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SchmodderundSchlonzversperrendieSicht?VideootoskopieundO77smedia

MonikaF.LinekDipECVDEBVS®Spezialis4nfürVeterinärdermatologie

SchmodderundSchlonzversperrendieSicht

Waswollenwirsehen:§  DenOhrkanalindergesamtenLänge

§  Einengungen/Hyperplasien/Neoplasien§  Fremdkörper§  Unterschiedever4kal/horizontal

§  Trommelfell:Struktur,Vorhanden+/-§  O44smediajaodernein§  Sekretbeschaffenheit/Proben

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SchmodderundSchlonzversperrendieSicht

EswerdeLichtamEndedesTunnels:

2,5/3,5/4,5mm!Länge=4,5cm

4/6/7mm!Länge:5,7/6,5/9cm

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SchmodderundSchlonzversperrendieSicht

SchmodderundSchlonzversperrendieSicht

WirbrauchenLichtundWirmüssenreinigenOhrreiniger:werdarfauchinsMi`elohr§  Squalene§  TrisEDTA§  AlleanderenOhrreinigernichtzuverlässiggeprüc

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SchmodderundSchlonzversperrendieSicht

Squalane,ArachisHypogaeaOil,Caprylic/CapricTriglyceride,VitaminE22%Squalene,IsopropylMyristate,ParaffinumLiquidum

SchmodderundSchlonzversperrendieSicht

Wirmüssenreinigen:GeräteAuriflush® Ballonspülung

RalfMüller

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SchmodderundSchlonzversperrendieSicht

BesteReinigungmi`elsVideootoskopie

TelePackLED

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Videootoskopie/O44smedia

VorbereitungSchwellung/Exsudat/Ulzera4onenverringern:§  8-14Tage:systemischeoderpotentelokaleGlukocor4ocide

§  Prednisolon1mg/kgKGW1xtäglichfür8Tage§  Oder/und(Trommelfell??)§  Lokal:Hydrocor4sonaceponatDexamethason1-2% Mometasoninjek4onsware

VideootoskopieundO44smedia

Vorbereitung:§  Venenkatheder§  Seda4onmitstarkemSchmerzmi`el

§  Intuba4on§  Monitoring§  Schräglagerung§  EvtRöntgen§  CT

TSH

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VideootoskopieundO44smedia

VideootoskopieinNarkose,warum:§  Schmerz§  AbwehrbewegungIntuba4onundSchräglagerung,warum:§  BeidefektemTrommelfellZugangüberdieEustach´scheRöhre

zumRachen/Bronchen/Lunge

VideootoskopieundO44smedia

Spüllösungen§  LauwarmesNaCl/Wasser§  Sequen4elleSpülungenmit§  NaCl,verdünntemEssig,TrisEDTA,verdünntemPolyvidon

§  Otoproof®(Carbamidperoxid;Dioctylnatriumsulfosuccinat;

Propylenglykol;Entmineralisiertes(DEMI)Wasser)

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Warumistesüberhauptnotwendig:§  ChronischeO44den:Schmerzen§  FortleitunginMi`elohr

§  FazialispareseundParalyse§  Hornersyndrom§  Parasympa4kusAusfall:KCSundparasympathe4cNose

§  FortleitunginsInnenohr§  Ves4bularsyndrom

§  Encephali4s

VideootoskopieundO44smedia

VideootoskopieeinzigeMaßnahmenfürDiagnos4kundTherapiebeiO44smedia

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Technik:Myringotomie

Griffin, 2006

EarwicksundGels

h#ps://www.youtube.com/watch?v=5pacClJSy_w

Ear wicks are surgical packs that have been used inhuman medicine for about 50 years to treat a varietyof aural conditions. They are used to treat otitisexterna, particularly in children, where topicalapplication of drops is difficult, the wicks can be usedto concentrate antibiotics in the ear canal (Taylor,1974). Papers have also been published in medicaltexts describing the use of wicks in the therapy of earcanal stenosis (Miller, 1978) as well as a post-operativedressing after minor surgical procedures includingmyringoplasty (McRae, 1992 and Cannon, 1985).

Ear wicks are made of polyvinyl alcohol (PVA),which forms a hard, compact structure. When theyare dry prior to insertion in the canal they can be cutand shaped.When the wick is soaked in any aqueoussolution the sponge will expand in a controlledmanner, which allows it to be positioned within theear. Expansion produces a soft internal ‘bandage’ thatadapts to fill the contours of the ear canal. In theauthor’s experience they are well tolerated providingthey are positioned correctly. In small dogs and catsoverlong wicks can be felt when the animalsarticulate their temporomandibular joint, which canlead to some discomfort on opening their jaws.Designed for human use they can be usedsuccessfully in all but the giant dogs. In normal earsof such breeds the canals are too wide so that evenwhen the wick is expanded they do not fill thewhole canal. They can however be used to treatstenotic ear canals in these breeds.The sponge has aporous interconnected structure, which gives it greattensile strength, so that it will not disintegrate or tearwhilst in situ or when it is grasped to be removed.The fine pores facilitate minimal tissue adhesionproviding it remains soaked.

Although the majority of ear wicks are used inseverely infected otic environments they are preparedto the same high degree of surgical asepsis as anyother operative pack.The design of the PVA wick issuch that it will not sustain microbial growthproviding it is not contaminated with organic debrissuch as blood, pus, wax etc. Effective cleaning of thecanal is thus critical to a successful outcome whenwicks are used. If the canal is not adequately flushedthen the wick will act as a cork to ‘bottle up’infection and can predispose to the development ofotitis media. The principal uses of ear wicks inveterinary medicine are:

● treatment of bacterial/yeast otitis externa● post-operative packing after non-ablative surgery● reduction of hyperplasia/stenosis of the external

ear canal

This article will deal with therapy of infectious otitisexterna using ear wicks, the next article in this serieswill discuss use of ear wicks in the therapy ofhyperplasia and stenosis of the canal and also post-operatively as a surgical pack.

THERAPY OF OTITIS EXTERNAOtitis externa lends itself particularly well to therapywith ear wicks. The author would recommend thefollowing steps in selecting and treating cases (thesecan only really be achieved in an anaesthetisedanimal):● Assessment of the ear canal and tympanic

membrane● Assessment of the otic discharge with cytology

+/- culture● Thorough cleaning of the canal● Selection of soak solution and placement of wick● Post flushing glucocorticoid administration

Therapy of otitis media will be discussed later in thearticle and requires a slightly different approach.

a) Assessment of the ear canal and tympanicmembraneAlthough it is possible to undertake otoscopicexamination in a conscious animal it can be achievedmuch more easily and thoroughly if the patient isanaesthetised. The use of a video-otoscope vastlyimproves the clinician’s ability to examine the canal.Otherwise a hand-held scope with a good lightsource can be used. If the ear canal is full of a waxyor purulent exudate cleaning of the canal may beneeded to assess the deeper regions of the horizontalcanal and the eardrum before a decision can be maderegarding appropriate therapy. Before this is started itis important to take adequate samples for cytologyand the author would generally also take one forculture at the same time if needed. These can beexamined whilst the ear is flushed. Initial flush shouldbe with warm water. In uncomplicated cases wherethe canal has no evidence of polyp formation orceruminous gland hyperplasia and the eardrum isintact and of a normal appearance an ear wick can beused.

SMALL ANIMAL ● DERMATOLOGY ★UK Vet - Vol 13 No 7 September 2008 1

Sue Paterson MA VetMB DVD DipECVD MRCVSRCVS AND EUROPEAN SPECIALIST IN VETERINARY DERMATOLOGYRUTLAND HOUSE VETERINARY HOSPITAL, ABBOTSFIELD REFERRAL CENTRE, ST HELENS.

Ear wicks in veterinary medicine: Part 1

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Komplika4onen§  Ves4bularsyndrom§  Fazialisparese...Beisorgfäl4gemundbehutsamenUmgangSehrsehrseltenbeimHund(eigenePa4enten0)Katzenhäufiger

VideootoskopischeSpülung/O44smedia

Nachsorge:§  Schmerzmi`el!!2-3Tage§  TopischeAn4bio4ka§  TopischeGK§  Ohrreiniger2-4xproWocheanfänglich§  Kontrollenalle10Tage,dannsteigern14

Tage3Wochen...

VideootoskopischeSpülung/O44smedia

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Zusammenfassung:SchodderundSchlonzmüssenenverntwerdenOhneReinigungwederDiagnoseNocheffek4veTherapiemöglichVideootoskopischeSpülungeffek4vsteMethodeNichtzulangewarten