EAR AFFECTIONS

Dr Amit SinglaSurgery & Radiology,DGCN COVAS, CSKHPKV, PalampurHimachal Pradesh (INDIA)

Otitis Externa

• Otitis externa is an inflammation of the

epithelium of the horizontal and vertical ear

canals and surrounding structures (i.e.,

external auditory meatus and pinna). Swimmer's

ear is a term used to describe otitis externa that

occurs after swimming or bathing.

• Otitis externa is often a clinical manifestation of

a generalized dermatologic condition.

Clinical Signs

• Head shaking

• Scratching and rubbing of the ears

• Discharge from the ears

• Pain around the ears or head

• Malodor

• Behavioral changes:

• Licking of ears by other pets

• The pet’s loss of hearing, although difficult to

document, is a common owner’s complaint.

Otoscopic Examination

• For equipment, a standard otoscope with a

diagnostic or operating head is generally

adequate; however, a video otoscope is

strongly recommended for enhanced imaging

and its specialty applications.

• Evaluate for the size of the ear canals; the

presence of parasites, exudate, hair, or foreign

material; the color of the epithelium; the

presence of ulcers or masses; and the

appearance and integrity of the tympanic

membrane.

• Sedation of the animal may be necessary.

• Topical anesthesia with 1% to 2% lidocaine HCl,

0.5% proparacaine, or other similar agents may be

sufficient.

• General anesthesia is indicated for removal of

most foreign objects; for biopsy, and for

thorough evaluation of the horizontal ear canal.

• Avoid trauma to the ear canal by advancing the

otoscope cone only while directly visualizing the

canal.

Otoscopic Abnormalities

Erythema: reddened epithelium

Exudation:

• Dark, dry, granular exudate is generally found

with ear mite infection;

• Moist, yellow, odoriferous exudate is generally a

sign of bacterial infection

• Brown, waxy exudate is generally consistent

with yeast infection and overgrowth;

• Yellow, waxy-to dry scale may be found with

keratinization disorders.

Cytology of otic exudates is

always indicated to confirm these

clinical clues.

• Hyperplasia (lichenification,

hyperpigmentation) is a sign

associated with chronicity.

• Ulcers suggest more severe disease

and indicate a need for aggressive

treatment—seen especially with

Pseudomonas and yeast

infections.

Medical management

• Purulent yellow or cream-colored exudates

may be associated with gram-negative

infections, particularly Pseudomonas and

Proteus spp.

• Dark brown or black exudates are more

commonly associated with yeast infections

or those caused by Staphylococcus or

Streptococcus spp.

• Do not apply cleansing agents, parasiticides,

ceruminolytic/keratolytic agents, disinfectants,

ototoxic antimicrobials, or oil-based

medications into the ear canal of animals in

which the tympanic membrane is ruptured.

• An average size dog (around 20 kg) would

require 0.5 to 1.0 ml of medication in the ear

canal to penetrate to the level of the tympanic

membrane.

• Gently massage the external canal for 15 to 30

seconds to help to deliver medications deep

into the horizontal canal.

• Lotions and solutions are more easily applied

deep in the external canal.

• Oil-based medications are useful to treat dry,

scaly lesions, such as those of seborrhea sicca.

• Creams, pastes, and powders are difficult to

apply deep in the external ear canal and may

leave a residue. These formulations are rarely

indicated in the treatment of otitis externa in

dogs and cats.

LATERAL EAR CANAL RESECTION

ZEPPS MODIFICATION (LECR)

• Typically, the most common clinical sign of otitis

media is chronic and recurrent otitis externa.

• To expose the medial portion of the vertical

canal and horizontal ear canal.

Prognosis

Prognosis for control of ear disease is good

provided that

• Surgery is performed correctly and for the right

indication.

• No middle ear disease is present.

• Postoperative medical management of otitis

externa is appropriate.

AURICULAR HEMATOMA

• Auricular or aural hematoma is an

accumulation of blood within the cartilage of

the pinna

• Auricular hematomas occur secondary to

inflammatory conditions of the pinna or external

ear canal, such as foreign bodies, food allergy,

bacterial infection, yeast infection, and ear mites

and by violent head shaking or scratching.

Ear Haematoma

Otitis Media and Otitis Interna

• Otitis media: Otitis media is defined as

inflammation of the middle ear and is an

important perpetuating cause of recurrent otitis

externa.

• Otitis media occurs as a direct extension from an

existing otitis externa through a ruptured

tympanic membrane.

ETIOLOGY

• Bacteria

• Yeast

• Primary secretory otitis media

• Neoplasia and polyps

• Otoliths

• Trauma and foreign bodies.

CLINICAL SIGNS

• Recurrent otitis externa may be the only

clinical sign associated with otitis media.

• Specific clinical signs indicative of otitis media

are facial nerve paralysis and Horner’s

syndrome is due to injury to the sympathetic

nerve fibers, which course near the middle ear,

and is characterized by ptosis, miosis,

enophthalmus, and protrusion of the nictitating

membrane.

Otitis Interna

• Signs of otitis interna are those typically

associated with peripheral vestibular syndrome

and include a head tilt, circling, falling, or

rolling toward the affected side; horizontal or

rotary nystagmus with the fast phase away from

the affected side; and asymmetric ataxia with

strength preserved

Treatment

The goals of treatment are to clean the external

and middle ear; remove infected, inflammatory,

or foreign

• Perform under general anesthesia.

• Soak the ear canal for 10 minutes with a

ceruminolytic ear cleaner, then flush using warm

saline:

• Once the exudate and debris are removed from

the ear canal, evaluate the tympanic membrane

with an otoscope or video otoscope.

• If the tympanic membrane is not intact, perform

cytology and bacterial C/S from the middle ear

cavity

• Once the ear has been cleaned and flushed,

begin systemic and topical

antimicrobial/antifungal treatment based on

cytologic results from the external and middle

ear.

• The most common coccoid bacteria isolated

from the middle ear of dogs with otitis media is

S. intermedius; appropriate antibiotic choices

include

• Cephalexin, 22mg/kg PO q12h

• Amoxicillin and clavulanate, 13.75 to 22mg/kg

PO q12h

• The most common rod bacteria is

Pseudomonas aeruginosa. A fluoroquinolone

such as

• Enrofloxacin, 5 to 20 mg/kg PO q24h

• Marbofloxacin, 2.75 to 5.5mg/kg q24h PO

• Certain systemic antibiotics (primarily

aminoglycosides) are ototoxic and should be

used cautiously.

• Use ketoconazole or itraconazole at 5mg/kg

PO q24h for yeast otitis media.

• Anti-inflammatory doses prednisolone 1mg/kg

PO q24h, then can be used to reduce

hyperplasia and stenosis of the ear canal to

facilitate therapy.

Thanks