Otitis Externa/Media in Cats & Dogs (Santoro) Flashcards
(53 cards)
1
Q
Otitis externa
A
Inflammation of the ear canal
2
Q
Otitis media
A
Inflammation of the bulla
3
Q
Otitis interna
A
Inflammation canaliculi and/or cochlea
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)
5
Q
Primary factors of otitis externa
A
- Disease, enough for inflammation
- Foreign bodies
- Allergies
- Autoimmune diseases
- Endocrinopathies
- Parasitic diseases
- Masses
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
7
Q
Otobius megnini (spinous ear tick)
A
- Larvae & nymphs induce inflammation
- Drops to ground as adult
Primary factor of OE
8
Q
Eutrombicula alfreddugesi (chigger)
A
- Bite causes irritation & variable pruritis
- Seasonal - late summer/fall
Primary factor of OE
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
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
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
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
13
Q
Nasopharyngeal polyp
A
- Congenital, bacterial, calicivirus
- Chronic uni/bilateral otitis, mass in ear canal, head tilt
- Treat surgically
Primary factor of OE
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
15
Q
Atopic dermatitis
A
- Erythema & inflammation
- Initially pinnae, vertical canal
- Entire ear canal when chronic
Primary factor of OE
16
Q
Causes of contact allergy in the ear
A
- Neomycin/gentamycin
- Miconazole 1%
- Propylene glycol
Primary factor of OE
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
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
19
Q
Autoimmune diseases as primary factors of otitis externa
A
- Pemphigus foliaceus
- Pemphigus erythematosus
- Systemic lupus erythematosus
20
Q
Juvenile cellulitis
A
- Puppies
- Vesiculopustular dz
- Dachshunds, golden retrievers, pointers
- Purulent otitis w/ head & facial lesions
- Blepharitis
- Lymphadenopathy
Primary factor of OE
21
Q
Secondary factors of otitis externa
A
- Infection secondary to the inflammatory process
- Bacteria
- Yeast
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
Pathologic changes caused by perpetuating factors of otitis externa
* Hyperkeratosis
* Epidermal hyperplasia
* Epithelial folds
* Dermal edema & fibrosis
* Cerumial gland hyperplasia/hypertrophy
* Lumen stenosis
* Calcification
26
Tympanic membrane changes perpetuating otitis exerna
* Opacity
* Dilation
* Diverticulum
27
Otitis media perpetuating factors for otitis externa
* Epithelial changes
* Purulent accumulation
* Caseation
* Cholesteatoma (skin growth in middle ear)
* Proliferation
* Destructive osteomyelitis
28
Clinical signs of otitis externa
* Odor
* Head shaking
* Discharge
* Pruritis
* Aural hematoma
* Head tilt
* Pain
* Erythema
* Edema
* Lichenification
* Hyperpigmentation
* Excoriations
* Mineralization
29
Causes of otitis media
* Extension of otitis externa (most common)
* Ascending infection via eustacial tube
* Hematogenous spread
30
Neurological signs of otitis media
* Facial nerve paralysis
* KCS
* Horner's syndrome
* Peripheral vestibular disease
31
Diagnostic tools for otitis media
* Ear cytology (collect before flush)
* Otoscopy
* Diagnostic imaging
* Biopsy
* Culture & sensitivity
32
Video-otoscopy
* Under general anesthesia
* Visualize tympanic membrane
* Useful for
* Deep ear flush
* Myringotomy
* Biopsy
33
Why deep ear flush for otitis media
* 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
Myringotomy
* Surgical rupture of the tympanic membrane
* Diagnostic - collection of material
* Therapeutic
* flush the bulla
* permanent opening
35
Post-flush drugs
* Abx
* Steroids
* Oral pred or triamcinolone
* Topical dexamethasone
36
Post-myringotomy care
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
Medical management of otitis externa
* Topical cleansers and antimicrobials
* Systemic antimicrobials and anti-inflammatories
38
Surgical management of otitis externa
* TECA-BO
* Vertical canal ablation and lateral wall resection
39
Medical management of otitis media
* Topicals
* Systemic drugs
40
Surgical management of otitis media
* TECA-BO
* VBO
41
Cerumynolytics
* 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
Acidifying agents
* 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
Astringent agents
Burrow's, domoboro, isopropy alcohol
44
Anesthetic agents
Proparacaine, lidocaine, pramoxine
45
Antimicrobial agents
Chlorhexidine, ketoconazole, hypochlorous acid
46
Tris-EDTA
* Alkalyzing agent
* works well w/ AG, fluoroquinolones
* Chelating agent
* disrupts cell membrane of bacteria & enhances abx therapy
47
Antibiotics
* Aminoglycosides
* inactivated by low pH or debris
* **Gentamycin**, tobramycin, amikacin
* Fluoroquinolones
* Enrofloxacin - always associated w/ topical antifungal
* Orbiflaxacin
* Cationic peptides (polymyxin B)
* Florfenicol
48
Antifungals
* Miconazole
* Clotrimazole
* Nystatin
* Thiabendazole
* Posaconazole
* Terbinafine
49
Topical glucocorticoids
* Topical formulations less effective
* Syn-otic
* Betamethasone
* Dexamethasone
* Mometasone
* Hydrocortisone
* Triamcinolone
* Prednisolone
50
Systemic anti-inflammatories
* Useful to decr. pruritis/pain and inflammation
* Decr. stenosis due to fibrotic changes
* no mineralization
51
Systemic antibiotics
* Only in cases of otitis media
* Extremely severe & chronic otitis externa
* Always w/ topical treatments
52
Systemic glucocorticoids
* Prednisone/prednisolone
* Methylprednisolone
* Triamcinolone
53
Treatment duration for otitis media
Minimum of 6-8 wks of topical and systemic antimicrobials
