Otitis Externa Aetiology Quiz

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Questions and Answers

What is the recommended dosage for topical medication applied to the ear?

  • 0.1 – 0.3 ml per ear twice daily
  • 0.5 ml per ear three times daily
  • 0.5 – 1 ml per ear usually twice daily (correct)
  • 1 – 1.5 ml per ear once daily

Which of the following is a recommended practice for treating secondary infections in otitis externa?

  • Only rely on clinical signs for medication selection
  • Use oral antibiotics as the primary treatment
  • Conduct in-house cytology to guide drug choice (correct)
  • Avoid using any topical treatments

What is the primary purpose of ear cleaning in otitis externa treatment?

  • To introduce new medications into the ear canal
  • To improve compliance with medication use
  • To prevent owner involvement in the treatment process
  • To remove earwax and enhance exposure to topical treatments (correct)

What should be included in the cleaning fluid for manual ear cleaning?

<p>Ceruminolytics, surfactants, and antimicrobial agents (D)</p> Signup and view all the answers

What is the guideline for frequency of ear cleaning in general treatment?

<p>Once or twice weekly (D)</p> Signup and view all the answers

What does the term otitis externa specifically refer to?

<p>Inflammation of the outer ear canal (A)</p> Signup and view all the answers

Which anatomical feature is absent in the lower ear canal of horses?

<p>Hair follicles (B)</p> Signup and view all the answers

What is cerumen commonly known as?

<p>Ear wax (B)</p> Signup and view all the answers

What type of skin is found in the normal ear canal?

<p>Thin stratified keratinizing epidermis (B)</p> Signup and view all the answers

Which of the following is NOT a common aetiological factor for otitis externa?

<p>Ototoxicity (D)</p> Signup and view all the answers

Which procedure is essential for determining the aetiology of otitis externa?

<p>Otoscopy (A)</p> Signup and view all the answers

What role do sebaceous glands play in the ear canal?

<p>Producing cerumen (B)</p> Signup and view all the answers

Which of these statements about otitis externa is incorrect?

<p>It is a rare condition in small animal practice. (B)</p> Signup and view all the answers

What effect does TrizEDTA have on bacterial cells?

<p>Damages bacterial cell walls (B)</p> Signup and view all the answers

What is the primary benefit of ear flushing in initial otitis externa therapy?

<p>Improves visualization of the ear canal (B)</p> Signup and view all the answers

When should TrizEDTA be administered relative to other ear treatment products?

<p>20-30 minutes before other products (B)</p> Signup and view all the answers

What role do porphyrins play in photodynamic therapy?

<p>Sensitize organisms to light exposure (A)</p> Signup and view all the answers

Which medication can be used for treating ear infections in dogs and cats?

<p>Fluralaner (Bravecto®) (B), Corticosteroids (C)</p> Signup and view all the answers

What treatment is NOT commonly utilized for primary keratinisation disorders?

<p>Weight management (C)</p> Signup and view all the answers

Which of the following factors is important to address in the treatment of otitis externa?

<p>Addressing underlying systemic disease (D)</p> Signup and view all the answers

Which of the following corticosteroids has the highest potency for treating otitis externa?

<p>Betamethasone (B), Fluocinolone (C)</p> Signup and view all the answers

What is a necessary requirement for performing ear flushing?

<p>Use of general anesthesia (A)</p> Signup and view all the answers

In treating secondary infections caused by bacteria or yeasts, which is an appropriate treatment option?

<p>Antibiotics (B)</p> Signup and view all the answers

Why might surgical procedures be considered in the treatment of otitis externa?

<p>To remove primary neoplasia or stenotic canals (A)</p> Signup and view all the answers

For immune-mediated conditions, which of the following medications is commonly used?

<p>Corticosteroids (D)</p> Signup and view all the answers

What is the most common reason for recurrence in treatment failure?

<p>Failure to identify the primary cause (D)</p> Signup and view all the answers

What type of saline solution is recommended for use during ear flushing?

<p>Sterile saline or dilute chlorhexidine solution (D)</p> Signup and view all the answers

Which of the following is considered a primary cause of skin issues?

<p>Food allergies (C)</p> Signup and view all the answers

What is the recommended approach for treating foreign bodies in the ear?

<p>Irrigate and flush the ear (A)</p> Signup and view all the answers

What is the primary function of corticosteroids in treating acute otitis externa?

<p>Reduce inflammation (D)</p> Signup and view all the answers

What type of therapy is preferred for the treatment of secondary diseases?

<p>Topical treatment (A)</p> Signup and view all the answers

Which of the following is a common consideration when choosing topical treatments for infections?

<p>Systemic vs topical application (B)</p> Signup and view all the answers

Which category includes allergens related to skin conditions?

<p>Flea allergies (A)</p> Signup and view all the answers

What should be done when treating infections caused by ear mites?

<p>Systemic treatment (D)</p> Signup and view all the answers

Which of the following is NOT part of the treatment process for allergies?

<p>Immediate surgical intervention (B)</p> Signup and view all the answers

In the management of primary keratinisation disorders, what treatment option is often utilized?

<p>Zinc supplements (A)</p> Signup and view all the answers

Which of the following factors is NOT categorized as a perpetuating factor in skin treatment?

<p>Dietary choices (D)</p> Signup and view all the answers

What is the primary purpose of lateral wall resection (LWR)?

<p>To improve drainage and access lesions (D)</p> Signup and view all the answers

In what scenario is vertical canal ablation (VCA) considered appropriate?

<p>For irreversible disease of the vertical canal (D)</p> Signup and view all the answers

What is a common reason for the recurrence of otitis externa?

<p>Failure to identify the primary cause (D)</p> Signup and view all the answers

What should be done if the ear canal is swollen shut?

<p>Use cortisone to reduce swelling before examining the canal (D)</p> Signup and view all the answers

Why is it important to educate the client about ear cleaning?

<p>To ensure they can help in long-term management (A)</p> Signup and view all the answers

What is TCA and when is it indicated?

<p>Used for chronic end-stage otitis and neoplasia (D)</p> Signup and view all the answers

What is the first step in managing otitis externa?

<p>Find and treat the primary cause (B)</p> Signup and view all the answers

What is the significance of follow-up examinations in treating otitis externa?

<p>They ensure the primary cause has been resolved (D)</p> Signup and view all the answers

Flashcards

What is otitis externa?

Inflammation of the outer ear canal. Can affect any species with external auditory components.

What is canine otitis externa?

A type of skin inflammation that can affect the external ear. It's a common reason for small animal visits to the vet.

Describe the anatomy of the outer ear.

The cartilage and bony portion of the outer ear, as well as the eardrum, are covered by skin.

What is the epidermis of the ear?

The outer layer of skin, thin and layered, containing keratin.

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What is the dermis of the ear?

The inner layer of skin containing structures like hair follicles, sebaceous glands, and apocrine glands.

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What are sebaceous glands?

Oil glands in the ear that produce sebum.

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What are apocrine glands?

Modified sweat glands in the ear that also contribute to earwax.

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What is cerumen?

A mixture of secretions from sebaceous and apocrine glands, as well as dead skin cells. It helps clean the ear canal.

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Ear mite treatment for dogs & cats (Spot-on)

Salamectin (Stronghold®) is a spot-on treatment for ear mites in dogs and cats.

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Ear mite treatment for rabbits (Spot-on)

Ivermectin (Xeno ® Spot on) is a spot-on treatment for ear mites in rabbits.

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Ear mite treatment for dogs & cats (Advocate)

Imidacloprid (Advocate®) is a spot-on treatment for ear mites in dogs and cats.

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Ear mite treatment for dogs & cats (Bravecto)

Fluralaner (Bravecto®) is a spot-on treatment for ear mites in dogs and cats.

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Corticosteroids for ear infections

Corticosteroids are used to reduce inflammation and pain in acute and chronic ear infections.

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Recicort® for ear infections

Recicort® is a topical corticosteroid that targets ear infections without affecting bacteria or fungal infections.

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Treating ear infections with antibiotics & antifungals

Antibiotics and antifungals are used to treat bacterial and yeast infections in the ear.

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Systemic vs. topical ear treatment

The choice between systemic and topical treatment depends on the severity and type of ear infection.

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What is the most common reason for ear infections to recur?

The most common reason for ear infections to return is not properly identifying the root cause.

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What are the four key aspects to consider when treating ear infections?

Addressing the primary cause, secondary causes, perpetuating factors, and predisposing factors are crucial for successful treatment.

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What are predisposing factors in ear infections?

These relate to underlying conditions that contribute to ear infections.

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What are perpetuating factors in ear infections?

These are things that maintain or worsen an ear infection.

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What are key aspects of treating allergic ear infections?

Cleaning the ears, treating secondary infections and inflammation, and managing owner expectations are important aspects of allergy treatment.

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Why is systemic treatment recommended for ear mites?

Systemic treatment is recommended as mites can live on the body and re-infest.

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What are some examples of infectious causes of ear infections?

Examples include fleas, ticks, fungal infections, and viruses.

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What are primary causes of ear infections?

These are conditions that directly cause the ear infection.

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Otitis Externa

A type of ear infection that affects the outer ear canal (between the eardrum and the outside of the ear).

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Biofilm

A thin layer of bacteria and other microorganisms that can build up on the surface of the ear canal, making it difficult for medications to penetrate.

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Ear Wicks

These are used to help remove debris and bacteria from the ear; they are usually made of cotton or other absorbent material and inserted into the ear canal.

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Ear Cleaning Fluids

Solutions used to clean the ear canal, often containing ingredients that break down wax, soften debris, and/or have mild antimicrobial properties.

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Ear Irrigation

A technique that involves using a gentle stream of liquid to flush out debris from the ear canal.

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Irritant

A substance that causes irritation or inflammation, often due to direct contact with the skin or mucous membranes.

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Ototoxic

A substance that can damage the inner ear, potentially leading to hearing loss or balance problems.

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TrizEDTA ear cleaning solution

A specialized cleaning solution for the ears, containing TrizEDTA, that helps break down biofilm and potentiates the effectiveness of antimicrobial agents.

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Ear flushing

A procedure to clean the ear canal using a syringe and a fluid, usually sterile saline or diluted chlorhexidine solution.

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Photodynamic therapy for ear infections

Photodynamic therapy is a treatment that utilizes porphyrins as photosensitizing molecules to target and destroy microorganisms. It involves the uptake of porphyrins by the microorganisms, followed by exposure to white light, leading to their destruction. This therapy is considered a potential alternative treatment for ear infections.

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Perpetuating & predisposing factors for ear infections

Factors that contribute to ongoing or recurring ear infections, such as humidity, incorrect cleaning practices, or underlying systemic illnesses.

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Surgery for ear infections

Surgical procedures may be necessary in cases of ear infections that are resistant to medical management, such as removing a growth (neoplasia) or correcting a congenital narrowing (stenosis) of the ear canal.

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What is a Lateral Wall Resection (LWR)?

A surgical procedure that removes a portion of the lateral wall of the ear canal to improve drainage and provide better access to the ear canal for inspection and treatment. Often used for recurring infections or tumors in the ear canal.

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What is Vertical Canal Ablation (VCA)?

A surgical procedure that involves destroying the vertical canal of the ear to treat severe, irreversible ear infections. This procedure is rarely recommended as it is often unsuccessful.

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What is Total Ear Canal Ablation (TCA)?

A surgical procedure that involves completely removing the ear canal and sometimes removing a portion of the bone (bulla) in the ear. This procedure is often chosen for cases of chronic, severe ear infections or ear tumors. The dog will be deaf in the affected ear after this surgery.

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What is the most common reason for ear infections to return?

A common reason for recurring ear infections in dogs?

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What is the key first step in treating ear infections?

A crucial step in treating ear infections is to identify and address the underlying causes, such as allergies or ear mites, to prevent the infection from recurring.

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What should you do before starting treatment of ear infections?

Prior to starting any treatments, thoroughly clean and remove all debris and discharge from the ear canal, as this can make a big difference in managing the infection.

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What should you do if the ear canal is swollen shut?

Inflammation of the ear canal often requires medications to decrease the swelling and improve drainage, but these medications are ineffective if the canal is completely closed. To address this, corticosteroids can be given for a short time to reduce the swelling, allowing for examination and follow-up treatment.

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What is important after treating ear infections?

Establishing a long-term management plan after treating ear infections is critical to prevent recurrence. This involves regular cleaning, ongoing medication, and follow-up examinations

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Study Notes

Otitis Externa

  • Otitis externa is the inflammation of the outer ear canal.
  • It has variable degrees of severity.
  • Normal ear anatomy includes cartilage and bone covered by skin, hair follicles, sebaceous glands, and apocrine glands.
  • The skin of the normal ear has a thin keratinising epidermis and a thin dermis containing adnexal structures.
  • Cerumen, commonly called earwax, is a mixture of secretions from sebaceous and apocrine glands, and dead skin cells.
  • The density of hair follicles in the ear varies among species.
  • Otitis externa occurs in species with external auditory components.
  • Any dermatosis can affect the external ear.
  • Canine otitis externa is a common presentation in small animals.

Aetiology: PSPP

  • Primary causes affect healthy ears.
  • Secondary causes affect abnormal ears, often combined with predisposing factors.
  • Predisposing factors increase the risk of developing otitis externa.
  • Perpetuating factors occur as a result of otitis externa.
  • Primary causes include allergies, parasites, foreign bodies, immune-mediated disease, primary keratinisation disorders, neoplasia, endocrine diseases, and miscellaneous causes (e.g., atopic dermatitis, food allergy).
  • Secondary causes include bacteria (e.g., Staphylococcus, Streptococcus), yeasts (e.g., Malassezia), and gram-negative bacteria (e.g., Pseudomonas).
  • Perpetuating factors include ear canal stenosis, ulceration, otitis media, and ear cartilage mineralisation.
  • Predisposing factors include conformation, humidity, inappropriate cleaning, irritant treatments, and systemic disease.

Diagnosis

  • History is crucial to identifying primary causes (e.g., dietary history, medication history, environmental factors).
  • Clinical examination includes general and dermatological examination, evaluation of ear canal (hard, soft, pain), pinna examination (hair loss, erythema, scaling), examination of the ear canal (visual and digital).
  • Otoscopic examination; evaluation of ear inflammation, ulceration, discharge, foreign bodies, neoplasia, and stenosis.
  • Cytology involves sampling of the ear canal.
  • Culture and sensitivity are indicated in chronic recurrent cases where antibiotics are ineffective and when rods are observed on cytology.
  • The decision for cytology and culture/sensitivity is dependent on the primary cause(s) being revealed from the history or initial examination.

Treatment

  • Identify and treat primary causes.
  • Treat secondary causes.
  • Minimise perpetuating factors.
  • Correct predisposing causes.
  • Relieve pain, discomfort, and inflammation.
  • Educate owner.
  • May include ongoing treatment, or further investigation if necessary.
  • Medical treatments for primary disease, secondary disease (topical preferred), antibiotics, antifungals, anti-inflammatories, and cleaning agents.
  • Surgical options for primary disease, predisposing/perpetuating factors, and possible cases of irreversible disease.

Follow Up Examination

  • Revisit cases after 3 days of oral cortisone, 7-10 days of topical treatment.
  • Continue/amend treatment until primary and controlled secondary disease is resolved (on cytology).
  • Failure to identify primary cause is common reason for recurrence.

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