Topical aural steroids

Re: Topical aural steroids

Anthony Todd — Wed, 20 Aug 2014 14:41:02 GMT

You just did.............

Re: Topical aural steroids

Martin Atkinson — Wed, 20 Aug 2014 13:58:16 GMT

[quote user="Anthony Todd"]but aren't steroids dangerous?[/quote]

Re: Topical aural steroids

Anthony Todd — Wed, 20 Aug 2014 13:46:51 GMT

[quote user="robloxley"]Maybe I'm the only one who has found prednisolone to be effective for control of atopy - maybe you should try some! [/quote]

Thanks for the tip, wish I'd known about it when I was practising; but aren't steroids dangerous?

Re: Topical aural steroids

Rob Loxley — Wed, 20 Aug 2014 13:42:59 GMT

[quote user="Anthony Todd"]

[quote user="robloxley"]I've used pred forte for ears that just need some topical steroid[/quote]

With respect, and bearing in mind owner compliance I'd go for the stronger ones straight off.

[/quote]

Maybe I'm the only one who has found prednisolone to be effective for control of atopy - maybe you should try some!

Re: Topical aural steroids

Anthony Todd — Wed, 20 Aug 2014 12:11:46 GMT

[quote user="robloxley"]I've used pred forte for ears that just need some topical steroid[/quote]

With respect, and bearing in mind owner compliance I'd go for the stronger ones straight off.

This, from a NZ site might be useful:

Very potent or superpotent (up to 600 times as potent as hydrocortisone)

Clobetasol propionate (Dermol™ cream/ointment/scalp lotion)
Betamethasone dipropionate (Diprosone™ OV cream/ointment)

Class 2

Potent (100-150 times as potent as hydrocortisone)

Betamethasone valerate (Beta™ cream/ointment/scalp solution, Betnovate™ lotion/C cream/C ointment, Fucicort™ cream)
Betamethasone dipropionate (Diprosone™ cream/ointment, Daivobet® 50/500 ointment/gel)
Diflucortolone valerate (Nerisone™ cream/fatty ointment)
Hydrocortisone 17-butyrate (Locoid™ lipocream/ointment/scalp lotion/Crelo topical emulsion/)
Mometasone furoate (m-mometasone™ cream/ointment Elocon™ cream/lotion/ointment)
Methylprednisolone aceponate (Advantan™ cream/ointment)

Class 3

Moderate (2-25 times as potent as hydrocortisone)

Clobetasone butyrate (Eumovate™ cream)
Triamcinolone acetonide (Aristocort™ cream/ointment, Viaderm KC™ cream/ointment, Kenacomb™ ear drops)

Class 4

Mild

Hydrocortisone (DermAid™ cream/soft cream, DP™ lotion-HC 1%, Skincalm™, Lemnis™ Fatty Cream HC, Colifoam™ rectal foam 10%), Pimafucort™ cream/ointment, Daktacort™ cream, Micreme™ H cream, Resolve Plus™ 0.5%, 1% cream

Re: Topical aural steroids

Rob Loxley — Wed, 20 Aug 2014 00:18:16 GMT

I've used pred forte for ears that just need some topical steroid; if cleaning is needed I'd go for mixing steroid with cleaner (I did rather like the Malacetic HC for this!)

Re: Topical aural steroids

Glenn Hodgson — Tue, 19 Aug 2014 22:53:48 GMT

1:3 cortavance:epiotic. use in place of epiotic alone. works well for me. Cortavance is."good and strong", apparently.

Re: Topical aural steroids

ChrisBVSc — Tue, 19 Aug 2014 22:39:10 GMT

Our 'recipe' for cases like this is TrizEDTA with 5ml dex added to the solution (e.g. DuphacortQ, Colvasone etc). I think this came from a referral dermatologist at some point. Works well for chronic low grade inflammed/pruritic ears where there's likely to be an underlying allergic aetiology.

Re: Topical aural steroids

Evelyn Barbour-Hill — Tue, 19 Aug 2014 22:16:08 GMT

[quote user="Anthony Todd"]I wish we could [if I had access to cases] post pictures in the substance of a post.[/quote]

You can:

Re: Topical aural steroids

Anthony Todd — Tue, 19 Aug 2014 19:24:15 GMT

[quote user="Martin Atkinson"]involves the underside of the pinna to some extent.[/quote]

I wish we could [if I had access to cases] post pictures in the substance of a post. Derm. really is a visual discipline and a picture does negate a thousand words.

Arlo, gmail can, why not vetsureon.org?

Martin's reply is screaming for a picture!

Re: Topical aural steroids

Martin Atkinson — Tue, 19 Aug 2014 18:01:27 GMT

[quote user="Anthony Todd"]Don't you mean the vertical canals? I've never seen an allergic reaction on the pinna itself, only sunburn, sarcoptes and haematomata??[/quote]My experience with otitits due to atopic dermatitis always involves the underside of the pinna to some extent. This may extend someway into the vertical canal but rarely the horizontal canal unless there is a concurrent otitis externa due to an infection. Otitis principally affecting the underside of the pinna is IME almost pathognomic of atopic dermatitis. If the outside and edges of the pinna are principally involved then sarcoptes, or sunburn in a white dog, become a consideration.

Re: Topical aural steroids

Stephen Courtney — Tue, 19 Aug 2014 17:45:45 GMT

Sue Patterson advised me once to use clean aural with 2ml of dexadreson added to a 100ml bottle, for a dog that needed steroids to control his OE, yet did not need antibiotics. He had of course been properly worked up though, and so long as his initial flare was controlled he didn't get infected. The medicated ear cleaner was used twice a week and it worked really well.

Re: Topical aural steroids

Anthony Todd — Tue, 19 Aug 2014 17:44:52 GMT

[quote user="Martin Atkinson"]and just the pinnas are affected[/quote]

Don't you mean the vertical canals? I've never seen an allergic reaction on the pinna itself, only sunburn, sarcoptes and haematomata??

Re: Topical aural steroids

Anthony Todd — Tue, 19 Aug 2014 17:42:15 GMT

[quote user="Martin Atkinson"]Anthony you are losing it mate. You haven't taken my bait and now you're agreeing with yourself![/quote]

Yes, I think I am, at least, if I agree with myself, one person agrees with me....

Yes again, Glaxo didn't cover themselves in scientific glory with Ovarid.

Re: Topical aural steroids

Bob Russell — Tue, 19 Aug 2014 17:41:19 GMT

From memory panalog contained triamcinolone and had the most brilliant nozzle to get medication right into the worst stenotic ear canal. Oh! what happy days they were ...................

Re: Topical aural steroids

Martin Atkinson — Tue, 19 Aug 2014 17:31:36 GMT

[quote user="Anthony Todd"]I would suggest prescribing the strongest human topical steroid there is; you'll be surprised at the resolution, that's if I'm thinking about the same thing.

+1 for strongest topical steroids in these cases, usually the human strong ones work better, triamcinalone etc.[/quote]

Anthony you are losing it mate. You haven't taken my bait and now you're agreeing with yourself!

Re: Topical aural steroids

Anthony Todd — Tue, 19 Aug 2014 17:27:02 GMT

[quote user="Nicola Lawlor"]I have had some brilliant results for stenotic ears using this.[/quote]

+1 for strongest topical steroids in these cases, usually the human strong ones work better, triamcinalone etc.

Re: Topical aural steroids

Anthony Todd — Tue, 19 Aug 2014 17:25:02 GMT

[quote user="Nicola Lawlor"]I have had some brilliant results for stenotic ears using this.[/quote]

Used to see a lot of these, verrucose and stenotic with black thick tarry discharge. I always branded them some sort of localised allergic response as the response to local steroids [remember Panolog!!] or the potent triamcinalones that the humans use would give total remission without the need for systemic steroids at all.

They usually recurred but the same treatment worked every time.

Surgical ablation of the lateral wall, the old style aural resection, gave a chronic verrucose otitis externa without the lateral wall.....

I would suggest prescribing the strongest human topical steroid there is; you'll be surprised at the resolution, that's if I'm thinking about the same thing.

Re: Topical aural steroids

Nicola Lawlor — Tue, 19 Aug 2014 16:57:10 GMT

I am a huge fan of predforte in the ear. I tend to mix a 5ml bottle into 50ml of cleanaural for most cases, very occasionally use it neat in the ear with severe stenosis. I have had some brilliant results for stenotic ears using this.

Re: Topical aural steroids

Martin Atkinson — Tue, 19 Aug 2014 15:28:25 GMT

[quote user="Anthony Dennison"]Though also, why are these ears repeatedly bad?[/quote]My thoughts as well. If there is a chronic otitis involving the horizontal canal then hopefully someone has done some investigation/cultures to determine the cause and make a proper diagnosis. If as seems likely this is an atopic dermatitis and just the pinnas are affected then any sort of steroid ointment/cream smeared on should help. Also why are NSAIDs being given? Just a thought, that if the dog has OA and atopic dermatitis then preds might replace them and treat both conditions. PLT maybe?

(Awaits comeback from the steroid kings he has pilloried over the years)!!

Re: Topical aural steroids

Mary Thomson — Tue, 19 Aug 2014 15:22:52 GMT

Might be worth giving Virbac a call regarding Cortavance. I have a vague recollection of a discussion with someone in their technical support department about off licence use....

Re: Topical aural steroids

Bob Russell — Tue, 19 Aug 2014 14:55:47 GMT

I have resisted the idea of owners treating chronic ear problems 'as and when necessary' but at a CPD meeting a few months ago an eminent dermatologist stated this was not the crime of the century.

I now tend to allow Canaural to be used on an ad hoc basis, seeing the patient at least twice a year. they must also be seen if there is not a significant improvement within 48 hours of starting treatment.

There has to be a balance between the risks of extra resistance and animal welfare and a lot of these dogs get really distressed. Most of the cases I treat like this have allergic origins and are not going to cured. Systemic steroids or cyclosporin seem medical overkill.

I did follow the party line about not allowing products to be used in this way for a number of years but hated seeing low grade allergic dogs arriving with stenotic ear canals. I train owners to watch for changes in the appearance of the ear canal and treat for a few days when the dog shows discomfort and the ear becomes inflamed. Not sure I would go for 1-2 times weekly though. Better, more observant owners can make a bottle of Canaural last a long time.

Surgeons will want a surgical cure, medics will want a medical cure of course.

At the same time I keep asking for an ear version of Cortavance!

Re: Topical aural steroids

Anthony Dennison — Tue, 19 Aug 2014 14:52:32 GMT

I have had owners spray cortavance on the underside of the pinnae and let it dribble down. Otherwise, at our practice we often make our witches-brew ear preps using Before-X from Vetruus as the tris-EDTA base - could add some colvasone to a bottle of that and it may help.

Though also, why are these ears repeatedly bad?