safe topicals with suspect OM and ruptured ear drum

Re: safe topicals with suspect OM and ruptured ear drum

Braden Collins — Sun, 04 Aug 2013 07:21:24 GMT

www.vetsurgeon.org/.../3326.Antimicrobial-Therapies-in-Otitis-_2D00_-David-Robson-_2800_2011-update_2900_.pdf

Hopefully this works as an attachment. It's my little otitis bible.

Re: safe topicals with suspect OM and ruptured ear drum

John Ellis — Sat, 03 Aug 2013 18:49:20 GMT

I frequently use the following mix in dogs with ruptured TM's.... Triz aural + 16mls baytril 2.5% + 2-8mls of dexadresson then made up with 94-100mls of distilled water depending on how much dex I have used.

This is on the recommendation of a dermatologist, I didn't make it up myself! :p

Re: safe topicals with suspect OM and ruptured ear drum

Evelyn Barbour-Hill — Fri, 02 Aug 2013 13:43:21 GMT

If the cat has otitis media it is unlikely to be cured by medical means alone.

Re: safe topicals with suspect OM and ruptured ear drum

Rob Loxley — Fri, 02 Aug 2013 13:38:22 GMT

[quote user="Anthony Todd"]

And never Hibitane, in fact someone once said they only used normal saline.

Causes permanent deafness in people and dogs AFAIK.

[/quote]

Quite a few articles on chlorhexidine with differing conclusions e.g. http://www.dechra-us.com/Files/dechraUSA/downloads/Articles/Progress_in_Veterinary_Neurology.pdf

As for the OP, if the cat has recurring ear infections with signs of middle ear involvement I'd be looking at further investigation e.g. bulla imaging, on top of treating the infection

Re: safe topicals with suspect OM and ruptured ear drum

John Flynn — Fri, 02 Aug 2013 12:00:24 GMT

The pouring of useful systemic antibacterials (such as fluoroquinolones) down an ear canal seems total madness to me. These drugs are designed to kill bacteria while being safe in bacteria-toxic levels in your bloodstream; there are plenty of antiseptics that you can wash out an ear with but wouldn't inject IV - I'd recommend starting there.

I'm also unaware of a problem with 0.05% chlorhexidine, but I may be missing something. Indeed I would have ranked this (along with 2.5% acetic acid) as some of the things that have been demonstrated safe to flush down an ear with a ruptured tympanic membrane?

I would have thought the main things to avoid were proprietary ear cleaners if one had concerns re ototoxicity in the presence of a ruptured tympanic membrane.

I tend to use steroid/polymixinB drops and find they work well for bacterial infections of ear when required.

Re: safe topicals with suspect OM and ruptured ear drum

Michael Woodhouse — Fri, 02 Aug 2013 00:11:58 GMT

[quote user="Mark Holmes"] I have probably put topical drops down hundreds of ears with ear drums that have either been ruptured or that have gone onto rupture after the drops were dispensed. I have never seen anything suggesting a problem.[/quote]

Exactly.

Occasionally I'll see an ear so red and painful that you can't even begin to look down there. Drops and anti-inflammatories (you all know which ones ) and rapid improvement. Have a good look down there a week later.

Re: safe topicals with suspect OM and ruptured ear drum

Mark Holmes — Thu, 01 Aug 2013 23:36:44 GMT

[quote user="Rob Davis"]

[quote user="Sammy82"]

I would avoid using any preparations containing ototoxic ABs, e.g. gentamycin, as these can cause permanent loss of hearing (and gentamycin is sometimes even being used in humans for this purpose, in the treatment of Meniere's Disease)

[/quote]

Gentamycin is ototoxic if given systemically, but appears to be fairly safe to use in the middle ear. I regularly use genticin drops for this specific purpose without any problems.

[/quote] I don't have the reference but I believe I read something that suggested that gentamycin is one of the few that have been demonstrated safe topically. I have probably put topical drops down hundreds of ears with ear drums that have either been ruptured or that have gone onto rupture after the drops were dispensed. I have never seen anything suggesting a problem. Infact I would argue that poorly managed otitis media is far more likely to be ototoxic than topical medications. I also assume that given how often they must be inadvertently applied to the middle ear, direct and measurable evidence of widespread ofotoxicity would be obvious by now if problems were occurring.

Re: safe topicals with suspect OM and ruptured ear drum

Rob Davis — Thu, 01 Aug 2013 23:08:01 GMT

[quote user="Sammy82"]

[/quote]

Gentamycin is ototoxic if given systemically, but appears to be fairly safe to use in the middle ear. I regularly use genticin drops for this specific purpose without any problems.

Re: safe topicals with suspect OM and ruptured ear drum

Rob Loxley — Thu, 01 Aug 2013 22:52:53 GMT

[quote user="Sammy82"] e.g. gentamycin, as these can cause permanent loss of hearing[/quote]

I was under the impression that it was much more vestibulotoxic rather than cochleatoxic

Re: safe topicals with suspect OM and ruptured ear drum

tess — Thu, 01 Aug 2013 19:36:17 GMT

We use the Triz/ Baytril thing but also with dex in it too. I'm not at work at the moment and I can't remember the amounts but will check it out & let you know. It came from CPD that one of the other vets attended.

Re: safe topicals with suspect OM and ruptured ear drum

Anthony Todd — Thu, 01 Aug 2013 18:41:24 GMT

And never Hibitane, in fact someone once said they only used normal saline.

Causes permanent deafness in people and dogs AFAIK.

Re: safe topicals with suspect OM and ruptured ear drum

Sammy82 — Thu, 01 Aug 2013 18:21:43 GMT

Re: safe topicals with suspect OM and ruptured ear drum

Louise6732 — Thu, 01 Aug 2013 18:09:45 GMT

The Vetruus website has a free 'ask a dermatologist' section which has referral level derm advice on the end of an email, worth an ask with them re the case! Louise

Re: safe topicals with suspect OM and ruptured ear drum

James Laidlaw — Thu, 01 Aug 2013 15:39:12 GMT

As far as I'm aware, most cases that develop any problems are reversible with cessation of topicals anyway and unlikely to develop permanent problems.

Re: safe topicals with suspect OM and ruptured ear drum

Utlendigur — Thu, 01 Aug 2013 14:24:19 GMT

Sue Paterson (Rutland House referrals) has been really helpful in a lot of our difficult ear cases.

We have used Triz -aural with (depending on culture) marbocyl SA injection or gentamicin injection (+/- dexadreson) in cases with ruptured TMs - can't remember the recipie and am at home at the moment but I will try to look it up this afternoon. As far as I remember it is often the carrier that standard ear drops contain that causes the problem rather than the antibiotics themselves.

Re: safe topicals with suspect OM and ruptured ear drum

Stephen Courtney — Thu, 01 Aug 2013 13:32:27 GMT

I don't think any topicals are 'safe' with a ruptured TM but I'm pretty sure that topicals are inadvertently used in many cased with ruptured TMs - it's not always possible to see it anyway especially if the canal is swollen and full of exudate and painful etc.

I'd suggest seeing if you can have a chat with a dermatologist, there is plenty of practical advice on things to try but typically I can't remember anything with sufficient detail to give specific advice!