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Unit 3 - Otitis Externa Flashcards

1
Q

What clinical features are associated with otitis externa?

A

pruritis, pain, foul-smelling odor, and discharge

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2
Q

What are the predisposing factors that may lead to otitits externa?

A

Conformation/breed predispositions, behavior of the patient, environment, trauma, obstructive disease, and immunosuppressive diseases

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3
Q

What conformation/breed predispositions predispose patients to otitis externa?

A

long, tortuous ear canal, stenotic pinnae, hair in the external ear canal, and thick, dense hair at the opening of the external ear canal

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4
Q

What behavior of a patient can predispose them to developing otitis externa?

A

swimming or excessive bathing

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5
Q

What environmental conditions can predispose to otitis externa?

A

high environmental temperatures and high relative humidity increase the risk of otitis

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6
Q

What does the external canal consist of?

A

skin overlaying cartilage - auricular and annular cartilage

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7
Q

What part of the external ear canal does the auricular cartilage make up?

A

the ventral canal

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8
Q

What part of the external ear canal does the annular cartilage make up?

A

the horizontal canal

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9
Q

True or False: Only certain breeds have hair follicles in their ear canal.

A

False - all breeds have hair follicles in their ear canals, some just have hairier ears

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10
Q

When visualising the tympanic membrane, what structures can you see?

A

Pars flaccida, pars tensa, and malleus

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11
Q

1

A

pars flaccida

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12
Q

2

A

pars tensa

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13
Q

3

A

malleus

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14
Q

4

A

external ear canal

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15
Q

The pars flaccida can change appearance based on ______.

A

pressure

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16
Q

What primary factors can induce otitis externa?

A

ectoparasites, foreign bodies, allergies, scaling disorders, autoimmune skin diseases, and juvenile cellulitis

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17
Q

What ectoparasites can cause otitis externa?

A

Otodectes cynotis, Otobius megnini, Sarcoptes scabeii, Notoedres cati, Demodex, and Cheyletiella

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18
Q

What is the most common primary factor of otitis externa in the dog?

A

atopic dermatitis

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19
Q

What are the perpetuating factors for otitis externa?

A

bacteria, yeast, otitis media, erroneous treatment, proliferative/pathological changes of the external ear canal, and polyps

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20
Q

What are the most common bacterial isolates in inflamed ears of dogs?

A

Staphylococcus pseudintermedius, Proteus mirabilis, Pseudomonas aeruginosa

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21
Q

What are the most common bacterial isolates in inflamed ears of cats?

A

Staphylococcus pseudintermedius and Pasteurella multocida

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22
Q

What are some pathological changes that can occur in the ear?

A

inflammation, glandular hyperplasia, epidermal hyperplasia, additional inflammation, fibroplasia, and ossification

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23
Q

What is evidence based medicine?

A

conscientious, explicit, and judicious use of current best evidence in making decisions

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24
Q

What are ‘best practicies’?

A

Procedures/methods shown by research and experience to produce optimal results that are established or proposed by experts in a field as a standard for use - used to provide clinical practice guidelines

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25
What are the best practices in the management of otitis?
1. Use appropriate diagnostics 2. Prepare the canal for treatment 3. Choose treatment wisely 4. Medications must be administered properly 5. Use quality control to evaluate the environment 6. Consider long-term maintenance therapy 7. ID and control primary factors
26
What are the appropriate diagnostics for diagnosing otitis externa?
medical history, PE, otoscopic examination, cytology, culture and sensitivity, and diagnostic imaging
27
What are the keys/goals of otoscopic examination?
examine both canals, visualize the tympanic membrane, and do no harm (may need sedation/anesthesia as necessary)
28
What tools can be used for otoscopic examination?
otoscopes, pneumo-otoscopy, and video otoscope
29
What are the benefits to using a video otoscope?
increased magnification over hand held otoscopes, better light and clarity, and they give you the ability to adapt better for individuals visual defecits
30
What is the 'key' diagnostic test in otology?
cytology
31
True or False: Cytology should be done in both ears regardless if the disease is unilateral
TRUE
32
How do you perform an ear cytology?
1. Introduce a cotton-tipped applicator gently into the horizontal external ear canal 2. Roll the cotton swab gently onto a glass slide 3. Heat fix sample (if greasy) 4. Stain with Wrights, Diff Quik, or New Methylene Blye 5. Rinse off the extra stain with water (do this by applying water to the non-stained edge and let it run down the slide until it turns clear) 6. Air dry, or dry with cool blower
33
What is normal to find on an ear cytology?
keratinocytes, cerumen (ear wax), occasional bacteria (cocci or rods), and occasional yeast
34
What are you looking for on an ear cytology?
Presence of bacteria, including relative nubers, type (rods, cocci), and whether a pure or mixed infection is present The presence of Malassezia or other fungi, including relative numbers, and if a mixed infection with bacteria The presence of inflamatory cells: if present, a culture and systemic antimicrobial therapy is indicated The presence of parasites The presence fo other atypical cells - like neoplastic cells
35
If examining for ear mites, what should you do with your cytology?
Place the sample in mineral oil, cover slip, and then examine without staining under low power magnification
36
What are the indications for bacterial culture?
known resistant organisms, failure to respond to standard-of-care therapy, previous administration of (several) antibiotics, single population of rods on cytology, and concurrent systemic signs
37
What are the indications for diagnostic imaging of the ear canal?
clear loss of tympanic membranes, unable to adequately visualize the TMs, and recurring infections
38
What are the options for otic diagnostic imaging?
radiography, ultrasonography, MRI, and CT
39
What must you do prior to treatment of otitis externa?
treat the perpetuating factors, remove or control primary factors, and minimize predisposing factors of otitis externa
40
When should thorough cleansing of the ear canal be done?
after the otoscopic examination and collection of samples for cytology and culture - if indicated
41
What cleansing agents can be used for cleansing of the ear canal?
Ceruminolytic agents with or without drying agents
42
Should hair be removed pror to treatment of otitis externa?
It is highly recommened because it can prevent proper evaluation, is possibly a predisposing or perpetuating factor, and it blocks penetration of medication into the ear
43
What is the purpose of cleaning the ear canal?
Remove debris that causes irritation Removes debris/hair that blocks movement of medication into horizontal canal Removes debris that interferes with 'self-cleansing' Removes debris that can interfere with activity of active ingredients Reduces the burden of microorganisms
44
What bacterial otitis externa infections are frequently associated with biofilm production?
Pseudomonas (40-90%) and Staphylococcus spp. (30% (otitis) - 96% (various))
45
What are the mechanisms of antimicrobial tolerance with biofilms?
antimicrobial depletion - agent doesn't reach the biofilm slow penetration - gives cells chance to initiate a stress response stress response - cells change activity in response to challenge altered microenvironment - metabolically inactive persister cells - spore-like cells that can survivie an antimicrobial challenge
46
When is deep ear cleaning/flushing indicated?
When you can not clearly see the tympanic membrane
47
What is the goal of deep ear cleaning/flushing?
to thoroughly clean the ear
48
What techniques can be used to facilitate deep ear cleaning/flushing?
special catheters, teflon-coated catheters, and pump-suction instruments
49
What cleaning agents can be used for deep ear cleaning/flushing?
Ceruminolytic agents - squalene, DSS, urea, and carbamine peroxide
50
What cleaning agent is safe for the middle ear?
squalene
51
How is a teflon catheter used for deep ear cleaning?
Deep general anesthesia is needed, a teflon coated catheter is attached to an IV extension set and then is attached to a 3-way stopcock. The other 2 ports of the stopcock are attached to suction and a 60cc syringe (for saline). The clinician can direct the suction and flushing to specific areas in the ear using this technique
52
Cleaning techniques should be based upon what?
history, diagnostic results (organisms present), susceptibility patterns, and locations of infections, and owners abilities, perceptions, finances, etc.
53
What is animax (and similar products) made up of?
neomycin, thiostrepton, nystatin, and triamcinolone
54
What are the benefits of using animax?
good broad-spectrum action
55
What are the cons to using animax?
esthetics and ointment base
56
What is Tresaderm made up of?
neomycin, dexmethasone, and thiabendazole
57
What are the benefits of using Tresaderm?
Mild antibacterial and yeast, propylene glycol base, and good for first occurance
58
What are the cons to using Tresaderm?
Mild activity, must be stored refrigerated/warmed prior to use, and propylene glycol base (toxic effects to ear, can creaste a white substance that looks like pus)
59
What is Otomax/Mometamax made up of?
gentamicin, clotrimazole, betamethasone (systemic), mometasone (localized)
60
What are the benefits to using Otomax/Mometamax?
excellent ingredients and ointment base
61
What are the cons to using Otomax/Mometamax?
ointment base, gentamicin is ototoxic, packaging is terrible (can't see how much is in bottle)
62
What is Posatex made up of?
orbafloxacin, posaconazole, mometasone furoate
63
What are the benefits to using Posatex?
broad spectrum, excellent anti-inflammatory, and excellent antifungal
64
What are the cons to using Posatex?
ointment base, terrible packaging, and pricing
65
What is Baytril otic made up of?
enrofloxacin and silver sulfadiazine
66
What are the benefits to using Baytril otic?
excellent activity agains Pseudomonas, broad spectrum, and aqueous base
67
What are the cons to using Baytril otic?
minimal anti-fungal activity and no glucocorticoid
68
What is easOtic made out of?
gentamicin, miconazole, hydrocortisone aceponate
69
What are the benefits of using easOtic?
good ingredients, excellent applicator, excellent anti-inflammatory
70
What are the cons to using easOtic?
gentamicin is ototoxic, total volume is insufficient, thicker ointment base, pricing
71
What is Surolan made up of?
polymyxin B, sulfates, miconazole, and prednisolone
72
What are the benefits to using Surolan?
good activity against Pseudomonas and excellent for Malassezia
73
What are the cons to using Surolan?
activity in presence of pus is questionale and is ointment based
74
What commercial otic medications are FDA approved drops?
Claro and Osurnia
75
What is Claro made up of?
Florfenicol (for gram positive cocci), terbinafine, and mometasone
76
What is Ketocort Otic made up of?
Ketoconazole and hydrocortisone
77
What is Osurnia made up of?
Florfenicol (for gram positive cocci) , terbinafine, and betamethasone
78
When are residual otic preparations indicated?
when clients cannot (or will not) treat daily
79
Aside from commercial otic products, long-acting topical medications, and residual otic preparations, what can be used to treat otitis externa?
opthalmologic products, flushes and products labeled for otic use, and compounding (do not try at home)
80
What would be a benefit to using compounding pharmacies?
they provide a wide range of active ingredients and a wide range of formulations - there are short half-lives
81
What would be a con to using compounding pharmacies?
poor qualitiy control and variability
82
What are the advantages of topical therapy?
delivers medication directly to the affected area, high concentrations, and inexpensive
83
What are the disadvantages of topical therapy?
Delivery deep into ear may be questionable, owner compliannce, poor penetration if middle ear is involved
84
Is there value to a culture?
yes - it informs clinician of organisms that are present, it identifies sensitive antibiotics, and may provide insight ito efficacy of other choices
85
What are the best choices for S. pseudintermedius?
Florfenicol, aminoglycosides, fluoroquinolones, and SSD
86
What are the best choices for Pseudomonas spp?
aminoglycosides, fluoroquinolones, polymyxin B, SSD
87
What are the best choices for Malassexia?
azoles, terbinafine, and nystatin
88
What are the best choices if there is a ruptured tympanic membrane?
fluoroquinolones
89
Wjat are the best choices if there are client compliance issues?
Claro and Osurnia
90
Choosing wisely is of NO value if?
proper application of treatment isn't facilitated - dose, physical application of the dose, frequency of treatments, and duration of treatment
91
Dosage of medication is dependent on what?
the size of the ear canal
92
What is the recommendation for mLs in a dog that is less than 10kg?
0.4-0.5 mL
93
What is the recommendation for mLs in a dog that is 10-20 kg?
0.5-0.7 mL
94
What is the recommendation for mLs in a dog that is greater than 20kg?
1 mL
95
What are the negatives to using mL based on size versus using 'drops' that the label says to use?
it is a higher cost than using labeled doses and there are possible increased systemic effects

Small Animal Medicine (100 decks)

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