VETTECH U 2024 / HOUSTON, TX
OTITIS: INSIDE & OUT (CONT.)
Sponsored by
SATURDAY PM • SEPTEMBER 21
CHANTELLE HANNA, CVT, VTS (DERMATOLOGY) ANIMAL DERMATOLOGY CLINIC-CHARLOTTE
TREATMENT OPTIONS FOR OTITIS EXTERNA Treatment options will vary from doctor to doctor and patient to patient. Topical treatment is typically a foregone conclusion. This may be a medication that owners will administer at home or perhaps a leave-in treatment to ensure better compliance with difficult patients. An oral antibiotic may be added if otitis media is also on the table. Systemic and topical steroids are typically needed to reduce swelling, inflammation, and pruritus. Cleaners can be tailored to specific needs depending on whether they’re being used as a maintenance treatment, or to clean during an active infection, be it bacteria or yeast. CLEANERS Maintenance cleaners are typically just that. We use them to keep cerumen to a minimum, regulate the keratinization turnover rate of the ear canal, act as a drying agent after swimming, and may have some antimicrobial activity. Frequency of use is typically once a week and no more than twice a week. We want to avoid keeping the canal too moist or interfering with the natural epithelial migration. • Epi-Otic Advanced™: 0.2% salicylic acid, 0.1% chloroxylenol, 0.5% EDT and DSS - mild, drying, neutral pH, antimicrobial. • DOUXO Micellar Solution™: Ophytrium and micellar technology - mild, hydrating, restorative, emulsifying. • MalAcetic Otic™ Cleanser: 2% acetic and boric acid- drying, antimicrobial, degreasing. Cleaners for active infections have slightly different ingredients and are slightly more powerful when dealing with active infections, which is not to say you can’t use the maintenance cleaners during active infection or one of these cleaners as a maintenance cleaner. USP Tris EDTA is safe to use in ears where the TM may not be intact.
cytology so keep an eye out. There are typically two methods of quantification. Many doctors prefer a scale of rare or trace, occasional, 1+, 2+, 3+, and 4+. Others prefer a more direct count per oil immersion field (oif) or high-power field (hpf), such as #/ hpf, using TNTC (too numerous to count) for fields where counting organisms is impossible. OTHER DIAGNOSTICS, IMAGING, AND PROCEDURES When ear infections become resistant to treatment, a culture and sensitivity may be necessary to choose a more appropriate antibiotic. If otitis media is suspected, computed tomography (CT) (and MRI to a lesser extent) is the gold standard prior to performing a deep ear flush using a video otoscope. Findings may lead to a recommendation of surgery such as a total ear canal ablation and bulla osteotomy (TECABO) instead. Feline patients will often be referred to surgery, usually for a lateral bulla osteotomy (LBO) because of the dual chamber of their bullae. If the patient is suspected of having PSOM or a middle ear infection, anesthesia can be used to perform a deep ear flush. Using a video otoscope, a myringotomy can be performed to remove any debris or infection from the bulla. Cytology and culture and sensitivity may be collected from the middle ear to help select the appropriate oral antibiotic for treatment of the bacterial otitis media. Medication can also be applied directly to the middle ear through the video otoscope. Depending on other symptoms, the doctor may also recommend a thyroid panel, ACTH stim/LDDS, or even biopsy. If there’s suspicion that the ear infection is secondary to an underlying allergy, then, an allergic work-up would be warranted. A novel protein food trial should be performed to investigate underlying food allergy. Intradermal allergy testing can help identify any environmental allergies and desensitization with allergy serum can be started. Desensitization is a long-term solution to managing the underlying environmental allergy. It can take 6-12 months before benefits are seen.
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SEPTEMBER 20-22, 2024 | PROCEEDINGS | VETGIRLONTHERUN.COM
VETTECH U
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