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Dermatology 2 > Otitis 2 > Flashcards

Otitis 2 Flashcards

1
Q

Evaluate the use of povidone iodine as an otic flushing solution

A
  • Recommended by some but others state ototoxicity

- May be useful if Proteus is present

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2
Q

Evaluate the use of saline as an otic flushing solution

A

Safe, widely available, sterile

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3
Q

Evaluate the use of chlorhexidine as an otic flushing solution

A
  • Problematic at higher concentrations
  • 0.15% safe in dogs but not cats
  • Use TRIZChlor flush only, any higher concentration is ototoxic
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4
Q

When should cerumolytics, aqueous solutions and drying agents be used as flushing solutions?

A

Only when the drum is known to be in tact

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5
Q

Evaluate the use of cerumolytics as an otic flushing solution and give examples

A

To emulsify ear wax for easy removal, e.g. squalene, alcohols

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6
Q

Evaluate the use of aqueous solutions as an otic flushing solution

A

Aid in removal of pus, mucus and serum from the ears

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7
Q

Evaluate the use of drying agents as an otic flushing solution and give an example

A

Decrease moisture in ears and dessicate the surface keratinocytes, e.g. boric acid

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8
Q

Outline the anaesthetic requirement during ear flushing

A
  • Required in severe/chronic cases
  • ET tube protects from aspiration of flushing solution via eustachian tube
  • Hearing often present even with sedation
  • Allows adequate assessment of the ear, especially if painful
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9
Q

Outline the disadvantages and advantages of the manual otoscope and syringe method for ear flushing

A
  • Spreul needle used, but reusable and often damaged with sharp edges, disposable better
  • Cut down gauge 6 urinary catheter
  • Large catheter cover
  • Precise but time consuming
  • can make ear sore through rubbing of speculum, premed with steroids at least one day before
  • Equipment inexpensive
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10
Q

Outline the disadvantages and advantages of the video otoscopy method for ear flushing

A
  • Precise
  • Able to record data if data capture technique
  • Custom made curettes, biopsy and grabbing tools available
  • Small bore channel means slow cleaning in some cases
  • May not fit the smallest ears
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11
Q

What are the aims of otitis treatment?

A
  • Remove/reduce microbes
  • Reduce swelling, discomfort or pain
  • Normalise canal lumen and function
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12
Q

Give a key advantage and disadvantage of Aurizon ear treatment

A
  • Broad spectrum

- But poor for diabetics

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13
Q

Give a key advantage and disadvantage of Easotic ear treatment

A
  • Better for diabetics

- Poorly absorbed steroids

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14
Q

Give the key advantages and disadvantages of Osurnia ear treatment

A

Advantages:

  • Good for incompetent owner or very painful dog
  • Good anti-staph and anti-malassezia treatment
  • First line treatment

Disadvantages

  • Poor for Pseudomonas
  • Poor for progressive disease
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15
Q

What is the main issue with all ear treatments?

A

All state not for use if ear drum not intact, but difficult to assess so need to go off license or avoid ototoxic drugs

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16
Q

List drugs which are ototoxic

A
  • Gentamicin
  • Polymyxin B
  • Ticarcillin and imipene
  • Propylene glycol
  • Chlorhexidine at moderate concentrations
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17
Q

Outline a basic treatment for acute otitis

A
  • Use first line ointment with antimicrobial, steroid and antifungal based on cytology and otoscopy
  • Once to twice daily for 7-14 days
  • Ensure use of sufficient amount )0.7-1ml for large dog)
  • Combine with suitable cleaner e.g. TRIXChlor, Cleanaural, Malacetic otic
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18
Q

When presented with ear disease with a great deal of discharge and unclear time course, what would be a logical approach?

A
  • Admit for flush etc., treat as chronic case

- Cannot be confident that disease has not been there for a while

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19
Q

List cytological indications for bacterial culture in otitis

A
  • Rods seen, need suitable antibiotic
  • Marked purulent discharge without organisms noted
  • Pyogranulomatous inflammation
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20
Q

Why is bacterial culture recommended in a case of otitis with pyogranulomatous inflammation?

A
  • Organisms difficult to see with cytology in this uncommon ear inflammation
  • Culture obligatory
  • Basement membrane breached, ulcerated ears
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21
Q

List the clinical infications for bacterial culture in otitis

A
  • In the event of treatment failure
  • If there is a suspicion of MRSP, MRSA, MRSS
  • If considering video otoscopy or ear flush for diagnosis, or treatment in a bacterial otitis
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22
Q

Why is bacterial culture recommended in a case where video otoscopy is to be used?

A

Risk of adverse event following these procedures e.g. neurological signs meaning that systemic antimicrobials may be required

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23
Q

When should an ear with otitis be re-checked?

A

Obligatory 7-10 days recheck

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24
Q

What should be assessed at the re-check for otitis?

A
  • Improvement?
  • Asses owner compliance
  • Identification of next stage of treatment
  • May need to restore epithelial migration
  • Identificaiton of underlying cause
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25
Q

Outline the treatment recommended for teh treatment of chronic allergy leading to otitis

A
  • Avoid use of antibiotics
  • Control microflora through cleaning
  • Use topical steroids to control inflammation
  • Lokivetmab and oclacitanib are poor for ear disease, will commonly need a treatment for the body and a treatment for the ear
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26
Q

What is the importance of Pseumonas otitis?

A

Common cause of otitis - 35% of OE and/or OM and aggressive treatment required

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27
Q

What is Pseudomonas otitis commonly associated with?

A
  • Poorly managed or untreated Malassezia or Staphylococcal otitis
  • Immunosuppression
  • Swimming
  • Prior use of antibacterials
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28
Q

Describe the appearance of Pseudomonas otitis

A
  • Swelling, pain, malodour common
  • Often ulcerated
  • Green to browny-black discharge
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29
Q

Outline the plan for Pseudomonas otitis with severe disease

A
  • Always flush if purulent material
  • Presume drum ruptured as a result of collagenase produced by bacteria
  • Presume OM and likelihood of OI
  • Warn owner of risks of flushing, treatment and disease itself e.g. Horner’s, facial paralysis, hearing loss
  • Possibly TECA
  • Use of non-licensed products e.g. OE medication such as Aurizon
  • Bacteriology, flush and clean, disinfectant cleaner e.g. TRIZChlor, apply suitable antibiotic, provide anti-inflamm and analgesia
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30
Q

Outline a treatment plan for a dog with Pseudomonas otitis that has received little previous treatment

A
  • Cleaning with saline
  • Disinfect with TRIZChlor 10 minute soak
  • Aurizon antibiotic
  • Introperative opiod analgesia e.g. morphine
  • Dexamethasone 0.3mg/kg IV at end of procedure
  • Home on Aurizon ear cream 0.4-0.7ml BID for 7 days, TRIZChlor SID starting on day 4, prednisolone 0.5mg/kg SID PO
  • Reassess at 7 days
  • If doing well and marked chronic changes, increase dose of steroids, consider reducing frequency of drops and cleaner
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31
Q

Outline a treatment plan for a dog with Pseudomonas otitis that has been identified as a multi-resistant organism

A
  • Cleaning with saline, disinfect with TRIZChlor 10 min soak
  • Silver sulfadiazine antibiotic
  • Intraoperative morphine, dexamethasone 0.2mg/kg IV at end of procedure
  • Home on TRIZChlor BID, silver sulfadiazine 1:9 aqueous soln at least BID to fill ear (OR gentamicin, ticarcillin if suitable susceptibility data), pred 0.5mg/kg SID PO, pain relief
  • Reassess at 5 days to allow complete flushing and disinfection
  • Further otoscopy/fushing as needed
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32
Q

What can ear canal stenosis be a consequence of?

A
  • Chronic low grade trauma
  • Severe acute disease untreated
  • Trauma
  • Mcuinosis +/- confirmation in shar Pei
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33
Q

What are the potential approaches to a stenotic ear?

A
  • Potent topical steroids
  • Oral steroids (pred 1-2mg/kg PO)
  • Tacrolimus 0.1% ointment
  • Intralesional steroids
  • Treatment can be concurrent with, or if inappropriate after infection control
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34
Q

Outline the use of potent topical steroids in the treatment of otic stenosis

A
  • Commercial medications for extended course e.g. Easotic, Posatex, Aurizon
  • Beware local and systemic steroid side effects esp. in small dogs
  • Long periods of treatment needed
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35
Q

Outline the use of tacrolimus 0.1% ointment (topical ciclosporin) in the treatment of otic stenosis

A

Applied to ear twice daily with care (gloves)

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36
Q

Outline the use of intralesional steroids in the treatment of otic stenosis

A

Inject ring around canal using video otoscopy

37
Q

What defines an ear as “end stage”?

A

If any, or a combination of the following becomes unacceptable

  • Welfare of pet or family
  • When ear disease of is intractable, or very quickly recurrent due to stenosis, marked granulation in middle ear, ceruminous and sebaceous gland hyperplasia
  • Cost of repeated medical interventions is unacceptable
  • Inability to treat ear by the owner
38
Q

What procedures are available for the treatment of end stage ears?

A

ONLY Total Ear Canal Ablation (TECA)

Avoid antibiotics where possible

39
Q

How can further otic disease be prevented once treated?

A
  • Treat underlying disease
  • Use cleaners to maintain clean dry ear, support epithelial migration, and small amounts of steroid in cleaner reduce inflammation
  • Gently remove loose hair by shaving ears of thick haired dogs
  • Avoid antibiotics where possible
40
Q

List the products most suitable for use in Ttaphylococcal otitis

A
  • Aurizon
  • Easotic
  • Posatex
  • Also: canaural, osurnia, otomax, surolan
41
Q

List the product suitable for Pseudomonas otitis before culture results are available

A
  • Aurizon, Easotic, Otomax, Posatex, Surolan

- Products with polymyxin B, fluoroquinolones and gentamicin are suitable

42
Q

When would the use of oral antibiotics in the treatment of otitis be indicated?

A

Where there are neurological signs present

43
Q

Suggest ear ointment treatment options for a dog with severe otitis, with Pseudomonas present that is susceptible to gentamicin and ticarcillin, with a ruptured ear drum

A
  • Gentamicin ototoxic as is Ticarcillin
  • Can use off licence if careful
  • Using injectable fluroquinolones in TRIZEDTA cleaner could be used as the concentration may exceed the MIC for resistant Pseudomonas aeruginosa
  • Silver sulfadiazine also an option
44
Q

What are the major indications for ear surgery?

A
  • Trauma
  • Aural haematoma
  • Neoplasia
  • Certain cases with chronic otitis externa
  • Chronic otitis media (infection, middle ear polyps, cholesteatoma)
45
Q

What are the indications for surgery of the pinna?

A

Trauma or neoplasia

46
Q

Evaluate the need to repair trauma to the pinna surgically

A
  • Depends on level of trauma, usually will heal on its own
  • Often looks dramatic as can bleed a lot
  • Repair of pinna does not tend to stay together well as dog shakes/rubs head
47
Q

What is an important consideration when surgically repairing pinnal trauma?

A

Need to incorporate a part of pinnal cartilage into the suture to buttress the repair and avoid it being held just by the integument

48
Q

List the most common benign and malignant neoplasms of the pinna of dogs

A

Benign:

  • Pinnal histiocytoma
  • Papilloma

Malignant:

  • Mast cell tumour
  • Squamous cell carcinoma
49
Q

List the most common benign and malignant neoplasms of the pinna of cats

A

Benign:
- Basal cell tumour

Malignant:

  • Squamous cell carcinoma
  • Mast cell tumour
  • Fibrosarcoma
50
Q

Outline the surgical management of pinnal squamous cell carcinoma

A

Removal of pinna

51
Q

What are the management options for aural haematoma?

A
  • Surgical incision, drainage and suture
  • Drainage with an indwelling drain
  • Drainage and glucocorticoid instillation
  • Closed suction drainage
52
Q

What is the key principle in the management of an aural haematoma?

A

in all cases, need to remove blood then keep skin in close association with underlying cartilage while it heals

53
Q

How should sutures be place on the pinna and why?

A
  • Blood suppl comes in laterally and medially and runs vertically
  • Do not place sutures on lateral planes - more likely to occlude blood supply
54
Q

How can pressure be equalised on the sutures used on the pinna

A

Sutures can have short lengths of drip tube attached

55
Q

How can close apposition of the pinnal integument and he cartilage be achieved?

A
  • Stitch the integument to the cartilage
  • Forces healing with scar tissue to hold the two together
  • Use multiple interrupted sutures either full or partial thickness
56
Q

Evaluate the use of bandages for ears

A
  • Cut foam pads to correct shape and size then stitch on

- Bandage can prevent damage from head shaking but risk of making area too warm and moist

57
Q

What surgical management options are available for otitis externa?

A

Lateral wall resection and vertical canal ablation

58
Q

What are the indications for a lateral wall resection?

A
  • Persistent/recurrent OE with mild, potentially reversible hyperplasia of epithelium and adnexae
  • Neoplasia of lateral wall of vertical canal
  • Rarely in management of OM to facilitate flushing and drainage of bulla
59
Q

What structures are commonly implicated in external ear canal neoplasms?

A

Often ceruminous glands are involved, can be benign or malignant

60
Q

List the benign and malignant neoplasms of the external ear canal of the dog

A

Benign:

  • Papilloma
  • Cutaneous histiocytoma
  • Mast cell tumour
  • Basal cell tumour
  • Ceruminous gland adenoma
  • Sebaceous gland adenoma

Malignant:

  • Ceruminous gland adenocarcinoma
  • other carcinomas
  • Squamous cell carcinoma
61
Q

List the benign and malignant neoplasms of the external ear canal of the cat

A

Benign:
- Ceruminous gland adenoma

Malignant:

  • Cerumous gland adenocarcinoma
  • Squamous cell carcinoma
  • Other carcinoma
62
Q

What is the main purpose of a lateral wall resection?

A

Will not cure the animal of underlying disease, but will improve the micro-environment of the ear. May allow easier treatment of ear as it allows medication to reach areas where it is required

63
Q

Evaluate the role of lateral wall resections in the treatment of cancer

A

Only a small number of cancers are effectively resected with LWRs - only useful if cancer is situated in the lateral wall

64
Q

Briefly outline the procedure for a lateral wall resection

A
  • Incise skin down to level of horizontal canal, reflect dorsally.
  • make parallel vertical incision either side of the vertical canal now visible, and reflect ventrally
  • Remove the cartilage
  • Stitch the skin to the remaining cartilage, placing sutures at the level of the horizontal canal first
65
Q

What are the indications for vertical ablation?

A
  • Where only the vertical canal is diseased
  • Hyperplastic otitis externa, trauma, neoplastic disease and polyps restricted to the vertical ear canal
  • Unlikely to be effective as a treatment for chronic otitis as the underlying ear disease is not resolved
66
Q

Outline the procedure for a vertical canal ablation

A
  • Lateral and medial wall of vertical canal removed

- Only horizontal canal in place, stitch skin together leaving an opening over the horizontal canal opening

67
Q

What are the surgical management options for otitis media?

A
  • Total Ear Canal Ablation and Bulla Osteotomy (TECA BO)

- Ventral bullaosteotomy

68
Q

What are the indications for a TECA BO?

A
  • Chronic/recurrent OE assocaited with irreveseible, hyperplastic changes in the luminal epithelium
  • Failure of more conservative surgery to alleviate OE/OM
  • Neoplasia of external ear canal
  • Otitis media
69
Q

What are the disadvantages of a TECA BO?

A
  • Technically difficult
  • Potentially for significant life-threatening complications
  • Should not be attempted by inexperienced surgeons
70
Q

Outline the procedure for a TECA BO

A
  • Incision around opening of vertical canal on pinna, and T shaped incsion down lateral wall of vertical canal
  • Cut through cartilage to to free up auricular portion of external ear canal i.e. vertical canal
  • Dissect down to canal and to skull at annular cartilage
  • Once at external acoustic meatus, cut and remove
  • need to move all cartilage running down to TM
  • Make hole into middle ear cavity
  • Remove all integument of external ear canal
  • Close completely
71
Q

When is a ventral bulla osteotomy indicated?

A
  • Indicated in cases with middle ear disease where TECA is not indicated
  • Certain brachy breeds of dog
  • Often in cat due to anatomy of bulla and inflammatory polypoid disease in absence of chronic OE
72
Q

Outline the procedure for a ventral bulla osteotomy

A
  • Enter ventrally, under skull between mandibles
  • Lateral approach
  • Care re. material on bulla which contains post-ganglionic fibres to eye
73
Q

What surgical treatments are indicated for a cholesteatoma?

A

TECA BO or VBO

74
Q

Outline what causes a cholesteatoma and the clinical signs

A
  • Arise when TM comes into contact with and adheres to inflamed mucosa in middle ear
  • Cystic lesion lined with stratified squamous epithelium and keratin squames
  • Similar signs to any animal with middle and external ear disease: head tilt, scratching, Horners possible
75
Q

Describe the aetiology of inflammatory polyps in cats

A
  • Largely unknown
  • more common in younger cats, but can occur in older as well as dogs
  • Associated with infections commonly, esp. early exposure to cat flu/resp virus
76
Q

Where do to inflammatory polyps emanate from the tympanic bulla to? How?

A
  • Nasopharynx (via eustachian tube)

- Horizontal ear canal (from laterodorsal compartment through TM)

77
Q

What are the consequences of inflammatory polyps in cats?

A
  • Otitis media
  • Leads to inflammatory, non-cancerous growths
  • May block drainage of middle ear, leading to build up of secretions
78
Q

Describe the clinical signs of inflammatory polyps in cats

A
  • Often present with condition due to blockage of nasopharynx e.g. mouth breathing, difficulty swallowing
  • Often not considered as ear disease
  • Radiographically look the same as infection
79
Q

Outline the removal of inflammatory polyps in cats

A
  • Traction removal: palpate orally using spay hook, remove by grasping and pushing down throat without breaking stalk, towards oesophagus and will come away as single structure
  • Otherwise can allow to resolve by itself
  • Examine ear canals in case of polyps
80
Q

Compare the anatomy of the canine and feline middle ear

A
  • Cats have 2 separate compartments, separated by bony wall
  • Larger ventromedial compartment, smaller dorso-lateral
  • External ear canal joins smaller to larger
81
Q

List the proposed causes of associations of aural haematomas

A
  • Otodectes cynotis
  • Otitis externa
  • Trauma
  • Autoimmunity
  • Hypersensitivity
  • Any cause involving pruritus
82
Q

List potential complications of drainage of aural haematomas

A
  • Cosmetic alterations (scar tissue and mis-shapen ear common)
  • Recurrence of haematoma (common)
  • Pinnal necrosis
83
Q

List potential complications of lateral wall resections

A
  • Few cancers resolved by LWRs
  • Post-op pain/discomfort
  • Incisional dehiscence
  • Persistent OE
  • Persistent, unrecognised OM
  • Failure to provide adequate drainage of horizontal canal leading to horizontal canal stenosis
84
Q

What increases the risk of incisional dehiscence following otic surgery?

A

High level of contamination

85
Q

List the potential complications of vertical canal ablations

A
  • Post-op pain/discomfort
  • Incisional dehiscence
  • Persistent OE
  • Persistent, unrecognised OM
  • Stenosis of horizontal canal
  • Facial paralysis
86
Q

List the potential complications of a TECA BO

A
  • Post-op pain/discomfort
  • Deafness
  • Incisional dehiscence
  • Facial nerve paralysis
  • Vestibular disturbances e.g. nystagmus, nausea
  • Haemorrhage
  • Horner’s syndrome
  • Recurrences/abscess formation
87
Q

What condition do the following clinical signs indicate?
Anisocoria with ipsilateral miosis, ptosis of upper eyelid, narrowing of palpebral fissue, enophthalms, protrusion of third eyelid

A

Horner’s syndrome

88
Q

List the potential complications of a VBO

A
  • Post-op pain/discomfort
  • Deafness
  • Incisional dehiscence
  • Facial nerve paralysis
  • Vestibular disturbances
  • Haemorrhage
  • Horner’s syndrome
  • Recurrence, abscess formation

Dermatology 2 (23 decks)

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