Diagnosis and medical treatment of otitis externa in the dog and cat

Otitis externa is no longer viewed as an isolated disease of the ear canal, but is a syndrome that is often a reflection of underlying dermatological disease. Causes are classified as predisposing (increase the risk of otitis); primary (directly induce otitis), secondary (contribute to otitis only in an abnormal ear or in conjunction with predisposing factors) and perpetuating (result from inflammation and pathology in ear, prevent resolution of otitis). Common primary causes include foreign bodies, hypersensitivity (particularly atopy and food allergy), keratinisation disorders (most commonly primary idiopathic seborrhoea and hypothyroidism) and earmites, particularly in cats. A systematic diagnostic procedure is required to identify causes and contributing factors. This should include history, clinical examination, otoscopy and cytology in all cases and culture and sensitivity as well as otitis media assessment and biopsy in severe and recurrent cases. Ancillary tests may be required depending on the underlying cause. Treatment consists of identifying and addressing predisposing and primary factors; cleaning the ear canal; topical therapy; systemic therapy where necessary; client education; follow-up; and preventive and maintenance therapy as required.     

Medical management of otitis externa

Successful medical management of otitis externa requires attention to all of the following points: 1. Diagnose and treat systemic or underlying disease(s). 2. Carefully clean and examine the entire ear canal before starting therapy. This includes removal of foreign bodies, parasites, hair, and other obstructions. 3. Apply carefully chosen topical preparations based on gross and microscopic examination. 4. Educate clients as to the causes of the otitis externa and their role in treating the disease. 5. Schedule regular follow-up examinations until the disease is completely cured. 6. Recommend preventive procedures such as drying ears after swimming, corrective surgery, and so on. 7. Use systemic treatment when indicated by chronicity of disease or the owner's inability to treat the patient.     

Topical ear treatment – options,indications and limitations of current therapy

Topical otic products form an integral part of the overall management of otitis externa. With an ever increasing array of ear drops and cleaners to choose from, appropriate selection of therapy can be difficult. The investigation of all cases of otitis externa should consider primary and secondary causes and predisposing and perpetuating factors. This article considers topical therapy under these same broad headings and discusses, through literature review, the various properties of the components of the ear cleaning solutions and drops.     

Preventive ear care for dogs and cats

Prevention of ear disease in dogs and cats depends on early detection of factors that predispose these animals to otitis externa. This article reviews the conditions and diseases that place the dog and cat at risk for otitis externa. Routine care of the ears is discussed, and otoscopic examination and techniques for cleaning the external auditory canals are described. Avoidance of potentially harmful therapeutic procedures and irritating or ototoxic pharmacologic substances is emphasized.     

Malassezia dermatitis and otitis.

The incidence of dermatitis and otitis resulting from overgrowth of M. pachydermatis is great enough that cytological sampling techniques should be considered a routine part of the dermatological examination. Because most cases of MD and Malassezia otitis cannot be grossly distinguished from bacterial pyoderma and otitis, respectively, efficiency in performing cytology testing of skin and ear canal exudate is essential to the successful diagnosis and management of pruritic skin diseases and otitis. Although Malassezia infections are rarely primary, therapy can be instituted to remove the yeast as a confounding factor while a differential diagnosis is pursued in evaluating the underlying disease process.     

Diseases of the pinna

Many diseases can affect the pinna of the dog and cat. These diseases represent most categories of cutaneous disease, from infectious to neoplastic. Although some diseases affect primarily the pinna, most pinnal dermatoses occur in conjunction with other integumentary disorders. One should approach the diagnostic work-up of pinnal disease in an organized manner, obtaining first a thorough history and physical examination. A systematic approach is required in the diagnostic evaluation in order to arrive at a tentative or definitive diagnosis. Skin scrapings, cytologic examination, and culture for dermatophytes provide the minimum database. A variety of diagnostic tests, including hematology, serum biochemical profiles, urinalysis, serology, intradermal skin testing, hypoallergenic diet trials, histopathology, and direct immunofluorescence, may be necessary in some cases before a definitive diagnosis is reached. The ears are somewhat difficult to biopsy, although in many instances histopathologic examination is essential to the diagnosis. In this author's opinion, it is preferable to use a no. 15 scalpel blade rather than a punch biopsy when obtaining a pinnal biopsy. This allows the veterinarian to obtain an elliptical or wedge biopsy, which can frequently be sutured. In some instances, biopsies are required from the ear margin and a full ear thickness biopsy is obtained. Sutures may not hold in this situation, and cautery may be necessary for hemostasis. As in other situations in which the ear is bleeding (aural hematomas, vasculitis, fly bite dermatitis, and so on), bandaging and immobilization of the ear may be necessary to prevent further trauma. Although symptomatic therapy is sometimes helpful when treating pinnal diseases, a definitive diagnosis is preferred. This is especially important following the second or third presentation of an animal for ear disease. Although ear diseases are frequently viewed as a nuisance rather than a serious condition, anyone who has owned or worked closely with an animal suffering from chronic otitis externa should appreciate the animal's discomfort and the owner's frustration. All too frequently, the chronic otitis externa is the result of a hypersensitivity (either inhalant or food) that has been overlooked in the attempt to treat the subsequent infectious otitis. Thus, in animals with recurrent otitis externa, every attempt should be made to identify and treat the underlying etiology.     

Ulcerative otitis externa responsive to immunosuppressive therapy in two dogs

Two middle-aged dogs were presented with bilateral severe ulcerative otitis externa without previous history of disease or evidence of other skin disease. Based on the exclusion of microbial infection and other primary causes, histopathological findings and response to immunomodulatory treatment, a diagnosis of presumed immune-mediated ulcerative otitis externa was made in both cases. However, the two cases differed with regard to their histopathological characteristics and the course of the disease. This report indicates that primary ulcerative disease needs to be considered in cases of ulcerative otitis externa which are unresponsive to appropriate antimicrobial therapy.     

Otic cytology in health and disease.

Accurate characterization of the primary cause and perpetuating factors is essential for successful management of ear disease in dogs and cats. Cytology is a simple, rapid, and practical diagnostic test that should be performed routinely on any and all patients presented for clinical signs consistent with otitis externa. In combination with clinical signs, otoscopic evaluation, and diagnostic testing of primary disease, serial cytology enhances the ability of veterinarians to diagnose secondary infections, monitor progression of disease, evaluate response to therapy, and make appropriate management decisions. Cytologic specimens should be evaluated for the presence, numbers, and characteristics of three key features: yeast, bacteria, and leukocytes. More than five yeast organisms or more than 25 bacteria per high-powered field is suggestive of significant microbial activity warranting therapeutic intervention. The presence of leukocytes, particularly with phagocytized bacteria, indicates "true infection" rather than overgrowth; if suppurative discharge is present, systemic therapy is needed. Cytology combined with culture and susceptibility is the best method for identification of bacterial overgrowth and infection; however, if only one test can be performed, always choose cytology. Culture results assist in the selection of appropriate antibiotic therapy, but cytology determines whether systemic antibiotics are indicated, which organisms are most significant, and when therapy can be discontinued.     

Causes of otitis externa.

Dogs with long-standing, chronic, recurrent otitis externa often represent one of the most frustrating types of problems in daily clinical practice. The important aspect of this discussion is that the clinician may be presented with a patient in which the primary chief complaint is otitis externa but a wide variety of disease processes may be causing the problem, including various combinations of the primary, predisposing, and perpetuating causes as discussed previously. The use of a thorough history and general and dermatologic physical examinations often leads the clinician to establish a systematic approach to identify the specific underlying problems. Until this is accomplished, the recurrent nature of the otitis externa will remain as a persistent problem.     

一例犬真菌与螨虫混合感染并发脓皮病诊治

脓皮病是由化脓性细菌感染引起的皮肤化脓性疾病,又称为化脓性皮炎。根据致病原因可分为原发性的和继发性脓皮病。本文所描述的就是一例由真菌和螨虫混合感染后继发性脓皮病。在治疗过程中,根据病情和药敏试验的结果,调换局部涂抹和全身抗菌消炎的药物,取得了满意的效果。     

Surgical Management of Rabbit Ear Disease

Clinical signs associated with otic disease in rabbits (Oryctolagus cuniculus) are very similar to those demonstrated in dogs and cats. The surgical treatment options to resolve diseases involving the rabbit ear are also comparable with those used for canine and feline species. However, there are key anatomic and physiologic differences that must be accounted for to perform proper surgical treatment on a rabbit that has been diagnosed with ear disease. This article describes the diagnostic and treatment options for otitis externa, otitis media, and otitis interna, with an emphasis on surgical procedures and the important distinctive otic features of the rabbit patient. The ventral bulla osteotomy procedure is recommended for management of otitis media in rabbits without otitis externa. In rabbits with pathology in the external ear canal and the middle ear, total ear canal ablation and lateral bulla osteotomy should be performed. This combined procedure will allow the surgeon to address pathology in both sites, with the ultimate goal of resolution of the underlying disease etiology. Lateral ear canal resection is only appropriate in rabbits with otitis externa without otitis media; however, this surgical procedure may not resolve the otitis externa. If this is a concern, a total ear canal ablation should be done because it offers a greater chance of success.     

Uses and indications for video-otoscopy in small animal practice.

Acute and chronic otitis externa and otitis media are common disorders in dogs and cats. In combination with other diagnostic and therapeutic procedures, the video-otoscope is a useful and effective tool in the management of clinical cases. The enhanced illumination and magnification provide the practitioner with more detailed information for diagnosis and prognosis, and the configuration of the working channel facilitates sampling, improves efficacy of cleaning procedures, and decreases risks of iatrogenic injury to structures of the middle and inner ear. Photographic documentation of clinical cases enhances the medical record, communication with colleagues, and client education. Although video-otoscopy facilitates diagnosis and therapy, it does not replace other important diagnostic tests such as evaluation for atopy, adverse food reactions, and immune-compromising disease. Failure to identify the underlying primary cause usually results in treatment failure regardless of the technology employed.     

A review of techniques for the investigation of otitis externa and otitis media

Otitis externa, inflammation of the externa ear canal, is relatively easy to diagnose based on the history and physical examination findings. The diagnosis of otitis media, inflammation of the middle ear cavity, is more challenging, with the work-up being both costly and, at times, invasive. The pathogenesis of otitis externa has been classified into predisposing, primary, and perpetuating factors. It is critical to the management of ear disease that the clinician recognize and investigate which factors are contributing to each individual patient's ear disease. Failure to identify and address the primary and/or predisposing factors is the most common cause of chronic recurrent otitis externa. Chronic inflammation of the ear canal leads to the development of the perpetuating factors, which may be the major reason for treatment failure, regardless of the primary cause of the ear disease. In this article, the predisposing, primary, and perpetuating factors involved in ear disease will be presented, along with a review of the techniques used in the diagnosis of otitis externa and otitis media.     

Measurement of body temperature by use of auricular thermometers versus rectal thermometers in dogs with otitis externa

OBJECTIVE: To compare measurements of body temperature obtained with auricular thermometers versus rectal thermometers in dogs with otitis externa. DESIGN: Prospective study. ANIMALS: 100 client-owned dogs: 50 with and 50 without clinical evidence of otitis externa. PROCEDURE: Dogs were evaluated for the presence of otitis externa on the basis of clinical signs, otoscopic examination, and cytologic evaluation of ear exudate. Auricular and rectal temperatures were obtained simultaneously in all dogs prior to and following ear examination. RESULTS: There was a high correlation between auricular and rectal temperatures in dogs with otitis externa both prior to and after ear manipulation. Significant differences were not detected in temperature measurements among dogs with different degrees of otitis externa. CONCLUSIONS AND CLINICAL RELEVANCE: Auricular temperature readings obtained by use of an auricular thermometer in dogs with otitis externa are accurate measurements of body temperature, compared with rectal temperature measurements. Temperature measurements are reliable before and after examination of the ear canal.     

Total ear canal ablation combining bulla osteotomy and curettage in dogs with chronic otitis externa and media

Ear canal ablation combining bulla osteotomy and curettage was performed on 44 dogs (n = 72 ears). Indications for the procedure included one or more of the following: chronic nonresponsive otitis externa and/or media (n = 71), tumor in the horizontal portion of the ear canal (n = 1), failed lateral ear resection (n = 11), ossified auricular cartilages secondary to chronic otitis externa (n = 22), failed previous total ear canal ablation (n = 1), and otitis interna (n = 1). In 40 dogs, the surgery was successful in alleviating all clinical signs of otitis externa and media. During the immediate postoperative period, 2 dogs died of causes unrelated to otitis. Complications related to the surgery developed in 9 of the surviving 42 dogs. Ultimately, 95% (40 of the surviving 42) of the dogs were cured by use of this procedure. Surgery successfully resolved the original problems in 97% (66 of 68) of the surgically treated ears of these dogs.     

Identification and antimicrobial susceptibility of bacteria and yeasts isolated from healthy dogs and dogs with otitis externa

The bacterial and fungal flora of the external ear canal of dogs with otitis externa and of healthy dogs were studied. The most frequently isolated microorganism from otitic ears was Staphylococcus intermedius (58.8%), followed by Malassezia pachydermatis (30.9%), Streptococcus canis (29.9%), Proteus spp. (14.4%) and Escherichia coli (10.3%). A statistical analysis of our results showed that the prevalence of these microorganisms is significant in dogs with otitis externa. Furthermore, the antimicrobial susceptibility patterns of isolated strains were determined. Majority of all bacterial isolates were most susceptible to gentamicin. Malassezia pachydermatis, the most prevalent yeast in this study, showed an excellent level of susceptibility to all antifungal agents tested.     

Identification and antimicrobial susceptibility patterns of bacteria causing otitis externa in dogs

Bacterial agents are considered important pathogens causing external otitis in dogs. It is essential to carry out bacterial culture and antimicrobial susceptibility test in the case of otitis externa, particularly for chronic or recurring cases. Sterile swab samples were obtained from terminal part of vertical ear canals of 74 dogs with otitis externa for cytology, bacterial culture and antimicrobial susceptibility test. Cytologic smears were stained using Gram and Giemsa staining methods. Aerobic bacterial culture performed on blood agar and MacConkey agar. Among total number of 92 isolated bacteria, 68 were Staphylococcus intermedius. Other isolated bacteria included: Pseudomonas aeruginosa, Proteus mirabilis, Escherichia coli, Pasteurella canis, and six other species of coagulase-negative Staphylococcus. Antimicrobial susceptibility test were performed for all isolated bacteria using 14 antibiotics. Based on the results of this study, all isolated Staphylococcus spp. were sensitive to amikacin, enrofloxacin, and rifampin, and had low resistance to gentamicin, cephalothin and ceftriaxone. More than half of gram-positive isolates were resistant to penicillin and ampicillin. Generally, all isolated gram-negative bacteria, were sensitive to amikacin and enrofloxacin, and had low resistance to ceftriaxone and gentamicin. They were highly resistant to penicillin, eythromycin, and cephalothin. Regarding the results of this study, in cases of uncomplicated otitis externa, it is possible to select antimicrobial drugs merely based on cytology, but it is recommended to perform bacterial culture and antimicrobial susceptibility test. However, in complicated or refractory cases, antimicrobials should be selected based on bacterial culture and antimicrobial susceptibility test.     

An idiopathic facial dermatitis of Persian cats

The clinical and histopathological features of 13 Persian cats which presented with chronic skin disease primarily affecting the face are described. Lesions were characterized by black material adherent to the skin and hair, accompanied by erythema and variable degrees of excoriation. Concurrent ceruminous otitis externa was observed in 7 cases. Histopathological examination of skin biopsy specimens showed marked acanthosis with crusting, hydropic degeneration and dyskeratotic basal epithelial cells, a mixed diffuse superficial inflammatory infiltrate and sebaceous hyperplasia. Malassezia pachydermatis yeasts and various bacteria were isolated from the lesions in some of the cats but in no case was antimicrobial therapy curative. The response to glucocorticoids was variable and often poor. No satisfactory therapeutic regimen could be identified and the cause of the disorder is unknown although a genetic basis is possible.     

Wound contamination and antimicrobial susceptibility of bacteria cultured during total ear canal ablation and lateral bulla osteotomy in dogs.

OBJECTIVE: To detect contamination of wound sites from surgical handling of excised tissues during total ear canal ablation and lateral bulla osteotomy in dogs, and to compare susceptibility of bacterial isolates to cefazolin with susceptibility to other antimicrobial agents. DESIGN: Prospective clinical study. ANIMALS: 13 dogs. PROCEDURE: Dogs were treated surgically for otitis externa and media via total ear canal ablation and lateral bulla osteotomy. Specimens for aerobic bacterial culture were obtained from SC tissue immediately following skin incision, tissues excised from the osseous bulla (after transection of the horizontal ear canal and lateral bulla osteotomy), and from SC tissue prior to skin closure. Antimicrobial susceptibility of bacterial isolates to various antibiotics was determined by use of a broth dilution assay. RESULTS: There was a significant association between isolation of Streptococcus canis and Escherichia coli from specimens from the osseous bulla and specimens from the SC tissues prior to skin closure, indicating contamination of the SC tissues during surgery. Seventy percent of bacterial isolates were susceptible to cefazolin. CLINICAL IMPLICATIONS: Measures to limit bacterial contamination resulting from tissue handling during total ear canal ablation and lateral bulla osteotomy are necessary. Bacteriologic culture of tissue of the osseous bulla and determination of antimicrobial susceptibility are recommended. Administration of cefazolin alone may not be efficacious for antimicrobial prophylaxis.     

Cholesterol granuloma associated with otitis media and destruction of the tympanic bulla in a dog

An 8-year-old, male neutered Irish Setter was presented with a 2-week history of pain upon opening the mouth and chronic otitis externa. Computed tomography examination revealed destruction of the left tympanic bulla with a soft-tissue density within the remains of the tympanic cavity. Cytology of aspirates collected from tissue adjacent to the tympanic bulla revealed suppurative inflammation and bacteria. A ventral bulla osteotomy was performed. Histopathology of granulation tissue within the remains of the tympanic cavity was diagnostic of cholesterol granuloma.