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• TrizUltra + Keto™ Flush: USP tris EDTA, 0.15% ketoconazole - alkalinizing, chelates bacterial cell walls to increase susceptibility to antibiotics, anti-biofilm, antifungal. • Mal-A-Ket™ Plus TrizEDTA Flush: 0.15% Chlorhexidine and Ketoconazole, USP Tris EDTA - alkalinizing, antimicrobial, chelates bacterial cell walls, blocks Pseudomonas efflux pump. The last category of ear cleaner is for pets who present with severely waxy exudate in their ears. The ingredients are ceruminolytics that break down thick waxy exudate and ceruminoliths. • Cerumene™: Squalane 25%, mineral oil, myristate (safe for ruptured TMs), and typically reserved for in-clinic use due to the need for thorough lavage after use. • pH-Notix™: Capryloyl glycine, glycerin, LipacideTM UG (intact TM) TOPICAL THERAPY There are various things to consider when choosing topical therapy and are prescribed on a case-by-case basis. One of the primary considerations is whether the owner is willing and able to treat at home. If not, a leave-in treatment may be warranted. Are there any drug interactions? Commercially available products should always be considered first. You should always be aware of the company’s recommendations when it comes to the tympanum being intact. In fact, based on current literature and a recent study, gentamicin appeared safe and did not induce any detectable alteration of cochlear or vestibular function. Below is a list of the more common ear medications we see dispensed in general practice but know that this is in no way a comprehensive list. • Mometamax®, Otomax®, Posatex®, easOtic®, Surolan®, Baytril® Otic, etc.- commercially available dispensable topical medications • Osurnia®, Claro®, Simplera®- commercially available leave- in treatments. Occasionally, there is no infection and we need to reach for a product that addresses itch. There are several ear medications that can be used.
Compounded ear medications can certainly be an option if used with care and the owner’s full consent. Compounded medications need to be made at time of dispensing for each patient and the expiration date of the combined products needs to be changed. Doctors need to defer to current literature or a compounding pharmacist to determine the expiration date. They also have a short shelf life (typically 14-30 days). Lanolin-based compounded leave-in ear treatments have gained ground in recent years and come in many different formulations. Active ingredients available include enrofloxacin, amikacin, mupirocin, polymyxin-B, nystatin, ketoconazole, and triamcinolone. The risks of using a lanolin based compounded medication should be discussed with owners. ORAL MEDICATIONS Oral antibiotics are warranted in cases where the TM is not intact. Otitis media should be assumed. Treatment is typically going to last for at least 4 weeks, sometimes longer. Steroids may also be warranted in cases of severe pruritus, inflammation, stenosis, and pain. CONCLUSION Otitis is a common problem in our small animal companions, dogs more-so than cats. There are many factors that predispose our pets to ear disease, and many more primary factors that play a direct role. Add to that an even larger number of perpetuating and secondary factors and the number of components affecting the normal function of the ear is near staggering. A successful treatment outcome is achievable if we can correctly diagnose the problems, regulate and correct the predisposing, perpetuating, and secondary factors, and help normalize the micro-environment. REFERENCES • Gotthelf LN. Small Animal Ear Diseases: An Illustrated Guide. 2nd ed. St. Louis: Elsevier Saunders; 2005. • Horne K, Schwassermann M, Logas D. Small Animal Dermatology for Technicians and Nurses, Hoboken: Wiley-Blackwell 2020. • Paterson S. Brainstem auditory evoked responses in 37 dogs with otitis media before and after topical therapy. JSAP 2018;59(1):10-15. • Strain GM. Ototoxicity assessment of a gentamicin sulfate otic preparation in dogs. AJVR 1995;56(4):532-8. • Noli C, Columbo S. Feline Dermatology. Gewerbestrasse. Springer Nature Switzerland; 2020:175-208. • Miller W, Griffin C, Campbell K. Small Animal Dermatology. St. Louis: Elsevier Mosby; 2013. • Hnilica K. Small Animal Dermatology: A Color Atlas and Therapeutic Guide. 3rd ed. St. Louis: Elsevier Saunders 2011.
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