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RUSVM SAM 2 > Otitis Externa And Media > Flashcards

Otitis Externa And Media Flashcards

1
Q

What are the parts of the tympanic membrane ?

A

Pars flaccida-> often mistaken for a cyst structure just in from of ear drum

Pars tensa

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2
Q

What nerve passes through the middle ear and can be affected in otitis media?

A

Facial nerve

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3
Q

Inflammation of the ear canal is called?

A

Otitis externa

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4
Q

What are predisposing causes to otitis externa?

A 
Stenosis 
Hair in canals 
Pendulous pinnae 
Swimmers ear 
Overactive glands 
Polyps 
Neoplasms
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5
Q

What are primary causes of otitis externa?

A

Parasites, microbes, atopy, food hypersensitivity, drug reactions, contact hypersensitivity, keratinization, glandular disorders, autoimmune disease, solar dermatitis

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6
Q

What are perpetuating factors to otitis externa?

A

Bacteria, yeast, topical rxn, foreign bodies

Epidermal hyperplasia, hyperkeratosis, dermal edema or fibrosis, lumen stenosis, cartilage mineralization, tympanic membrane changes, middle ear disease

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7
Q

A dog comes into the clinic with erythema, swelling, scaling, crusting, alopecia, otic discharge, and pain on palpation.. you try to do an otic exam but the ear canal is swollen

What do you do?

A

Anti-inflammatory for 4-7days then redo the exam

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8
Q

What is the most common cause of otitis externa in dogs?

A

Allergies

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9
Q

What is the main cause of otitis externa in cats?

A

Parasite- otodectes

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10
Q

Clinical signs of acute otitis externa?

A

Head shaking - hematoma

Scratching ears 
Rubbing ears 
Otic discharge 
Malodor 
Red pinna 
Swollen ear
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11
Q

You do a ear exam and there is a coffee ground like discharge in the ear.. what is you top dx?

A

Ear mites

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12
Q

You do a ear exam and there is a moist brown discharge.. what is your top dx?

A

Staph or yeast

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13
Q

You do a ear exam and there is a creamy yellow discharge.. what is you top dx?

A

Gram neg bacteria

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14
Q

Ear exam done and there is a oil, yellow, tan discharge .. what is your top dx?

A

Glandular disorder or hypersensitive

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15
Q

You are going to do cytology in an otitis externa case.. where should you collect your sample..

A

Horizontal ear canal — 2-3 swales

Mites - swab debris on slide with a drop of mineral oil
Yeast / inflammatory cells/ bacteria - roll swab onto slide and heat fix

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16
Q

T/F: if you have a unilateral problem with the ears, you should examine the good ear first

A

True

  • decreases spread of infection
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17
Q

T/F: you should always culture ears

A

False

Not usually needed for acute cases, Do for chronic rucurrent cases or unresponsive cases

18
Q

Why should we clean out ear canals with otitis externa?

A

Remove large amount of debris

Allow drugs to penetrate Ernie canal

19
Q

Treatment of otitis externa?

A

Predisposing cause

Cleaning

-ceruminolytic (docusate sodium, emulsify wax and lipids)

Removal of pus 
- saline or water 
-bulb syringe or 3 way stop cock system 
-automatic systemic 
—ear current 
-suction system

Drying agent
-acetic acid/ salicylic acid/ benzoic acid

20
Q

What can you used to clean the ears when you have an intact pars tensa?

A

Ceruminolytic emulsify wax/lipids - use 10mins priori to cleaning

Cleaning solutions remove debris - chlorhexidine/chlorhexiderm

Drying products -chlorhexiderm, oticlens, and malacetic acid

21
Q

What can you use to clean the ear canal if you cant see an intact pars tensa?

A

Avoid ceruminolytic, cleaning solutions, or drying agents

USE normal saline

22
Q

Treatment of otitis externa?

A

Topicals
- glucocorticoids, antibiotics, antifungals, parasiticides

Antibiotics
—> aminoglycosides —> must have intact tympanic membrane

—> chloramphenicol

First line - neomycin-polymixin (doesnt work in pus)
Fluoroquinolones

23
Q

What is the MOA of poloxamer otic gels?

A

Liquid state at refrigerated temperature; change to gel at body temp

Can be compounded with drugs

Reaches horizontal ear without puncturing the tympanic membrane
Ear canal should be cleaned prior

24
Q

81% of gram negative otitis externa are resistant to aminoglycosides and flourorquinolones. What are they often susceptible to?

A

Polymixin-B
—> ticarcillin
—> amikacin

25
Q

What topical antiseptic is effective against pseudomonas?

A

Silversulfadiazine

Acetic acid (1minute contact time)

26
Q

What systemic antibiotics can use used for otitis externa?

A 
TMS
Clindamycin 
Cephalexin 
Enrofloxacin 
Marbolfoxacin
27
Q

T/F: otitis externa is manageable but not curable unless primary cause is addressed

A

True

28
Q

Mites are diagnosed causing otitis externa. How will you treat?

A

SQ ivermectin injection q2wks x 2

29
Q

When it otitis externa considered chronic ?

A

Persistent >2months

Recurrent > 6months

30
Q

When is surgery indicated for otitis externa?

A

Chronic

  • severe calcification of cartilage
  • irreversible soft tissue pathology
  • bony changes in tympanic bulla =otitis media
  • persistent otitis media
31
Q

What is the pathophysiology of chronic otitis externa?

A

Chronic inflammation -> hyperplasia and hyperkeratosis —> increased ceruminolytic predispose to 2nd infection —> stenotic ear

Seb gland degeneration, stenosis, fibrosis, +/- mineralization —> end stage ear

32
Q

How many cases of chronic otitis externa will have middle ear disease ?

A

50%

33
Q

What are the clinical signs of otitis media?

A

Horners syndrome
Facial paralysis

If inner ear becomes involved =vestibular signs

34
Q

What are the 5ways to diagnose otitis media?

A

Signs: horners syndrome and/or facial paralysis

Abnormal tympanic membrane: ruptured, bulging

Bullae rads/CT/MRI

Myringotomy

Cytology and culture of middle ear

35
Q

When is myringotomy indicated ?

A

Opening through the pars fascia into the middle ear

—> bundling ear drum with C/S of fluid in middle ear

36
Q

What changes can indicated otitis media on radiographs?

A

Tympanic bullae with increased density

37
Q

What are indications for surgical intervention for otitis media?

A 
If medical therapy is ineffective 
—> clean/flush under anesthesia 
—> myringotomy with C/S
—> systemic antibiotics based of C/S
—> treatment of underling causes

If ear canal is occluded/stenotic from proliferative tissue

If there is a mass in outer or middle ear

38
Q

Primary secretory otitis media is common in what breed

A

King Charles spaniel

39
Q

How would you diagnose primary secretory otitis media?

A

Bulging pars flaccida in King Charles spaniel

If flat …CT

40
Q

Treatment of primary secretory otitis media?

A

Myringotomy and middle ear flush

RUSVM SAM 2 (44 decks)

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