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Dermatology (VEM 5387) > Otitis Externa/Media in Cats & Dogs (Santoro) > Flashcards

Otitis Externa/Media in Cats & Dogs (Santoro) Flashcards

1
Q

Otitis externa

A

Inflammation of the ear canal

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2
Q

Otitis media

A

Inflammation of the bulla

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3
Q

Otitis interna

A

Inflammation canaliculi and/or cochlea

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4
Q

Predisposing factors of otitis externa

A
  • Conformational defect (hair, stenosis)
  • Swimming/humidity
  • Obstructive ear disease (neoplasia, polyps, foreign body)
  • Trauma
    • improper ear cleaning
    • topical irritants
  • Excessive cerumen production
  • Systemic dz (catabolic states, immune suppression, debilitation)
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5
Q

Primary factors of otitis externa

A
  • Disease, enough for inflammation
    • Foreign bodies
    • Allergies
    • Autoimmune diseases
    • Endocrinopathies
    • Parasitic diseases
    • Masses
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6
Q

Otodectes cynotis (ear mite)

A
  • Non-burrowing psoroptid mite
  • On skin surface
  • Protected by thick, brown (coffee ground) crust
  • Feed on lymph & blood

Primary factor of OE

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7
Q

Otobius megnini (spinous ear tick)

A
  • Larvae & nymphs induce inflammation
  • Drops to ground as adult

Primary factor of OE

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8
Q

Eutrombicula alfreddugesi (chigger)

A
  • Bite causes irritation & variable pruritis
  • Seasonal - late summer/fall

Primary factor of OE

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9
Q

Otodemodicosis

A
  • More common in cats
  • Ceruminous otitis externa
  • Suspect immynosuppression
    • FeLV, FIV, diabetes, neoplasia
  • Ear swab, no need to scrape

Primary factor of OE

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10
Q

Sacroptes scabiei canis (canine scabies)

A
  • Usually ear tips, but can be otitis externa
  • Severe pruritis
  • Female burrows in epidermis and layws eggs
  • Thick, yellow crusts

Primary factor of OE

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11
Q

Notoedres cati (feline scabies)

A
  • Medial, proximal pinnae
  • Face, eyelids, neck, feet, perineum
  • Female mites burrow
  • Intense pruritis
  • Highly contagious
  • Abundant mites

Primary factor of OE

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12
Q

Intraluminal tumors

A
  • Relatively uncommon
  • Obstructive lesions
  • Ulceration & necrosis
  • Malignant (cats > dogs)
    • Ceruminous gland adenocarcinoma
    • Squamous cell carcinoma
    • mast cell tumors

Primary factor of OE

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13
Q

Nasopharyngeal polyp

A
  • Congenital, bacterial, calicivirus
  • Chronic uni/bilateral otitis, mass in ear canal, head tilt
  • Treat surgically

Primary factor of OE

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14
Q

Apocrine cystomatosis

A
  • Cysts of apocrine glands
  • Adult animals
  • Solitary, well-circumscribed, smooth, bluish tense swelling
  • Located on concave surface of pinna, vertical ear canal
  • Uni or bilateral
  • Treat: benign neglect, surgery

Primary factor of OE

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15
Q

Atopic dermatitis

A
  • Erythema & inflammation
    • Initially pinnae, vertical canal
    • Entire ear canal when chronic

Primary factor of OE

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16
Q

Causes of contact allergy in the ear

A
  • Neomycin/gentamycin
  • Miconazole 1%
  • Propylene glycol

Primary factor of OE

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17
Q

Primary idiopathic seborrhea

A
  • Incr. cerumen production
  • Altered cerumen composition
  • Delayed desquamation and stenosis
  • Often progress to calcifying otitis externa/media in cocker spaniel

Primary factors of OE

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18
Q

Endocrinopathies as a primary factor of otitis externa

A
  • Hypothyroidism, sex hormone imbalance
  • Incr. mucin deposition in dermis
  • Hyperplasia/hyperkeratosis of epidermis
  • Altered fatty acid production

Primary factor of OE

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19
Q

Autoimmune diseases as primary factors of otitis externa

A
  • Pemphigus foliaceus
  • Pemphigus erythematosus
  • Systemic lupus erythematosus
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20
Q

Juvenile cellulitis

A
  • Puppies
  • Vesiculopustular dz
  • Dachshunds, golden retrievers, pointers
  • Purulent otitis w/ head & facial lesions
  • Blepharitis
  • Lymphadenopathy

Primary factor of OE

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21
Q

Secondary factors of otitis externa

A
  • Infection secondary to the inflammatory process
    • Bacteria
    • Yeast
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22
Q

Bacteria as secondary factors of otitis externa

A
  • Staph pseudointermedius
  • Proteus mirabilis
  • Pseudomonas
  • E. coli
  • Klebsiella
  • Corynebacterium
23
Q

Yeast as secondary factors of otitis externa

A
  • Malassezia pachydermatis
    • ​in some normal dog/cat ears
  • Candida albicans
24
Q

Perpetuating factors of otitis externa

A
  • NOT responsible for the otitis, but cause the otitis to presist
  • Otitis media
  • Mineralization of the ear canal
  • Hyperplasia of the ear canal
25
Q

Pathologic changes caused by perpetuating factors of otitis externa

A
  • Hyperkeratosis
  • Epidermal hyperplasia
  • Epithelial folds
  • Dermal edema & fibrosis
  • Cerumial gland hyperplasia/hypertrophy
  • Lumen stenosis
  • Calcification
26
Q

Tympanic membrane changes perpetuating otitis exerna

A
  • Opacity
  • Dilation
  • Diverticulum
27
Q

Otitis media perpetuating factors for otitis externa

A
  • Epithelial changes
  • Purulent accumulation
  • Caseation
  • Cholesteatoma (skin growth in middle ear)
  • Proliferation
  • Destructive osteomyelitis
28
Q

Clinical signs of otitis externa

A
  • Odor
  • Head shaking
  • Discharge
  • Pruritis
  • Aural hematoma
  • Head tilt
  • Pain
  • Erythema
  • Edema
  • Lichenification
  • Hyperpigmentation
  • Excoriations
  • Mineralization
29
Q

Causes of otitis media

A
  • Extension of otitis externa (most common)
  • Ascending infection via eustacial tube
  • Hematogenous spread
30
Q

Neurological signs of otitis media

A
  • Facial nerve paralysis
  • KCS
  • Horner’s syndrome
  • Peripheral vestibular disease
31
Q

Diagnostic tools for otitis media

A
  • Ear cytology (collect before flush)
  • Otoscopy
  • Diagnostic imaging
  • Biopsy
  • Culture & sensitivity
32
Q

Video-otoscopy

A
  • Under general anesthesia
  • Visualize tympanic membrane
  • Useful for
    • Deep ear flush
    • Myringotomy
    • Biopsy
33
Q

Why deep ear flush for otitis media

A
  • Removes exudate
    • visualization of tympanic membrane
    • un-mask foreign body, tumor
    • purulent discharge will inactivate medications
  • Perform myringotomy
  • Collect curlture/cytology of middle ear
  • Flush out middle ear
34
Q

Myringotomy

A
  • Surgical rupture of the tympanic membrane
  • Diagnostic - collection of material
  • Therapeutic
    • flush the bulla
    • permanent opening
35
Q

Post-flush drugs

A
  • Abx
  • Steroids
    • Oral pred or triamcinolone
    • Topical dexamethasone
36
Q

Post-myringotomy care

A

Send patient home w/ topical flush, topical medicatoin, and oral abx based on best guess. Change therapy once you receive culture and sensitivity results.

37
Q

Medical management of otitis externa

A
  • Topical cleansers and antimicrobials
  • Systemic antimicrobials and anti-inflammatories
38
Q

Surgical management of otitis externa

A
  • TECA-BO
  • Vertical canal ablation and lateral wall resection
39
Q

Medical management of otitis media

A
  • Topicals
  • Systemic drugs
40
Q

Surgical management of otitis media

A
  • TECA-BO
  • VBO
41
Q

Cerumynolytics

A
  • Used to soften impacted material prior to deep flushing
  • Some are irritating and potentially ototoxic
  • Propylene glycol, lanolin, glycerine, squalene, urea peroxide, DSS, mineral oil
42
Q

Acidifying agents

A
  • Dry the ear canal
  • Less habitable for microbes
  • Not for use w/ AG
  • Acetic acid, lactic acid, malic acid, boric acid, benzoic acid, salicylic acid
43
Q

Astringent agents

A

Burrow’s, domoboro, isopropy alcohol

44
Q

Anesthetic agents

A

Proparacaine, lidocaine, pramoxine

45
Q

Antimicrobial agents

A

Chlorhexidine, ketoconazole, hypochlorous acid

46
Q

Tris-EDTA

A
  • Alkalyzing agent
    • works well w/ AG, fluoroquinolones
  • Chelating agent
    • disrupts cell membrane of bacteria & enhances abx therapy
47
Q

Antibiotics

A
  • Aminoglycosides
    • inactivated by low pH or debris
    • Gentamycin, tobramycin, amikacin
  • Fluoroquinolones
    • Enrofloxacin - always associated w/ topical antifungal
    • Orbiflaxacin
  • Cationic peptides (polymyxin B)
  • Florfenicol
48
Q

Antifungals

A
  • Miconazole
  • Clotrimazole
  • Nystatin
  • Thiabendazole
  • Posaconazole
  • Terbinafine
49
Q

Topical glucocorticoids

A
  • Topical formulations less effective
  • Syn-otic
  • Betamethasone
  • Dexamethasone
  • Mometasone
  • Hydrocortisone
  • Triamcinolone
  • Prednisolone
50
Q

Systemic anti-inflammatories

A
  • Useful to decr. pruritis/pain and inflammation
  • Decr. stenosis due to fibrotic changes
    • no mineralization
51
Q

Systemic antibiotics

A
  • Only in cases of otitis media
  • Extremely severe & chronic otitis externa
  • Always w/ topical treatments
52
Q

Systemic glucocorticoids

A
  • Prednisone/prednisolone
  • Methylprednisolone
  • Triamcinolone
53
Q

Treatment duration for otitis media

A

Minimum of 6-8 wks of topical and systemic antimicrobials

Dermatology (VEM 5387) (17 decks)

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