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EV ACVD Study > Otology > Flashcards

Otology Flashcards

1
Q

Ear label (apex, scapha, cutaneous marginal pouch, median/rostral margin, lateral/caudal margin)

A
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2
Q

T or F: Breed matters more than heat/temp of the ear canal

A

T

No temp/humidity difference between diseased and normal ears.

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3
Q

T or F: environmental humidity can affect ear canal humidity

A

F

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4
Q

Do ear canals with or without hair have a higher temperature

A

Canals WITHOUT hair are hotter

Canals WITH hair are cooler

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5
Q

Which breed has higher ear canal temperatures than other dogs

A

GSD

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6
Q

Breed with ceruminous gland hyperplasia

A

Cocker spaniels

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7
Q

Pendulous ears vs hair relationship

A

Pendulous ears WITH hair get more otitis

(but maybe actually more related to breed)

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8
Q

Erect ears vs hair relationship

A

Erect ears +/- hairs get less otitis

(but maybe actually more related to breed)

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9
Q

Predisposing, Primary, or Perpetuating: Conformation (hair, anatomic stenosis, pendulous pinnae)

A

Predisposing

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10
Q

Predisposing, Primary, or Perpetuating: Otodectes cynotis

A

Primary

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11
Q

Predisposing, Primary, or Perpetuating: excessive moisture (swimming)

A

Predisposing

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12
Q

Predisposing, Primary, or Perpetuating: trauma from cotton swabs

A

Predisposing

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13
Q

Predisposing, Primary, or Perpetuating: hair plucking

A

Predisposing

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14
Q

Predisposing, Primary, or Perpetuating: atopic dermatitis

A

Primary

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15
Q

Predisposing, Primary, or Perpetuating: bacterial/yeast infection

A

Perpetuating

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16
Q

Predisposing, Primary, or Perpetuating: otitis media

A

Perpetuating

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17
Q

Predisposing, Primary, or Perpetuating: Hypothyroidism

A

Primary

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18
Q

Predisposing, Primary, or Perpetuating: pemphigus foliaceus

A

Primary

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19
Q

Predisposing, Primary, or Perpetuating: primary idiopathic seborrhea, juvenile cellulitis, sebaceous adenitis

A

Primary

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20
Q

Definition of predisposing factor

A
  • Facilitate inflammation by permitting alteration of
    microenvironment
  • Establishment of secondary infections
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21
Q

Definition of primary cause

A

*Conditions or disorders that initiate the inflammatory
process

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22
Q

What is the most common primary cause of otitis in dogs

A

Allergic disease

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23
Q

What are the 3 most common causes of otitis in cats

A

Parasites
Polyps
Allergic disease

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24
Q

What percent of dogs with atopic dermatitis have otitis as their ONLY clinical sign?

A

10%

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25
Q

What percent of dogs with CAFR have otitis as their ONLY clinical sign?

A

25%

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26
Q

What is the definition of a perpetuating factor

A

*Sustain and aggravate the inflammatory process

  • Prevent resolution of the otitis externa

*Worsen the otitis externa

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27
Q

Chronic otitis media can lead to ______: a cystic mass near the Eustachian tube

A

Aural cholesteatoma

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28
Q

Label a pinna (lateral process of antitragus, medial process of antitragus, intertragic incisure, tragis, medial crus helix, tragohelicine incisure, lateral crus helix, anthelix)

A

*Helix rostrally
*Tragus laterally
*Antitragus caudally
*Anthelix medially

*Intertragic incisure

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29
Q

Routes of infection for otitis media (2)

A

1) Extension of OE through TM
2) Via eustachian tube

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30
Q

What perent of dogs with chronic recurrent OE develop OM?

A

89%

(73% still had intact TM! Intact TM does NOT rule out OM)

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31
Q

Which bacteria are most common in canine OM?

A

-Staphylococcus pseudintermedius
-Pseudomonas aeruginosa

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32
Q

T or F: Malassezia can cause OM

A

True, in 23.7% of sampled ears in one study!

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33
Q

Breed with PSOM

A

CKCS

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34
Q

Clinical signs of PSOM

A

-Head and neck scratching, neurological signs, hearing
loss, otic pruritus, abnormal yawning, head tilt, facial paralysis, or vestibular
disturbances
-Intact tympanic membrane, mucoid exudate

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35
Q

Signs of facial nerve paralysis (3)

A

*Drooping of ear/lip
*Drooling saliva
*Absent palpebral reflex

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36
Q

What eye sign can be related to OM?

A

Neurogenic
keratoconjunctivitis
sicca (KCS)

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37
Q

Which nerve in the middle ear can cause Dry Nose (xeromycteria)

A

Parasympathetic

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38
Q

Which nerve in the middle ear can cause Horner’s syndrome

A

Sympathetic nerve

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39
Q

Signs of Horner’s Syndrome

A
  • Ptosis
    -Drooping of upper lid
  • Miosis
    -Contraction of pupil
  • Enophthalmos
    -Backward displacement of
    eyeball
    into the orbit
  • Protrusion of nictitating
    membrane
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40
Q

Signs of Otitis INTERNA

A

*Horizontal
nystagmus

*Head tilt, falling, rolling
to affected side

*Asymmetric ataxia

*Hearing loss

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41
Q

Where do you put your cone for otoscopic exam within pinnal structures?

A

Intertragic incisure

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42
Q

What is the relationship between BW and length of ear canal

A

Linear relationship exists between BW and ear canal volume

(more drops in larger dogs)

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43
Q

Where are there more hairs: Proximal or distal ear canal

A

Proximal

Decrease in number
from distal to proximal

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44
Q

What type of gland are ceruminous glands

A

-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

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45
Q

Who has a faster epithelial migration: the Pars tensa or Pars flaccida?

A

Pars flaccida!

-Pars tensa = 96.4 μm/d; Pars flaccida = 225.4 μm/d

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46
Q

Is epithelial migration mostly radial or centrigual

A

Radial

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47
Q

What does the TM look like on histopath? Layers?

A

– Outer and inner epithelium
– Core of collagen
– Hairless, glandless

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48
Q

Label

A

Chorda tympani, right ear, dog. The chorda tympani ( arrow ) courses dorsally across the neck of the malleus ventral to the muscular process of the malleus (Mp), in close proximity to the pars tensa. The stapes (S) is anchored in the oval or vestibular window and the foot plate ( arrowhead ) is clearly visible in the opened vestibule (V). The stapes and incus (I) articulate to form the incudostapedius joint. Tendon of the stapedius muscle ( asterisk ). C, cochlea; M, manubrium of the malleus; TT, tensor tympani muscle.

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49
Q

Ways feline middle ear is different from dog:

A

*Divided by a septum into 2 separate tympanic
cavities; connected through a foramen between
septum and petrous bone
*Dorsolateral (pars tympanica)
–Auditory ossicles, ostium of auditory tube, tympanic
membrane
–Smaller of the two
*Ventromedial (pars endotympanica)
–Air-filled tympanic bulla

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50
Q

Label middle ear, part of inner ear

A

Right ear, rostral view, dog. The middle ear has three main compartments. The epitympanic recess ( arrow ) is the smallest, most dorsal compartment occupied by the articulated malleus and incus (I). The next largest is the tympanic cavity proper (Tp) demarcated laterally by the tympanic membrane (torn in this image) and medially by the promontory of the petrous portion of the temporal bone (P). The largest is the ventral compartment (V) surrounded by the bone of the tympanic bulla ( asterisk ). Ventral bony ridge of the external acoustic meatus ( double asterisk ); stapes ( arrowhead ). Bs, brainstem; C, cochlea; Cr, cerebellar cortex; E, external ear canal; F, facial nerve in its facial canal; S, incomplete septum bulla.

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51
Q

Is the oval or round window adjacent to the pars flaccida?

A

Oval

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52
Q

Does the foot of the stapes touch the oval or round window?

A

Oval

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53
Q

What is the other name for the oval window

A

vestibular

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54
Q

What is the other name for the round window

A

cochlear

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55
Q

What is the eustachian tube

A
  • Extends from
    nasopharynx to tympanic
    cavity
  • 8mm long
  • 1.5mm diameter
  • Equalizes pressure
  • Cartilagenous,
    junctional, osseous
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56
Q
A
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57
Q

Where is the ideal myringotomy site?

A

Ventocaudal

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58
Q

Name of the fluid inside the inner ear

A

Perilymph

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59
Q

Portion of spiral passage that ascends into cochlea

A

Scala vestibuli

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60
Q

Portion of spiral passage that exists cochlea

A

Scala tympani

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61
Q

What is inside the cochlea duct (that runs alongside the scala vestibuli and scala tympanic

A

endolymph

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62
Q

What sends nerve impulses to the brain due to vibrations from the basilar membrane in the cochlea?

A

Organ of corti via cochlear nerve

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63
Q

What cells are inside the organ of corti, to induce nerve transduction

A

Hair cells

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64
Q

T or F: most PSOM cases have bacteria isolated via traditional culture

A

False

Due to increased production of mucus vs decreased drainage via eustachian tube

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65
Q

Healing time for ruptured TM in ideal conditions

A

21 to 35 days

66
Q

Possible complications from deep ear flush

A

-Facial nerve paralysis
-Horner’s Syndrome
-Vestibular disturbances
-Deafness

67
Q

Which of these medications are ototoxic?
-Gentamicin
-Chlorhexidine
-Ceruminolytic agents
-Tris-EDTA
-Tobramicin

A

-Gentamicin
-Chlorhexidine (if >0.2% in dogs, ANY CONCENTRATION IN CATS)
-Ceruminolytic agents
-Tobramicin

Tris-EDTA is SAFE
Tobramycin is V BAD. Can cause both hearing loss AND vestibular signs

68
Q

What cytology result is the strongest indicator of OE?

A

Inflammatory cells
Never present in normal ears

69
Q

Are rods on cytology normal in a canine ear?

A

No, but cocci can be

70
Q

For MRI: is T1 or T2 better for distinguishing fluid in bulla

A

T2: fluid shows up hyperintense

(isointense on T1)

71
Q

Brachycephalic bulla on MRI

A

Brachycephalics have smaller bullae, so the bulla wall can look thicker on MRI

72
Q

Why is Cerumene for in-clinic use only?

A

Urea or carbamide peroxide ceruminolytics need to be flushed out

72
Q

T or F: 64% brachycephalics had OM on CT; many with OM also had changes to soft palate thickness

A

T

73
Q

MOA of ceruminolytics

A

Hydrate desquamated sheets of corneocytes, inducing keratolysis and disintegration of cerumen

74
Q

MOA of surfactants

A

Decrease surface tension between water and lipids or organic solids to break up and help remove debris

75
Q

MOA of lubricants

A

Softening effect

76
Q

Which organism is Malacetic proven effective against?

A

Yeast

77
Q

Effect of topical glucocorticoids on sebaceous and apocrine glands

A

Decrease sebaceous and apocrine secretions

78
Q

Effect of topical glucocorticoids on adrenal glands

A

Can occasionally cause adrenal suppression

79
Q

Which 2 medications are most likely to cause a topical reaction

A

Neomycin
Propylene glycol

(no source for this, but from Lynette Cole lecture)

80
Q

Which bacteria is Polymixin B ineffective against?

A

Proteus

81
Q

What inactivates polymixin B

A

Purulent debris

82
Q

What can be combined with polymixin B for a synergistic effect against Pseudomonas and Malassezia

A

Miconazole

83
Q

Which bacteria is florfenicol ineffective against

A

Pseudomonas

84
Q

Which bacteria (3) is fluoroquinolones ineffective against

A

Streptococcus, Enterococcus, Anaerobes

85
Q

Are gram positive or gram negative bacteria more susceptible to Tris-EDTA

A

Gram negative

86
Q

MOA of Tris-EDTA

A

*Leakage of cellular
components,
permeability of
antibiotics
*Tromethamine
enhances the effect of
EDTA

87
Q

Mechanism for permanent deafness or balance issues

A

Loss of hair cells in inner ear

88
Q

Medications with highest risk of ototoxicity, usually permanent

A

Aminoglycosides (gentamicin, amikacin)
Cisplatin

89
Q

Which heart medication can be ototoxic?

A

Furosemide (loop diuretic)
Usually temporary

90
Q

With ototoxicity, is hearing loss first a high or low frequencies?

A

High frequencies are lost first

91
Q

2 non-drug causes of hearing loss

A

Noise, age

92
Q

Other than aminoglycosides, which other antibiotics have been associated with ototoxicity

A

Erythromycin

93
Q

Which antipyretic has been associated with temporary hearing loss

A

Salicylates

94
Q

Can SQ aminoglycosides still induce ototoxicity?

A

Yes

95
Q

Does gentamicin target balance, hearing, or both

A

Both

96
Q

Does amikacin target balance, hearing, or both

A

Hearing only

97
Q

T or F: aminoglycosides can cross the placental barrier and cause deafness in fetuses

A

T

98
Q

MOA of ototoxicity by aminoglycosides

A

Oxidative stress caused by the overproduction of reactive oxygen species (ROS)

99
Q

How can you prevent ototoxicity in animals

A

Give a concurrent antioxidant with your drugs (ie aspirin, but never in cats. ie silymarin, vitamin E)

100
Q

MOA of furosemide temporary ototoxicity

A

Increase in the sodium concentration and a reduction in potassium activity in the endolymph.

101
Q

Relationship between brachycephalics and otitis media w/effusion (OME) on MRI

A

CKCS w/ bilateral OME had a significantly greater thickness of the soft palate and reduced area of the nasopharynx compared with CKCS without OME.

102
Q

Most common aural tumors in dogs

A

*Ceruminous gland adenoma/carcinoma
*Papilloma
*Histiocytoma

103
Q

Most common aural tumors in cats

A

*Ceruminous gland adenoma/CA
*SCC of the pinna
*Inflammatory polyps of the middle ear

104
Q

Which is the germinal center of the TM

A

Umbo

105
Q

Where do polyps arise from in cats

A

mucosal lining of the middle ear, the auditory tube, or the nasopharynx

106
Q

Etiology of polyps in cats

A

Chronic inflammation of the middle ear mucosa from a:
-viral-mediated otitis media
-chronic stimulation
-ascending bacterial infection

107
Q

Feline polyp histopath findings

A

-Vascularized fibrous connective tissue
-Stratified squamous or columnar epithelium
-Lymph, plasma cells, macrophages
present

108
Q

Canine polyp histopath findings

A

-Keratinizing squamous epithelium
-Hair follicles, sebaceous, ceruminous glands present usually, but some lacked adnexa.
-SOME have cuboidal to ciliated columnar epithelium

109
Q

Treatment options for aural inflammatory polyps (3+1)

A

1) Trans-tympanic traction-avulsion
2) Traction-avulsion with rostral soft palate retraction
3) Ventral bulla osteotomy
4) Normograde rigid rhinoscopy-assisted traction-avulsion

110
Q

Recurrent ear mite infection in cats can predispose them to _____

A

Ceruminous gland adenocarcinoma

111
Q

Breed predisposed to leproid granuloma

A

Boxer

112
Q

Organism implicated in canine leproid granuloma; location on body

A

Saprophytic Mycobacteria, base of ears (anywhere on head, distal limbs. No LN involvement)

113
Q

Is hot or cold more associated with development of leproid granulomas

A

Cool; why they prefer ears. More common in cooler months.

Spread by inoculation from bug bites vs trauma

114
Q

Diagnosis of leproid granuloma

A

Acid fast + on FNA or histopath

Macrophages contained many small, non-staining (clear) linear structures, consistent with Mycobacterium sp.

115
Q

Treatment leproid granuloma

A

Spontaneous resolution is reported, but usually sx or long term antibiotics (rifampin, clarithromycin) needed

116
Q

Organisms that can cause infectious cutaneous granulomas (9) on the pinna

A

Leishmania sandflies bite the ears and face

-Blastomyces dermatitidis
-Crytococcus
-Histoplasma capsulatum
-Neospora caninum
-Toxoplasma gondii
-Trypanosoma cruzi
-Sporothrix schenchkii
-Other opportunistic fungal infx

117
Q

What should you evaluate for in a pet with a para-auricular abscess

A

Usually 2’ obstructive hyperplastic proliferative OE

Can be due to neoplasia, OM, TECA, trauma –> always check for cancer

118
Q

Origin of most aural polyps in dogs

A

Ear canal

119
Q

Origin of most aural polyps in cats

A

Tympanic bulla, eustachian tube

120
Q

Virus associated with aural polyps in cats

A

Calicivirus

121
Q

Of cats that required TECA for end stage ear 2’ chronic OE, which histopathologic feature was present 100%

A

Ceruminous gland hyperplasia

122
Q

T or F sebaceous gland hyperplasia is 2’ chronic inflammation

A

False

123
Q

Pinna in a 3 month old cat. Diagnosis

A

Proliferative and Necrotizing Otitis Externa (of Kittens)

124
Q

Cell involved in Proliferative and Necrotizing Otitis Externa (of Kittens)

A

CD3+ T cells

125
Q

Treatment for Proliferative and Necrotizing Otitis Externa (of Kittens)

A

Tacrolimus (works in 2 weeks)

126
Q

T or F: Proliferative and Necrotizing Otitis Externa (of Kittens) is triggered by viruses

A

False.

At least, not yet found

127
Q

Mass occurring in the middle ear (pearly white mass); etiology = 2’ invagination of stratified squamous epithelium from the external ear canal.

A

Aural keratinizing cyst (cholesteatoma)

128
Q

Nonneoplastic mass in the bulla commonly associated with boney changes on CT (osteoproliferation, osteolysis)

A

Aural keratinizing cyst (cholesteatoma)

129
Q

Feline ceruminous cystomatosis sex predilection

A

Males

130
Q

Inflammatory mass in the middle ear of dogs with chronic OM. Cholesterol aggregates seen on histopath

A

Cholesterol graunloma

Yellow, round to irregular, variably friable mass

131
Q

Feline ceruminous cystomatosis breeds

A

Abyssinian, Persian

132
Q

Causes of noninfectious granulomatous lesions in dogs (4)

A

1) Sterile granuloma and pyogranuloma syndrome
2) Cutaneous xanthoma
3) Canine sarcoidosis
4) Foreign body reaction

133
Q

Diagnosis??

7 yo FS dog with nonpruritic, nonpainful papules, plaques, and nodules on trunk, neck, face, and ears. Responsive to steroids, cyclosporine

Histopath: multifocal nodular inflammation composed of pale, slightly vacuolated epithelioid histiocytes with giant cells and a few lymphocytes in the superficial-to-deep dermis. Gram/acid fast/GMS stains = negative.

Epitheliod cells = + for CD18 and Iba1 (macrophage)

A

canine sarcoidosis

134
Q

Which organisms do you need to rule out in “Sterile granuloma and pyogranuloma syndrome” that are difficult to culture

A

Mycobacterium
Leishmania

135
Q

Disease in cats&raquo_space;» dogs 2’ to dyslipoproteinemia. Results in as bilaterally symmetric, preauricular multi-
focal to coalescing, white-yellow plaques or nodules

A

Cutaneous xanthoma

136
Q

Species with Auricular chondritis/chondrosis

A

Cats (1 dog)

137
Q

T or F: other areas are also often affected with Auricular chondritis/chondrosis

A

False

138
Q

Clinical signs Auricular chondritis/chondrosis

A

Markedly swollen, curled, and painful pinna with intense erythema.

Unilateral progresses to bilateral

139
Q

Treatment Auricular chondritis/chondrosis

A

immunosuppression +/- pinnectomy

140
Q

Idiopathic benign lichenoid keratosis: clinical signs, treatment

A

hyperkeratotic plaque or papules on concave pinna

Sx = curative

141
Q

Body sites affected by Canine cutaneous histiocytomas

A

Head, pinnae

142
Q

Type of cell in Canine cutaneous histiocytomas

A

Langerhan cell

143
Q

IHC for _____ confirms langerhan cell origin in canine cutaneous histiocytoma

A

E-cadherin

144
Q

Plasmacytoma location on body

A

Feet, lips, and ear canal

145
Q

Are aural neoplasms more likely to be benign or malignant

A

Malignant

Cats (85%)
Dogs (60%)

146
Q

Though rare, what is the most common MIDDLE ear neoplasm in dogs and cats

A

SCC

147
Q

SCC on a pinnal tip and preauricular area. What signalment is most likely

A

White cat

148
Q

2 predisposing factors for SCC in external ear canal

A

1) Damaged skin
2) Continuous exposure to cerumen (potentially carcinogenic?)

149
Q

Most common location of cutaneous hemangiosarcoma in cats

A

Pinnae (>50%)

Likely UV associated in light colored cats

150
Q

Body location of feline sarcoids (feline cutaneous fibropapilloma)

A

head (nares, lips, and pinnae)

151
Q

Virus implicated in feline sarcoids (feline cutaneous fibropapilloma)

A

BPV-14

152
Q

Signalment of animal with feline sarcoids (feline cutaneous fibropapilloma)

A

Rural, young male cat

Fighting behavior?

153
Q

Treatment feline sarcoids (feline cutaneous fibropapilloma)

A

Surgery. Locally infiltrative, so concern for local recurrence

154
Q

Muscles responsible for the mobility of the pinna

A

Rostroauricular and ventroauricular muscles

155
Q

Breed with more excessive compound hair follicles within horizontal ear canal

A

Cocker spaniel

156
Q

Content of cerumen

A

Desquamated cornocytes, apocrine secretions, and sebaceous secretions

157
Q

Where does epithelial migration start? Where does it go?

A

Starts at manubrium of malleus (germinal center)– spreads laterally, radially

158
Q

Most common bacteria in dogs with acute OE

A

Staphylococcus and
Bacillus sp., yeast, and less frequent Streptococci, E.coli, Corynebacterium sp. and Micrococcus
species

Pseudomonas sp. and Proteus sp. are rarely cultured.

159
Q

Most common bacteria in dogs with chronic OE

A

Staphylococcus pseudintermedius,
Pseudomonas aeruginosa, E.coli, beta hemolytic streptococcus, Proteus sp., Enterococcus sp.,
Corynebacterium sp.

160
Q

Name for structure where tympanum attaches to surrounding bone

A

Annulus fibrocartilagenous

EV ACVD Study (21 decks)

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