Derm - Ear disease

Question 1

What are the 4 types of factor to consider in cases of otitis externa?

Answer 1

Primary
Secondary - aggravate it
Predisposing - more likely to develop
Perpetuating - more likely to continue

Question 2

What is the most common primary cause of otitis externa?

Answer 2

Allergic skin disease eg. atopic dermatitis, cutaneous adverse food reaction or contact dermatitis

Question 3

What primary factors can cause otitis externa?

Answer 3

Allergic skin disease
Ectoparasites
Foreign bodies
Tumours
Autoimmune
Hypothyroidism

Question 4

What secondary factors can exacerbate otitis externa?

Answer 4

Upsetting the ear microclimate
eg. inappropriate topical medication
Microbial overgrowth
Opportunistic infection - pseudomonas

Question 5

What predisposing factors can increase the risk of getting otitis externa?

Answer 5

Conformation of the ear - floppy ears, narrow ear canals
Water/humidity in the ear - swimming
Inappropriate overcleaning
Trauma
Neoplasia - blocking ear canal

Question 6

What are some perpetuating factors that can prolong otitis externa?

Answer 6

Lots of sebaceous glands producing cerumen - upregulation causing excess production encouraging microbial overgrowth
Excess cleaning can encourage upregulation
Stenosis of the ear canal due to chronic infection

Question 7

What does chronic proliferative otitis externa cause?

Answer 7

Scarring, stenosis, deformity of the ear canal
Irreversible calcification of the cartilage
This is a perpetuating factor

Question 8

What are the clinical signs of otitis externa?

Answer 8

Head shaking, scratching, pain
Ear canal firm on palpation
Discharge - cerumen, purulent or dark and tarry
Neuro signs - facial nerve paralysis, Horners syndrome

Question 9

What nerves are located in the inner ear?

Answer 9

Facial nerve and vestibulocochlear nerve

Question 10

What diagnostic tests can you do for ear disease?

Answer 10

Cytology of ear discharge
Tape impressions of skin folds
Culture

Question 11

When should you culture ear discharge in ear disease?

Answer 11

When not responding to antibiotic treatment
When risk of antimicrobial resistance
When you find rods on cytology

Question 12

What diseases do rods suggest if found on cytology from ear discharge?

Answer 12

Pseudomonas
E. coli
Klebsiella

Question 13

What diagnostic tests should you do if you suspect middle ear disease (otitis media)?

Answer 13

Radiography
CT scan of tympanic bullae

Question 14

What are signs of otitis media on CT scan?

Answer 14

Stenosis of external canal
Sclerosis, thickening of temporal bone
Sclerosis, thickening of tympanic bullae
Soft tissue opacity in bullae

Question 15

How are cats middle ears different to dogs?

Answer 15

The have a bony septum in middle ear

Question 16

How should you treat allergic skin diseases causing otitis?

Answer 16

Once/twice weekly ear cleaner and topical anti-inflammatories
Systemic glucocorticoids if this doesnt work

Question 17

Why is pseudomonas difficult to treat?

Answer 17

Biofilm formation hides it from treatment, increases resistance

Question 18

How do you treat pseudomonas?

Answer 18

PCMX
Marbofoxacin - fluoroquinolones
Gentamicin
Surgery?

Question 19

What parasite can cause otitis?

Answer 19

Ear mites - otodectes cynotis
Some cats are very hypersensitive to them, others show no signs

Question 20

How do you treat otodectes?

Answer 20

Selamectin and moxidectin
Canaural, surolan
Isoxazolines

Question 21

What get polyps in their ears?

Answer 21

Cats from 5 months ot 5 years

Question 22

What are polyps in the ears?

Answer 22

Benign inflammatory lesions located in the nasopharynx

Question 23

What are the clinical signs of polyps in the ears?

Answer 23

Persistent aural discharge
Otitis
Head shaking
Scratching
Head tilt
Nystagmus

Question 24

Which if these is not a primary cause of otitis externa?
A. grass seed
B. atopic dermatitis
C. keratinisation disorders
D. pseudomonas
E. otodectes cynotis

Answer 24

D. pseudomonas
Because it doesnt start the inflammatory process - only becomes a problem after inflammation already present

Question 25

Is otitis media a predisposing factor for otitis?

Answer 25

No - it is a perpetuating factor as it is only there because it has already had an ear infection before, makes it more likely to continue

Question 26

Is food allergy a predisposing factor for otitis?

Answer 26

No - it is a primary cause

Question 27

What is an aural haemotoma?

Answer 27

A blood filled swelling on the inner surface of the pinna

Question 28

What causes an aural haematoma?

Answer 28

Traumatic cartilage fracture and blood vessel rupture, separating the auricular cartilage from the skin

Question 29

What are the treatment options for aural haematoma?

Answer 29

Do nothing - not good Corticosteroids - ineffective Aspiration, flushing - recurrence likely Small incision and place haematoma tube - drips, not tolerated well Surgical repair

Question 30

What must you do in cases of aural haematomas?

Answer 30

Identify and treat the underlying condition eg. otitis

Question 31

What is the prognosis of surgical repair of an aural haematoma?

Answer 31

Excellent provided the underlying cause is addressed

Question 32

What is the simplest method of surgical repair of a aural haematoma?

Answer 32

S shaped incision Then flush, remove clots Add multiple staggered longitudinal sutures over whole haematoma incorporating the cartilage Incision left open Cover in dressing and bandage

Question 33

What should you do if there is material deep in the external ear canal?

Answer 33

GA and ear flush

Question 34

What are the complications of GA and ear flush?

Answer 34

Tympanic membrane damage Neuro damage Pain from irritation to the ear canal Aspiration of fluid

Question 35

What type of procedure does GA and ear flush count as?

Answer 35

Dirty

Question 36

What types of suture should you use to repair the pinna from traumatic wounds?

Answer 36

Vertical mattress suture and figure of 8 suture

Question 37

When do you need to do a pinna resection?

Answer 37

Resection of neoplastic masses

Question 38

What ear procedure is illegal in the UK?

Answer 38

Ear cropping

Question 39

What is the name of the procedure when the lateral part of the vertical ear canal is resented so there is a direct opening into the horizontal canal?

Answer 39

Lateral wall resection

Question 40

What is a lateral wall resection used for?

Answer 40

Excising masses located in the lateral part of the ear canal NOT for treatment of otitis externa

Question 41

What is a myringotomy?

Answer 41

Surgicla puncture of hte caudo-ventral tympanic membrane

Question 42

When do you perform a myringotomy?

Answer 42

Otitis media Biopsy of a mass within the bulla

Question 43

When is a tympanostomy tube (grommet) placed?

Answer 43

Primary secretory otitis media (glue ear)

Question 44

What dogs get primary secretory otitis media (glue ear)?

Answer 44

Cavalier King Charles Spaniels

Question 45

What is a TECA?

Answer 45

Total ear canal ablation - removing the entire vertical and horizontal ear canals

Question 46

What is a TECA always performed alongside?

Answer 46

Bulla osteotomy

Question 47

When do you perform TECA surgery?

Answer 47

Chronic otitis externa Neoplasm in horizontal ear canal

Question 48

What are complications of TECA surgery?

Answer 48

Facial nerve injury Chronic sinus tract development - para-aural abcess Wound breakdown, haemorrhage Vestibular signs

Question 49

What is the prognosis of TECA surgery?

Answer 49

GOod for otitis externa if avoid complications Mixed for neoplasia - guarded for SCC

Question 50

What is a ventral bulla osteotomy?

Answer 50

When the chamber of the bulla are opened and gently cleaned/flushed

Question 51

When is ventral bulla osteotomy performed?

Answer 51

For removal of nasopharyngeal polyps in cats

Question 52

What are some complications of ventral bulla osteotomy?

Answer 52

Horners Vestibular disease Polyp regrowth Haemorrhage Facial nerve damage

Question 53

What auricular nerve blocks can be used for ear disease/surgery?

Answer 53

Auriculotemporal nerve Greater auricular nerve