Otitis In Dogs ___________________________________ Management in - - PDF document

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Otitis In Dogs ___________________________________ Management in - - PDF document

What to Do About Ear Problems in Shelter and Foster Home Dogs June 4, 2015 ___________________________________ ___________________________________ ___________________________________ ___________________________________


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What to Do About Ear Problems in Shelter and Foster Home Dogs June 4, 2015 1 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________

Otitis In Dogs

Management in Shelters and Foster Homes

Karen Moriello, DVM, DACVD Clinical Professor of Dermatology University of Wisconsin-Madison Madison Wisconsin, USA

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What to Do About Ear Problems in Shelter and Foster Home Dogs June 4, 2015 2

Clinical Picture

Any age, breed or sex More common in warm weather More common in dogs with poor husbandry Conformational risk factors Pendulous ears Hair in the canal Narrowed canals (e.g., shar pei dog) Breed risks-high prevalence of allergic disease/cornification defects

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Clinical Signs

Scratching, rubbing ears Shaking head Odd carriage to the head-to the side or head tilt Odor, exudate, blood Aural hematoma Painful ears and associated behaviors

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Anatomy of the Dog Ear

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Pinna Vertical canal Horizontal canal Tympanic membrane Bulla/middle ear Inner ear

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“Recipe for Otitis”

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Inflammation

Increases volume of secretions in the ear Creates/contributes to stenosis Increase in internal temperature Changes surface of ear canal and environment

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Stenosis

Traps ear secretions Prevents normal ‘cleaning of ear canal’ Increases humidity in ear Inflammation-stenosis-more inflammation-even more stenosis Major cause of pain Prevent topical medications from reaching target area Can be temporary, if left untreated ear can become fibrotic or even calcified

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Micro-Organisms

Bacteria alone do not constitute an infection!! Need concurrent clinical signs Normal flora (Staphylococcus, Streptococcus, Malassezia) Bacteria in association with clinical signs Rods, especially Pseudomonas Yeast Cocci

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Cost Effective Diagnostics

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6/2/2015

UNIVERSITY OF WISCONSIN–MADISON 12

Cost Effective Diagnostics

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Slide for staining Slide in mineral oil (Demodex and Otodectes)

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Thumb Rules for Ear Cytology

  • Core diagnostic for ear disease
  • Interpret in light of whether or not there are clinical signs
  • Abnormal findings in the presence of clinical signs need an

action plan

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Typical “normal” debris from “dirty ear”

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Cytological Specimens

Cellular Samples

  • Neutrophils- assume infection
  • Number of organisms-not accurate reflection of severity of

infection-what are clinical signs?

  • Cocci and/or Yeast only: allergic diseases and primary

seborrheic disease

  • Rods: worst case scenario is Pseudomonas

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Malassezia

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Cocci and Rods Vs. Yeast

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Intra and Extra Cellular Cocci

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Nuclear Streaming

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Otitis Triage Examination

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Obvious trauma? Acute and curable? Complicated problem? Clearly end stage ear(s)? Immediate surgery?

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Otoscopic Exam - If you can

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Uncomplicated Otitis

Absence of any other clinical signs of skin disease Young dogs (e.g., ear mites) Common in warm humid weather Ears may be painful but palpate normally Erythema and exudate on pinna but no signs of chronic changes Responds to conservative treatment; ear cleaning and topic

  • tic ointments

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Hair in the Ear Canal

Standard poodles with unilateral congenitally narrowed ear canal Hair in the external ear canal

  • Hair roots can extend behind the TM
  • Plucking hairs can cause otitis media
  • Hairs ringing the TM

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One Time Trigger Treatments

Gentle ear cleaning Combination otic product (antibiotic/antifungal/steroid) Instill GENEROUS amounts

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Complicated Otitis

Obvious clinical signs of skin disease other than otitis Any age Ears OBVIOUSLY affected Painful Usually bilateral History and visual exam consistent with chronic otitis

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Visual Exam and Palpation

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Triage: End-Stage Ears or not?

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6/2/2015

UNIVERSITY OF WISCONSIN–MADISON 29

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Cost Effective Diagnostics

Diagnostic Imaging Radiographs CT Scan Culture to confirm multi-drug resistance Steroid Trial to Decrease Stenosis?

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Confirmation of End-stage Ear

Note obstructed canals and calcification in soft tissue Normal air filled ear canal

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End Stage Ear Disease and Surgery Total Ear Canal Ablation

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The BIG 4 Causes of Chronic Otitis

Obstruction Undiagnosed infection/resistant infection Otitis media Undiagnosed underlying skin disease

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#1 Obstruction

Includes but is not limited to: Result of inflammation Swelling of canal as a result of underlying skin disease Mechanical from foreign body Mechanical from tumor Breed related

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Proliferative Otitis 1 mg/kg orally for 15 to 30 days

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Foreign Bodies

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Ear Tumors

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Breed Related

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Primary Secretory Otitis Media (PSOM)

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#2 Undiagnosed and/or Resistant Infections

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  • Can complicate any of the big 4 causes of chronic otitis
  • May result from treatment related complications
  • Untreated Malassezia or Candida
  • Cocci-multiple strains, Methicillin resistant isolates
  • Rods-especially Pseudomonas
  • Multi-drug resistant infections may require TECA for

resolution

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Number of Organism Does Not Reflect Extent of Infection

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Rods-Most Worrisome

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Indications for Ear Culture

Includes but is not limited to: Complicated ear infection Purulent ear infection Lack of response to appropriate therapy Complicated ear infection Finding rods on cytology Persistent finding of bacteria

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#3 Otitis Media/Middle Ear Infection

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Myringotomy and Middle Ear Flush

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Culture Contents of Bulla

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#4 Undiagnosed Underlying Disease

Allergic Skin Disease (See Itchy Dog Webinar) Primary Disorder of Cornification (See Seborrhea Webinar)

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Allergic Skin Disease

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Primary Disorder of Cornification

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6/2/2015

UNIVERSITY OF WISCONSIN–MADISON 56

Primary Disorder of Cornification

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Urgent Treatment Goals

Immediate Triage-Is there an end stage ear? Decrease inflammation Decrease mechanical occlusion/swelling Treat micro-organisms Manage pain Coat Hygiene

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Why Steroids?

Topical Steroid Alone Equal parts dexamethasone injectable and propylene glycol 10 drops/1 squirt twice daily for 7 days, then once daily for 7 days, then as needed Combination Product? What about injectable steroids? Oral Steroids?

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Reduce Mechanical Occlusion- Ear Cleaning

Is sedation necessary?? Ear Cleaners-instill and allow to work! Gentle mechanical removal of debris Clean and massage Always apply otic steroids post cleaning

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Ear Cleaner Comments

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Pediatric Ear Currettes

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Beware!

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Treat Micro-Organisms

Routine ear cleaning ( with Tris buffered EDTA) Topical combination antimicrobial with a steroid Systemic antimicrobials Monitor via examination and cytology

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Address Underlying Trigger

Treatable and curable, e.g., ear mites? Foreign body Underlying allergies Underlying primary disorder of cornification

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Where are foster families needed?

Post surgical care of dogs having TECA Acute management of seborrheic otitis Itchy dog work up for dogs with allergic otitis Acute management into remission of diagnosed allergic otitis Post myringotomy/middle ear flush Treatment of dogs with Pseudomonas ear infection

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www.vetmed.wisc.edu

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