Stubborn malassezia otitis

Re: Stubborn malassezia otitis

Anthony Todd — Fri, 23 Jan 2015 15:06:27 GMT

What did you end up doing and how's the dog?

Re: Stubborn malassezia otitis

Anthony Todd — Tue, 13 Jan 2015 22:13:43 GMT

[quote user="Charlotte Lusted"]Have been attempting to treat a stubborn malassezia otitis in an English Setter for a few months [/quote]

See above, I'd just treat the symptoms.

Re: Stubborn malassezia otitis

Martin Atkinson — Tue, 13 Jan 2015 18:53:43 GMT

[quote user="Anthony Todd"]If I could draw, I'd produce something showing that the ear canal is ideal for a topical prep 'cos it can't be licked off , it's hard to misdirect the squirt and it don't drain out the bottom![/quote]I thought this topic had progressed to the point we were discussing atopic dermatitis which is more generalised rather than affecting just the ears.

Re: Stubborn malassezia otitis

Anthony Todd — Tue, 13 Jan 2015 18:28:23 GMT

[quote user="Martin Atkinson"]Are you feeling well Anthony, that the second time you've advocated not using oral corticosteroids? And while you may have a point even I would see some impracticality in applying a topical steroid on anything other than a focal area. [/quote]

Geez, Martin, you're losing it mate!

If I could draw, I'd produce something showing that the ear canal is ideal for a topical prep 'cos it can't be licked off , it's hard to misdirect the squirt and it don't drain out the bottom!

If anyone was to design a site for topical medication, and agree to the using of a dog or cat as a model, they'd pick the external canal, or possibly the anal glands, as the perfect site to put a drug in [sorry about the syntax, before Fowler's followers attack}.

Try looking at a wine glass, which I am at the moment; bloody 'ell. it's empty again.....

Re: Stubborn malassezia otitis

Anthony Todd — Tue, 13 Jan 2015 18:19:03 GMT

[quote user="Hannah Wynne Richards"]

Do you really mean incontinence, or just puddles in the house?

Wynne

[/quote]

Take your pick, the owners don't seem to distinguish between the two in my experience

Re: Stubborn malassezia otitis

Martin Atkinson — Tue, 13 Jan 2015 14:49:25 GMT

[quote user="Anthony Todd"]

Prefer a local potent human topical, keeps the steroidophobes happier, and no systemic effects like incontinence etc.and logically more effective.

[/quote]Are you feeling well Anthony, that the second time you've advocated not using oral corticosteroids? And while you may have a point even I would see some impracticality in applying a topical steroid on anything other than a focal area.

Re: Stubborn malassezia otitis

Hannah Wynne Richards — Tue, 13 Jan 2015 09:35:42 GMT

Do you really mean incontinence, or just puddles in the house?

Wynne

Re: Stubborn malassezia otitis

Anthony Todd — Tue, 13 Jan 2015 08:56:35 GMT

[quote user="Suzanne Kelly"]+1 for preds at a pretty high dose ( 1mg/kg sid) and malacetic wipes. I haven't tried the Dechra malacetic ear flush yet but that might be worth a go?

[/quote]

Prefer a local potent human topical, keeps the steroidophobes happier, and no systemic effects like incontinence etc.and logically more effective.

Re: Stubborn malassezia otitis

Martin Atkinson — Tue, 13 Jan 2015 08:46:53 GMT

[quote user="Suzanne Kelly"]+1 for preds at a pretty high dose [/quote]I've got some Apoquel back in stock hooray!!!

Re: Stubborn malassezia otitis

Suzanne Kelly — Mon, 12 Jan 2015 23:38:42 GMT

+1 for preds at a pretty high dose ( 1mg/kg sid) and malacetic wipes. I haven't tried the Dechra malacetic ear flush yet but that might be worth a go?

Re: Stubborn malassezia otitis

Anthony Todd — Thu, 08 Jan 2015 11:50:50 GMT

[quote user="Charlotte Lusted"]Ear canal inflammed and painful, has improved since starting treatment. [/quote]

Reading the query allergy/atopy posts and from experience I'd add a more potent topical steroid.

I know, I know, but this was a common presentation back in the day and, with the presenting signs you described, responded well to topical steroids only. [eliminating ear mites though]

l always wondered whether malassezia was a primary pathogen or just along for the ride on insulted skin?

Re: Stubborn malassezia otitis

Charlie Lyon — Thu, 08 Jan 2015 11:02:41 GMT

Ear canal inflammed and painful, has improved since starting treatment. Dark brown greasy material, not purulent. He is actually a breeder and has several dogs which are fine, just this dog causing problems with its ears, rest of skin ok

Re: Stubborn malassezia otitis

Anthony Dennison — Thu, 08 Jan 2015 09:22:11 GMT

+1 for systemic antifungals. The dermatologist at my practice usually reccomends pulse therapy (every (or perhaps other) weekend or something similar). Makes a big difference.

You can get sporanox (itraconazole) from most distributors.

Re: Stubborn malassezia otitis

Anthony Todd — Wed, 07 Jan 2015 23:10:10 GMT

What does the vertical canal look like viz red, swollen pus etc.?

What's the gunk Like?

I assume there aren't any other dogs or cats in the house and all their ears are OK?

Any other lesions or history of allergy/atopy anywhere in the patient?

Sorry to ask obvious questions....

Most of you will know where I'm going with the enquiry....

Re: Stubborn malassezia otitis

Charlie Lyon — Wed, 07 Jan 2015 22:15:09 GMT

Ta for the replies everyone. Most vets in the practice routinely do in house ear smears with diff quick for ear cases at the start of a case and then a free recheck at the end of the course to make sure cleared up (much happier clients!) so yes do cytology as well as sending off swabs for purulent/persistent infections. There were cocci to start but just left with yeasts now. Haven't tried itraconazole yet in any cases so will keep that in mind

Re: Stubborn malassezia otitis

Stephen Courtney — Wed, 07 Jan 2015 18:30:18 GMT

You can prescribe human itraconazole 100mg capsules under the cascade, and this can be brilliant at controlling malassezia, regardless of any underlying issues such as atopy, indeed our dermatology specialist often uses it as part of a multi targeted approach.

My difficult ear case, a spinone, was giving me a terrible time till the dermatologist recommended a course of itraconazole, and now he is maintained on vetruus otodine ear cleaner twice a week and the occasional two week course of itraconazole, far more successfully than anything else we tried. How he will be in the coming summer i don't know but hopefully his immunotherapy will have kicked in by then.

Re: Stubborn malassezia otitis

Tom Ward — Wed, 07 Jan 2015 17:04:08 GMT

Have you done any cytology? I've had a malassezia only culture result, tried chlorexyderm only to find out a week later on cytology that it was hooching with cocci. Unless it was the drops wot did it..?!

Re: Stubborn malassezia otitis

Michael Woodhouse — Wed, 07 Jan 2015 17:01:45 GMT

Thornit powder - maybe...................

Re: Stubborn malassezia otitis

Martin Atkinson — Wed, 07 Jan 2015 16:41:14 GMT

+1 for suspecting atopic dermatitis. However Malaseb shampoo can help by reducing the loading of Malassezia on these dog's coat and reduce the sources of re-infection.

Re: Stubborn malassezia otitis

Mark Hedberg — Wed, 07 Jan 2015 15:48:42 GMT

Some of these problem ears have an underlying atopic dermatitis - see here:

[quote]

http://www.ufaw.org.uk/canineatopicdermatitis.php

Otitis externa (inflammation of the ear canal) is often seen in atopic dogs and sometimes is the main clinical problem. This follows the same pattern as atopic disease elsewhere – the ear canal is lined with skin. Initially there may just be redness but constant irritation, excess secretions and thickening of the skin with secondary bacterial and yeast infections lead to a vicious cycle until the ear canal becomes irreversibly damaged. The clinical signs include scratching at the ears, head shaking, rubbing the ears on the ground, a smelly discharge from the ears. [/quote]

Especially because it's a Setter (one of the predisposed breeds) immunotherapy may be an appropriate aid!

Re: Stubborn malassezia otitis

Miriam Lodewyks — Wed, 07 Jan 2015 15:42:09 GMT

No magic wands here, but Otoprof ear cleaner really seams to shift grease like nothing else on earth!