Patient with Otitis Flashcards
clinical signs of external ear disease
head shaking, scratching, otic pain and otic discharge, aural hematomas
middle ear disease clinical signs
greater otic pain, more head shaking, lethargy, inappetance, pain when opening the mouth. Sometimes stuff like Horners, facial nerve paralysis can happen too
unitlateral otitis media
xeromycteria (unilateral dry nasal planum) and KCS
Peripheral vestibular signs (most obvious of inner ear)
When starting an ear exam, remember to…
look at the good ear first
Pain when opening the mouth tells us…
otitis media
The ear neuro exam should look for…
CN 7 paralysis
nystagmus
KCS
vestibular disease
If the ear canal is too obstructed to get a good view on otoscope, what do you do?
2 wks of oral corticosteroids, then you may be able to flush and look.
Definition of otitis externa
inflammatory condition with or without concurrent infection
What is the difference between causes and factors in otitis?
causes - can cause disease in the normal ear, primary and secondary
factors- just make it worse
What are examples of causes of primary otitis?
hypersens (90%) like atopy, adverse food reactions
Parasites like Otodectes, demodex and sarcoptes
IM Dz like pemphigus
Foreign bodies like grass awns and so on
Hypothyroidism
other glandular disorders
What are some secondary causes of otitis?
bacteria (staph and pseudo)
yeasts - malass
overcleaning
physical trauma
What are predisposing factors and what are some predisposing factors contributing to Otitis
Predisposing factors do not cause disease but increase risk of development
conformation of the ear - large and pendulous pinnae in the spaniels are the worst, narrow ear canals like the shar pei and excessive ear hair like the poodle
- Lifestyle of swimming or excessive ear care
- obstructive stuff like neoplasia or polyps
What are perpetuating factors and what are some examples of them?
do not initiate disease but they cause it to continue, FOLLOWING
- Otitis media
- progressive changes in the canal like edema, infiltration of inflamm cells, calcification, fibrosis, –>occlusion of the canal
What should our approach be to the otitis case?
Hx, clin/derm exam,
otoscopic exam - tympanic membrane
ear canal cytology - look for organisms, inflammation,
Ear swabs for culture or for otodectes
Try to identify primary/secondary causes, predisposing/perpetuating factors
Types of topical treatments for otitis
ear cleaning/drying agents
Topical glucocorticoids
topical antimicrobials
what ear cleaning/drying agent is good for gram negatives
tris-EDTA
What should we worry about with ear cleaning/drying agents?
that the tympanic membrane s ruptured, especially if there is chlorhexidine in the mix
What was Epi-otic suggested for in the notes?
possible to resolve malassezia or bacterial otic infections
What is the trouble with the commercial topical ear treatments? What is the biggest risk?
none are labelled when the tympanic membrane is not intact. The biggest risk is ototoxicity
Which preparation is least ototoxic for topical ear preps?
Baytril Otic - enroflox and siilver sulfadiazine
What are the benefits of topical glucocorticoids?
anti-pruritic, anti-inflamm, and antiproliferative.
reduce secretions
Which glucocorticoids can be used long term with less problems?
hydrocortisone
What do we use the Neomycin, Gent (with antifungal and glucocort) for and what are the drawbacks?
obvious ototixicity is a drawback
but it’ll hit the gram pos and negs
Where do we use the FLQL topicals and what is a formulation of it?
broad spectrum negs and pos.
Baytril Otic is the enro with silver sulf
What is surolan? what does it hit? what are it’s limitations?
Polymixin B so it hits Pseudomonas well. But cannot work in pus so deal with that. It will also cause ototoxicity
What are the topicals label for antifungal use?
Nystatin, miconazole, clotrimazole
What do we use systemic glucocorticoids for in otitis externa?
decrease stenosis
reduce edema
decrease hyperplasia of the vertical and horizontal ear canal
Can even be used for severe bacterial otitis
What is protocol for AM and AF in otitis externa?
not generally recommended but when necessary, make sure it is cultured
When ear infections are recurrent, consider…
otitis media
what is another pathogenesis from regular for otitis media in cats? what are clinical signs for that?
cats can have ascending from the auditory tubes.
ask about sneezing, discharge from eyes or nose.
Dx of otitis media
sometimes need to do myringotomy and get cytology and culture from it.
Tx of otitis media
myringotomy to flush it out
reduce inflammation with corticosteroids
topical AM and maybe systemic
weekly rechecks
Where is a myringotomy incision made?
ventral portion of the membrane
