malasezzia

staph

other gram +ve cocci

gram -ve rods- pseudomonas?

middle ear: malassezia less common, may differ from ear canals

Primary:cause of the ear disease

Predisposing: makes otitis more likely to occur or be severe

Perpetuating:  prevent resolution

FB

parasites

hypersensitivity

endocrinopathies

keratinisation diseases

IMD

ceruminous gland tumours

1. Conformation- hairy, narrow, pendulous, glandular

2. environment

3. iatrogenic

4. swimming

chronic pathological changes

ex. decreased cell migration, hyperplasia and hyperkeratosis, fibrosis, glandular hyperplasia, ear canal stenosis, tympanic membrane rupture

staph

pseudomonas

malassezia

1. Type

2. pruritis

3. pain

4. discharge

5. mobility

6. pliability

7. thickening and Fibrosis

mucosal proliferation

increased secretion and debris

cholesteatoma

mineralisation

osteomyelitis

depression, pain, head tilt

primary disease uncommon- primary secretory otitis media, feline nasopharyngeal polyp

otodectes

ID micro organisms

neutrophils

other cells- neoplasia? 

manual cleansing

bulb syring - danger of rupturing TM

ear flushing- only way to clean middle ear, need GA and ET tube. if ear stenosed- need glucocorticoid to open them. initially soak ear and bulb syringe 

Ceruminolytics

surfactants

soften and dissolve cerumen

propylene glycol

mineral oils

glycerine

xylene

essential oils

detergents to emulsify debris

- can be irritating, care if TM ruptured

- DSS/Docusate

- calcium sulphosuccinate

- peroxides- release oxygen- they dont really like that 

PCMX

organic acids

chlorhexidine

low ph

alcohols

sugar inhibition of staph and malasezzia adherence- reduced by alkyl polyglucoside ( APG

use in animals prone to otitis

inflamm usually preceds infection- decrease inflamm to restore canal environment, decrease humidity, decrease expression of adhesion molecules

Hydrocortisone in some products

may use topical glucocorticoids after ear cleaning 

usually very safe

but irritation, ototoxicity

vestibular syndrome

horners syndrome

deffnes

injury 

1. topical ear med- ab or antifungal, glucocorticoid

2. ear cleaning- manual lavage or bulb

3. suppurative otitis harder to treat: ab against pseudomonas, cleaning useful to reduce exudation 

directly ototoxic

resistant

first line ab for pseudomonas: FQs, gentamicin, polymixin B/miconazole ex. easotic, Surolan

potentiates antibiotic killing- chelates metal ions in cell wall

admin 15-20 min before antibiotic or with antibiotic ( mix with marbofloxacin, gentamicin, silver sulfadiazine)

can mix with dexamethasone- antiinflamm, analgesic, otoprotective

component of baytril Otic

1 % ointment flamazine

- inactivated by purulent debris

- promotes healing

- mix well with FQs and gentamicin 

polyvinyl acetate wicks

insert under GA

soak in ab/steroid

expands to fill ear canal- ab reservoir, absorb exudate, prevent scarring

- replace after 3-7 days

flush out debris- leave open to drain, avoid ear wicks

treat until clean- systemic AB for 4-6 weeks

Primary otitis often sterile- drain and treat with steroids if inflamed 

Topical glucocorticoids- mild inflamm, steroid containing ear products, TrizEDTA/dexmethasone solutions

Flucinolone acetonide/DMSO (Synotic) 

- reduces tissue hyperplasia 

pred-2-3weeks, use gut protectants- sulcrulfate, cimetidine, ranitidine

Isotretinoin or Vit A- sebacious hyperplasia

Topical treatment usually effective: clotrimazole, miconazole, nystatin

Systemic: itraconazole, poor penetration to tympanic bulla