx necessary because they will obstruct the canal
atopic dermatitis and OE
red and inflamed
pinna, vertical canal, entire canal when chronic. 50% have bilateral
____% of food allergy have OE
80%
contact allergy and otitis externa
usually associated with topical meds (gentamycin, propylene glycol (in lots of ear products) )
disorders of keratinization and OE
primary idiopathic seborrhea
hypothyroid
sex hormone imbalance
lipid related conditions
primary idiopathic seborrhea
(cockers!!) excessive cerumen production often progresses to calcifying OE and OM
endocrine disease and OE
(hypothyroid and sex hormone imbalance)
- inc. mucin in dermis and hyperplasia/hyperkeratosis epidermis
- chronic bilateral otitis +/- dermatitis, usually alopecia and scaling
- tx with hormones/sx
autoimmune disease and OE
pemphigus
tip of pinna, generally not in the canal
Juvenile cellulitis and OE
puppy strangles!
facial lesions and purulent otitis and facial ulcers…
secondary factors for OE
basically infections
- bacteria and yeasts (same ones on skin)
Bacteria: staph**, psuedomonas, proteus, e. coli, klebsiella)
Yeast: malassezia (normally in ear), candida (rare) doesn’t usually affect the ear
perpetuating factors of EO, cause otitis to persist
otitis media, mineralization, hyperplasia of canal
pathogenic changes
hard to differentiate, get harder/calcified (v. squishable, needs to be imaged for confirmation)
general clinical signs of OE we see
painful, red, edematous, pus
clinical signs of OE
- *odor, head shaking, discharge**
- head tilt, pain
- (with chronicity) erythema, edema, lichenification, hyperpigmentation, excoriation, mineralization
otitis media
extension of OE
(goes thru ear drum and sits there, rarely moves through eustacian tubes,)
- diagnosis difficult, can’t visualize tympanic membrane, very painful
- neurological signs - facial paralysis, horners syndrome (because of compression/inflammation)
ear cytology
easy, mandatory and fundamental!!!
heat fix a swab
video otoscopy
used to do a deep ear flushing, can visualize tympanic membrane
(also myringotomy artifical rupture of membrane)
purulent discharge and meds?
discharge will inactivate meds like gentamycin, polymyxin B
have to _____ if doing a deep ear flush
intubate! don’t want any nasties getting in the lungs
do a culture and sensitivity for ___ not ___
OM not OE
ceruminolytics
squalene or propylene
need to stay in 20 minutes and be flushed out
some are irritating and potentially toxic
acidifying agents
dry the canal
dont use with aminoglycosides
common antimicrobial agents
chlorhex
ketoconazole
hypochlorous acid
most common antibiotics
aminoglycosides (neomycin, gentamycin)
abx
aminoglycosides
fluoroquinolones(enrofloxacin)
polymyxin B
florfenicol (leave in a week)
when to use systemic abx for otitis?
and then always?
OM!!
or sever OE (fluroquinolines, clyndamycin)
Always use with topical tx!!
treat OM for minimum of
6-8 weeks
often have contact allergy
neomycin, gentamycin
otitis is not
so always?
a disease!!!
treat underlying disease
