Medical therapy of otitis externa and otitis media.

Medical regimens for the successful treatment of infectious otitis may vary widely depending on the degree of pathologic changes of the external ear canals, the status of the tympanic membranes, and the specific microorganisms involved. Chronic otitis media is especially problematic, because impaction of the bullae can be difficult to resolve and these cases often involve antibiotic-resistant bacterial organisms. In fact, the continuing emergence of resistant Pseudomonas spp and Staphylococcus spp will ensure that the medical therapy of otitis remains a dynamic art for the foreseeable future. This article considers the specific antimicrobial agents available for otic use, their potential toxicities, and guidelines for their use.     

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.     

Clinical and microbiological study of an otitis media outbreak in calves in a dairy herd.

On a dairy farm, otitis media was diagnosed in 64 suckler calves (21.8%) during a study period of 2 years, and in 10 calves (3.4%) in the third year. The inflammation was unilateral in 63 and bilateral in 11 calves. The affected calves were dull, lacked appetite, were pyrexic and displayed drooping ear or ears and tilted heads with purulent discharge exuding from the external ear canal. Of the affected animals, 56 (87.5%) were aged between 3 and 8 weeks. Morbidity was higher during the calving season and during the autumn and winter months (October-December). Pasteurella haemolytica was isolated from 21 (32.8%), P. multocida from 20 (31.2%), Actinomyces pyogenes from 11 (17.2%) and Streptococcus pneumoniae from three (4.7%) of the clinically affected calves only during the first two study years. The exudate of the acute ear infections contained, in addition to Pasteurella spp., various bacteria and yeasts. Most of these bacteria were isolated from healthy ears as well, and are likely to be part of the normal ear flora. On the other hand most of the yeasts were isolated from otitic calves. After a short course of an appropriate treatment infections healed in all cases. Possible preventive measures are discussed.     

A retrospective study of 29 cases of otitis media/interna in dairy calves

Epidemiological data, clinical findings, laboratory data, medical imaging, and outcomes were reviewed in 29 dairy calves with otitis media/interna. Age at admission ranged from 1 to 24 wk. The majority of calves were referred during winter. Clinical signs included drooping ear, ptosis, head tilt, abnormal nystagmus, strabismus, dysphagia, regurgitation, stiff neck, opisthotonos, facial hyperesthesia, and purulent aural discharge. Intranasal endoscopic examination of 5 animals revealed nasopharyngeal collapse in 4. Cerebrospinal fluid (CSF) was abnormal in all of 7 cases. Mycoplasma bovis was cultured from all but 1 case with external ear or tympanic bullae samples (n = 12), and Mycoplasma arginini was cultured from the remaining ear sample. Radiographs of the tympanic bullae were performed in 24 calves, tomodensitometry (CT) in 3 calves and ultrasound in 4 calves. According to medical imaging techniques or necropsy, 69% of the cases were classified as chronic. Mean duration of treatment was 23.3 d. The rate of clinical recovery was 75%.     

Experimental reproduction of septicemic pasteurellosis in feedlot lambs: bacteriologic and pathologic examinations

Septicemic pasteurellosis (SP) was induced in feedlot lambs. Twenty-eight lambs, randomly allotted into 7 groups, were given combinations of 3 treatments: (i) immunosuppression using hydrocortisone solubilized in dimethyl sulfoxide, (ii) rapid changes in feed, from 100% roughage to 90% concentrate, and (iii) oral inoculation of Pasteurella haemolytica biotype T. Feed changes and immunosuppression by hydrocortisone were needed for the production of SP. Pasteurella haemolytica inoculation was not necessary for induction of SP in all cases, indicating an endogenous source of infection. Clinical pathologic, bacteriologic, and gross and microscopic pathologic findings of induced SP were similar to those described for naturally occurring SP in lambs. Infection of lambs with P haemolytica biotype T via the gastrointestinal tract is discussed as a possible step in the pathogenesis of SP in feedlot lambs.     

Diagnosis and treatment of otitis media in dogs and cats.

Otitis externa/media is commonly found in dogs with chronic ear diseases and in cats with upper respiratory disease and polyps. Diagnosis of otitis media requires attention to history and clinical signs, but it also requires other methods of determining disease within the bulla. If the integrity of the eardrum cannot be determined, assume that there is middle ear disease and proceed accordingly. It is prudent to take necessary precautions to avoid the use of potentially ototoxic ear cleaners or topical medications in suspected otitis media cases. Therapeutic success is possible using systemic and topical treatment within the cleaned bulla. Referral to a dermatology specialist or a radiologist for a CT scan may be indicated in some refractory cases. Surgical intervention may be required to cure these difficult cases.     

Bulla curettage for chronic otitis media and interna in dogs.

In a series of 10 clinically affected and 6 clinically normal dogs, the technique of bulla curettage via the external ear canal, after lateral ear resection, was evaluated. In 5 of the 10 dogs with chronic otitis media and interna, the head carriage became normal 2 to 8 weeks after surgery and remained so for at least 18 months; 4 other dogs improved, but the improvement was either temporary or incomplete. In the clinically normal dogs, postsurgical complications were minimal; the tympanic membrane healed completely in 4 of the 6 dogs.     

Pathogenesis of Staphylococcus aureus mastitis: bacteriologic, histologic, and ultrastructural pathologic findings

Three lactating cows were experimentally infected with Staphylococcus aureus ATCC 29740 (Newbould 305 strain). Cows were euthanatized 2 to 216 hours after inoculation. Bacteriologic and microscopic examinations showed that S aureus attached to epithelial cells of the mammary gland in vivo. The histopathologic changes observed were progressive swelling, vacuolar degeneration of epithelial layers, and multiple foci of epithelial erosions and ulcers throughout the ductal system. The cellular response of the infected glands was demonstrated by a rapid increase in the number of somatic cells in the secretion and by accumulation of neutrophils below, within, and on the epithelium of the teat and lactiferous sinuses. The inflammatory response did not prevent infection nor subsequent pathologic changes in the inoculated glands.     

Streptococcus suis infection in swine. A sixteen month study.

A total of 349 isolates of Streptococcus suis retrieved from different tissues from diseased pigs were examined in this study. Only 48% of them could be categorized as one of serotypes 1 to 8 and 1/2. Among typable isolates, serotype 2 was the most prevalent (23%), followed by serotype 3 (10%). The majority of all isolates originated from lungs, meninges/brain, and multiple tissues. Forty-one percent of typable isolates and 33% of untypable isolates were retrieved in pure culture. Other isolates were found in conjunction with Pasteurella multocida, Escherichia coli, Actinobacillus pleuropneumoniae, Actinomyces pyogenes, and other streptococci. Typable S. suis isolates were more frequently isolated from pigs between five and ten weeks of age, while untypable isolates were mostly found in animals aged more than 24 weeks. No obvious monthly and/or seasonal variation of the prevalence of isolation of S. suis could be detected.     

A bacteriologic study of scabby-hip lesions from broiler chickens in Texas

Broilers from commercial flocks experiencing a 10-60% incidence of scabby-hip lesions at processing were examined, and selected skin lesions were cultured. Over 70% of the lesions were associated with traumatic excoriations, particularly on the caudal dorsal convexity of the birds. Most lesions were observed on birds that were 5 weeks of age or older. From the 27 specimens cultured, Clostridium perfringens was isolated in pure culture from 4 lesions and Staphylococcus species from 10 lesions. Pure cultures of staphylococci were recovered from 4 lesions, and 2-5 different staphylococci were isolated from 6 lesions. Eight staphylococci were identified as S. sciuri, 8 as S. simulans, 2 as S. epidermidis, 2 as S. lentus, 2 as S. warneri, 1 as S. cohnii, and 1 as S. intermedius. Fifty cutaneous specimens from 10 5-week-old normal broilers were cultured. A total of 197 isolates were identified including 65 S. sciuri, 52 S. lentus, 24 S. simulans, 12 S. hyicus, 11 S. warneri, 9 S. cohnii, 9 S. gallinarium, 8 S. xylosus, and 7 S. epidermidis.     

A study of swine dysentery by immunofluorescence and histology.

Twenty-six specific-pathogen-free pigs were fed pure cultures of Treponema hyodysenteriae. Five untreated pigs were controls. Distribution of this large spirochete in pigs with swine dysentery was shown by the indirect fluorescent antibody technique. Findings by this method were compared with those from dark-field examination of colonic mucosal scrapings and from tissue sections. The cultures caused mucohemorrhagic colitis which by 10 days after inoculation was indistinguishable from the colitis of swine dysentery. Control pigs remained normal. Pigs killed when spirochetes were first seen in the feces had normal colonic mucosa with only a few spirochetes. At the first sign of diarrhea, however, the colonic mucosa was thicker than normal and had many spirochetes. T. hyodysenteriae was confined to regions of hypertrophy and exudation of the large intestine mucosa throughout the course of disease.