Patient with Otitis

Question 1

clinical signs of external ear disease

Answer 1

head shaking, scratching, otic pain and otic discharge, aural hematomas

Question 2

middle ear disease clinical signs

Answer 2

greater otic pain, more head shaking, lethargy, inappetance, pain when opening the mouth. Sometimes stuff like Horners, facial nerve paralysis can happen too

Question 3

unitlateral otitis media

Answer 3

xeromycteria (unilateral dry nasal planum) and KCS

Peripheral vestibular signs (most obvious of inner ear)

Question 4

When starting an ear exam, remember to…

Answer 4

look at the good ear first

Question 5

Pain when opening the mouth tells us…

Answer 5

otitis media

Question 6

The ear neuro exam should look for…

Answer 6

CN 7 paralysis
nystagmus
KCS
vestibular disease

Question 7

If the ear canal is too obstructed to get a good view on otoscope, what do you do?

Answer 7

2 wks of oral corticosteroids, then you may be able to flush and look.

Question 8

Definition of otitis externa

Answer 8

inflammatory condition with or without concurrent infection

Question 9

What is the difference between causes and factors in otitis?

Answer 9

causes - can cause disease in the normal ear, primary and secondary
factors- just make it worse

Question 10

What are examples of causes of primary otitis?

Answer 10

hypersens (90%) like atopy, adverse food reactions
Parasites like Otodectes, demodex and sarcoptes
IM Dz like pemphigus
Foreign bodies like grass awns and so on
Hypothyroidism
other glandular disorders

Question 11

What are some secondary causes of otitis?

Answer 11

bacteria (staph and pseudo)
yeasts - malass
overcleaning
physical trauma

Question 12

What are predisposing factors and what are some predisposing factors contributing to Otitis

Answer 12

Predisposing factors do not cause disease but increase risk of development

conformation of the ear - large and pendulous pinnae in the spaniels are the worst, narrow ear canals like the shar pei and excessive ear hair like the poodle

2. Lifestyle of swimming or excessive ear care
3. obstructive stuff like neoplasia or polyps

Question 13

What are perpetuating factors and what are some examples of them?

Answer 13

do not initiate disease but they cause it to continue, FOLLOWING

1. Otitis media
2. progressive changes in the canal like edema, infiltration of inflamm cells, calcification, fibrosis, –>occlusion of the canal

Question 14

What should our approach be to the otitis case?

Answer 14

Hx, clin/derm exam,
otoscopic exam - tympanic membrane
ear canal cytology - look for organisms, inflammation,
Ear swabs for culture or for otodectes
Try to identify primary/secondary causes, predisposing/perpetuating factors

Question 15

Types of topical treatments for otitis

Answer 15

ear cleaning/drying agents
Topical glucocorticoids
topical antimicrobials

Question 16

what ear cleaning/drying agent is good for gram negatives

Answer 16

tris-EDTA

Question 17

What should we worry about with ear cleaning/drying agents?

Answer 17

that the tympanic membrane s ruptured, especially if there is chlorhexidine in the mix

Question 18

What was Epi-otic suggested for in the notes?

Answer 18

possible to resolve malassezia or bacterial otic infections

Question 19

What is the trouble with the commercial topical ear treatments? What is the biggest risk?

Answer 19

none are labelled when the tympanic membrane is not intact. The biggest risk is ototoxicity

Question 20

Which preparation is least ototoxic for topical ear preps?

Answer 20

Baytril Otic - enroflox and siilver sulfadiazine

Question 21

What are the benefits of topical glucocorticoids?

Answer 21

anti-pruritic, anti-inflamm, and antiproliferative.

reduce secretions

Question 22

Which glucocorticoids can be used long term with less problems?

Answer 22

hydrocortisone

Question 23

What do we use the Neomycin, Gent (with antifungal and glucocort) for and what are the drawbacks?

Answer 23

obvious ototixicity is a drawback

but it’ll hit the gram pos and negs

Question 24

Where do we use the FLQL topicals and what is a formulation of it?

Answer 24

broad spectrum negs and pos.

Baytril Otic is the enro with silver sulf

Question 25

What is surolan? what does it hit? what are it’s limitations?

Answer 25

Polymixin B so it hits Pseudomonas well. But cannot work in pus so deal with that. It will also cause ototoxicity

Question 26

What are the topicals label for antifungal use?

Answer 26

Nystatin, miconazole, clotrimazole

Question 27

What do we use systemic glucocorticoids for in otitis externa?

Answer 27

decrease stenosis
reduce edema
decrease hyperplasia of the vertical and horizontal ear canal
Can even be used for severe bacterial otitis

Question 28

What is protocol for AM and AF in otitis externa?

Answer 28

not generally recommended but when necessary, make sure it is cultured

Question 29

When ear infections are recurrent, consider…

Answer 29

otitis media

Question 30

what is another pathogenesis from regular for otitis media in cats? what are clinical signs for that?

Answer 30

cats can have ascending from the auditory tubes.

ask about sneezing, discharge from eyes or nose.

Question 31

Dx of otitis media

Answer 31

sometimes need to do myringotomy and get cytology and culture from it.

Question 32

Tx of otitis media

Answer 32

myringotomy to flush it out
reduce inflammation with corticosteroids
topical AM and maybe systemic
weekly rechecks

Question 33

Where is a myringotomy incision made?

Answer 33

ventral portion of the membrane