Pseudomonas otitis externa

Re: Pseudomonas otitis externa

Garry Bright — Thu, 07 May 2009 09:49:04 GMT

Hopefully some simple advise - ask the owners to note the temperature of the ears before and after eating.

If the ears get hot after eating - then its food related. In my experience 9/10 cases it will be related gluten.

Advise the owner to stop feeding normal propietary foods. Change the diet:

Here is a list of Gluten Free foods: Tinned Chappie/ Butchers Tripe, Dry James well beloved/ Burns /Arden Grange / Nutro ; TREATS - this is the BIG one advise Liver Freeze dried treats, or JWB Cracker jacks , Burns Kelties.

You have to hunt these owners down to find out what they are feeding. You must ask , ask again - and again - as they will not tell you what they feed. Eventually they will pipe up the dog gets this treat and that will be your answer. I don't know what it is but many people lie about what they feed their dogs.

Most owners will return flabergasted - that a dog that has suffered from ear problems can simply be resolved by a change of diet. Having followed this protocol for almost 10yrs- I actually cannot remember when I last treated a case of chronic otitis requiring surgical intervention.

If it does not work at first -go back and interiogate the owners - you will find they are feeding a gluten treat/food - that they failed to mention. HEREIN LIES THE SUCCESS OF THIS APPROACH TO TREATING EARS - DO NOT BELIEVE WHAT YOU ARE BEING TOLD.

Re: Pseudomonas otitis externa

Evelyn Barbour-Hill — Thu, 23 Apr 2009 22:46:24 GMT

[quote user="Clare Hogston"]

With otitis media and a ruptured ear drum - along with flushing and appropriate systemic antibiotics- are there any safe topical tretments?

Clare

[/quote]

Probably not, really. I have in the past infused several drugs into the bulla with good results and no side effects.... miconazole, corticosteroid, clotrimazole for instance.... but I would not now. Nothing but sterile saline goes into the bulla now.

Re: Pseudomonas otitis externa

Clare Hogston — Thu, 23 Apr 2009 16:52:04 GMT

With otitis media and a ruptured ear drum - along with flushing and appropriate systemic antibiotics- are there any safe topical tretments?

Clare

Re: Pseudomonas otitis externa

Emily Nightingale — Wed, 22 Apr 2009 20:43:20 GMT

Hello! Sometimes chronic ear problems have an underlying cause which can be allergy related. Perhaps doing a York Test could tell you if your patient has other intolerances which cause the ear dz to flare up? It wont help treat your pseudomonas problem but might provide a reason for why you are seeing rptd cases of the ear infection?

Let me know how you get on! =)

Emily x

Re: Pseudomonas otitis externa

toby travis — Wed, 22 Apr 2009 16:53:53 GMT

bit late since your original post so I hope you have cleared the infection.

I usually break things down as follows

1) clearing the infection- sounds like a prduct with gentamycin in (eg otomax, or even genticin ear and eye) should clear it up as the eardrum is in tact. but in pseudomonas cases you do need the ear to stay very clean. on one CPD meeting the lecturer said that in some resistant pseudomonas cases they were hospitalising the dogs and flushing the ears daily UGA for 2weeks! We also have good experience of using higher doses (10 or 15mg/kg) of baytril in such cases if the eardrum isn't in tact. In fatc, if it is still occurring and you dont have a video otoscope then you should consider rupturing the eardrum, swabbing and flushing if there is any sign of middle ear infection. Also xrays should be considered if it is a long term case as sclerosis of the tympanic bulla suggests you are up against it.

2)keeping the ear clean (and doing this long term)- triz edta is good fot this but i have also used white wine vinegar (when i worked at pdsa) but it is a bit more irritant but might be ok if the dog is on prednisolone. with ear cleaners i do find that different dogs require different ear cleaners so it's worth swapping around if one is irritant.

3) addressing underlying causes, surgery can be incorporated in this section, often as a last resort - I dont completely go along with the notion of my ENT surgery lecturer that "any ear surgery should be considered an admission of failure of medical therapy" (!) as in some breeds an LWR can be very useful as long as the secondary changes haven't occurred yet the the anatomy together with recurrent infetcions or atopy is telling you that they will occur and the dog is going to be a long term chronic case.

Re: Pseudomonas otitis externa

liza oparaocha — Fri, 17 Apr 2009 18:11:53 GMT

DEAR LISA,

I WOULD PUT THE DOG ON 1MG/KGPRED SID TILL THE INFLAMM,ATION RECEDES,THEN FLUSH AND KEEP ON STERIODS.

WHEN THE EAR IS NOT INFLAMMED AFTER FLUSHING START ON TOPICAL EAR MEDS.ACCORDING TO CYTOLOGY AND POSSIBLE SYSTEMIC TREATMENT.

I FIND YOU HAVE TO CONTINUE ON TOPICAL MEDS,LONG TERME.G ONE MTH AND THEN MAINTAIN ON EAR FLUSHINF WITH AN EAR CLEANER AT HOME AND DEX EAR DROPS OR TOPICAL MEDS TWICW WEEKLY.

THANKS LIZA

Re: Pseudomonas otitis externa

Anonymous — Wed, 01 Apr 2009 09:27:35 GMT

Dear Lisa,

I would advise that you carry out a bilateral Zepps,(aural resection), operation ASAP or if it is really bad, bilateral ablation ASAP.

The clinical history indicates that the condition has moved far beyond medical resolution alone.

The vast majority of ear infections are not, in my experience, caused by primary bacterial infection, but by pre-existing anatomical abnormalities in the canal itself, such as an over-narrow/long canal or cartilaginous "overhangs" just inside the canal neck. In both cases, heat amd moisture buildup occurs, causing bacterial activity that itself sets up a vicious cycle of inflammation, heat and further moisture/discharge.

If you dont correct these defects surgically and promptly, recurrent ear infection is inevitable. The longer you treat medically, the worse the canal will degenerate and thereby make the surgery so much more difficult.

Hope this helps.

Bluesky

Re: Pseudomonas otitis externa

listhestar — Mon, 30 Mar 2009 21:49:00 GMT

Thanks everyone so far- I'm amazed at the response.

To address a few of the other questions - I can look up the sensitivites and post them up.

Last flush -2 weeks ok I could visualise an intact ear drum in both

I did a diet trial and axiom bloods to no avail but the dog is a 5 year old cocker spaniel with recurrent interdigital cysts and dry eye as well as otitis externa. He's currently on low dose steroids approx 0.5mg/kg evey 3 days (he eats them out of house and home otherwise!) to help with ear stenosis (as well as his skin issues).

The dog is actually pretty amenable to treatment-no problem checking his ears or doing a STT at regular intervals, the owners are pretty good now but I think in some ways me taking over the case when the ears had become more chronic and the owners were not educated that well has made this all harder!

Other points-owners not really keen on ear surgery (anyway not ideal candidate at the minute!) and I struggled to get them to do one ga to flush and swab ears so although I've heard good things about ear wicks I think I my struggle getting them to do that.

Thanks guys.

I will try and remember the culture results (seem to be drowning in cases at the minute :s)

Regards

Lisa

Re: Pseudomonas otitis externa

Andrew Kent — Mon, 30 Mar 2009 20:54:55 GMT

One other thought:

How stenotic are the ear canals? If they are very thickened then steroids may also be indicated or antibiotic penetration will never be as good.

Andy

Re: Pseudomonas otitis externa

Andrew Kent — Mon, 30 Mar 2009 20:52:20 GMT

Hi Lisa,

Could you post the full antibiotic sensitivity profile?

If there is sensitivity to an antibiotic that you can get hold of then using that is the best bet, if there is complete resistance then still a few options:

Most fluoroquinolone resistance is dose dependent so if you increase the dose you can overcome this - use both topical and systemic quinolones.

There are also a couple of things you can add in to overcome the resistance eg Tris EDTA - either use this daily prior to medication or make up with for example enrofloxacin (I can give you the recipe if you need it!). The other thing is using Silver Sulfadiazine solution - it's not one I've ever had to use myself but I've heard of its use, though its a fiddly one as you have to make up a solution from Flamazine cream.

In animals where topical medication is difficult ear wicks can be fantastic in addition to the above.

You do also need to rule out the possibility of middle ear disease as this can be a cause of chronic otitis - these normally do need flushing either by yourselves or following referral to somebody with a video scope.

Hope that helps,

Andy

Re: Pseudomonas otitis externa

Mark Frost — Mon, 30 Mar 2009 14:49:25 GMT

We have referred a couple of these for video auriscope and middle ear flush and they have both done very well. In both cases the TM was ruptured and there was middle ear disease present, which they suggested was part of the reason for intractable disease despite appropriate anti biotics (based on c&s). Not an option in every case but successful in both of these.

Re: Pseudomonas otitis externa

Evelyn Barbour-Hill — Sun, 29 Mar 2009 22:34:21 GMT

What breed is the dog?

Is the tympanum intact?

How good are the owners (honestly, now) at applying ear medications?

What is the integument like?

Re: Pseudomonas otitis externa

PATRICK MARSHALL — Sun, 29 Mar 2009 21:47:59 GMT

Lisa

We have had some success medically with using ear-wicks soaked in appropriate ab to which Ps is sensitive after lavaging ears with Tris-EDTA and malacetic according to the instructions supplied with ear-wicks. Has to be repeated and continued for at least 3 weeks or until swabs are -ve. The seemingly esoteric ab's that the Ps is sensitive to can be used effectively in this way. have sometimes used parenteral ab's at same time as ear wicks.

Worth checking for underlying causes - atopy, immunosuppression, hypoT4 etc- as less likley to be successful if these issues are not addressed.

all expensive and time-consuming, so good client education and concordance is essential.

i am sure that others better qualified than me will be able to help you further.

Paddy Marshall