Myringotomy

Re: Myringotomy

Luciano Nebiante PGCertSAS — Mon, 20 Aug 2012 20:45:54 GMT

Thanks for your tips Rajat. I knew that website, but actually didn't look on it for myringotomy.

Re: Myringotomy

Rajat — Mon, 20 Aug 2012 11:06:08 GMT

Hi Luciano

There is a good guide here:

http://veterinarymedicine.dvm360.com/vetmed/article/articleDetail.jsp?id=780487&pageID=5

I think steroids at anti inflammatory doses are a good idea certainly before but also after in some cases to keep inflammation down if severe/marked/sore.

Can be used topically too (Pred forte eye drops)

If one has access to a rigid endoscope this could be substituted for a video otoscope..what I usually do - 2.7mm in smaller dogs and cats and 5mm in the medium sized ones with 10mm for the big boys. Excellent images with the larger size scopes. A arthroscope sheath will allow instrumentation and flushing without removing the scope from the ear.

Best

Raj

Re: Myringotomy

Luciano Nebiante PGCertSAS — Sun, 19 Aug 2012 19:38:09 GMT

Thanks Mark.

Re: Myringotomy

Mark Holmes — Sat, 18 Aug 2012 00:39:50 GMT

Yes just so it draws from the end

Re: Myringotomy

Luciano Nebiante PGCertSAS — Fri, 17 Aug 2012 22:40:44 GMT

[quote user="Mark Holmes"]Use a jacksons catheter and aspirate as you go. Nice sample for c+s and cytology

[/quote]

Do you cut the tip of it to aspirate?

Re: Myringotomy

Evelyn Barbour-Hill — Fri, 17 Aug 2012 21:57:30 GMT

[quote user="Mark Holmes"]Use a jacksons catheter and aspirate as you go. Nice sample for c+s and cytology

[/quote]

Cool idea.

Re: Myringotomy

Mark Holmes — Fri, 17 Aug 2012 18:31:39 GMT

Use a jacksons catheter and aspirate as you go. Nice sample for c+s and cytology

Re: Myringotomy

Luciano Nebiante PGCertSAS — Fri, 17 Aug 2012 15:36:01 GMT

Evelyn your "how to" is much appreciated.

[quote user="Evelyn Barbour-Hill"]

You wouldn't want corticosteroid treatment, would you?

[/quote]

I wouldn't and indeed I've never used them in these cases. Although I've seen some colleagues using them and actually I've seen corticosteroid advised in some literature, but with no reference to papers. So I was wondering if I was missing something.

However many thanks for your replies!

Re: Myringotomy

Evelyn Barbour-Hill — Fri, 17 Aug 2012 15:18:35 GMT

[quote user="Luciano Nebiante"]o you have any other tips to do it with a normal auriscope? And how do you manage the condition afterwards? Are general corticosteroids indicated?[/quote]

No special tips. You need the kind of auriscope with an open top that you can put instruments in, of course, and a big enough speculum. In a cat or small dog that's too small for the big speculum, you'd have to use a needly sort of instrument as suggested above - or just a piece of wire - and do it semi-blind, by which I mean you visualise the tympanum ok but you can't watch the needle go through it. Or, do it totally blind by poking a Spreull needle down.

You wouldn't want corticosteroid treatment, would you? I do lots of flushing and continue with an antibiotic for long enough. Culture and sensitivity has to be usefu to some extentl. Indeed, some do better than others. Some may need flushing repeated once or twice and of course ultimately some may need ventral bulla osteotomy.

Re: Myringotomy

Luciano Nebiante PGCertSAS — Fri, 17 Aug 2012 14:40:44 GMT

[quote user="Evelyn Barbour-Hill"]

Technically it is not difficult. I reckon many accidental myringotomies have been done by careless probing of the ear. You need to visualise the tympanum with an auriscope you can get instruments down. Then use one of those long thin scalpels (for which you can get a "myringotomy blade); or just about any long thin sharp object.

[/quote]

I was reading a guide on how to do a myringotomy and they were talking about using a Video-Otoscope, which I reckon is not a common instrument in general practice. And you're right, a lot might have been accidental.

Do you have any other tips to do it with a normal auriscope? And how do you manage the condition afterwards? Are general corticosteroids indicated?

I usually send them home on general ab's, triz-edta and I check them on regular frequent base. But some cases does not respond as well as others. In this cases I always try to send a sample for culture and sensitivity. So I wonder what do you do or if you use a different approach.

Re: Myringotomy

patrick murphy — Fri, 17 Aug 2012 13:36:16 GMT

I use either a Jackson cat catheter sylus, or if smaller a spinal needle, aim for the pars flacida. luck

Re: Myringotomy

Evelyn Barbour-Hill — Fri, 17 Aug 2012 13:20:47 GMT

In my experience in the majority of cases of middle ear disease the tympanum already has a hole in it.

If you can see pus bulging the tympanum, then puncture it. As with an abscess, the relief of pain and pyrexia will be immediate. It won't be sufficient by itself to cure the disease.

If you are sure the bulla is full of discharge and the tympanum is intact, no hard and fast rule but puncturing the tympanum is unlikely to be harmful and may very well be helpful. In any case, you are going to need to puncture it in order to flush the middle ear.