Ear not improving...

RE: Ear not improving...

Rob Loxley — Mon, 28 Mar 2016 09:39:51 GMT

[quote user="Mark Hedberg"]suggested that many dogs who are atopic may actually only have chronic ear issues as a symptom - wish I had the citation...[/quote]

I think you may end up chasing your tail with how you define 'atopy' as most schemes require a number of diagnostic features. I do agree that very often the only clinical problem the owners present the dog with is recurrent otitis. For these, topical steroids (used to use pred drops, now more cyclavance) are very helpful.

RE: Ear not improving...

Mark Hedberg — Sun, 27 Mar 2016 19:14:10 GMT

I read a paper a few years back that suggested that many dogs who are atopic may actually only have chronic ear issues as a symptom - wish I had the citation...

RE: Ear not improving...

Stephen Courtney — Sun, 27 Mar 2016 18:00:37 GMT

[quote user="Stephanie Fursland"]

Just to resurrect this thread...

I have just inherited a 7yo MN Labrador, bilateral malassezia otitis and bilateral tympanic membrane rupture. He isn't excessively itchy elsewhere, and is on a hypoallergenic diet already.

We have been using prednisolone for the irritation, Otodine cleans done daily at home, and have also sedated to flush the ears with lots of saline, and inspect the tympanum, on two occasions. The owners weren't keen on the suggestion of Sporanox - I think because of potential side effects.

Anybody with any bright ideas for topical (or otherwise) treatments that might be better than the otodine (and safe for a ruptured eardrum)? He has been under treatment for over a month now :-(

Thanks in advance!

[/quote]

The risk of side effects from itraconazole are slim indeed. the risk of a TECABO with uncontrolled otitis which is now in the middle ear is much higher.

I've used sporanox on several dogs with malassezia ears, and had good results, but it isn't a cure, as predisposing conditions invariably exist.

I have never had side effects. doesn't mean they couldn't happen....its a question of balancing risk vs benefit.

RE: Ear not improving...

Anthony Todd — Sat, 26 Mar 2016 13:05:32 GMT

[quote user="Neil Wheadon"]I might be wrong and hopefully someone will correct me, but if the skin integument heals itself then the Malassezia disappear?[/quote]

That's my impression in almost all cases when you haven't got frank pus, just sort of honey and intense irritation. Topical steroids always worked for me although you would get recurrences.

RE: Ear not improving...

Hannah Wynne Richards — Sat, 26 Mar 2016 08:18:03 GMT

I was once told (can't remember by whom) that although the data sheets say not to use with a ruptured drum, Aurizon is actually safe.

Wynne

RE: Ear not improving...

Rob Loxley — Fri, 25 Mar 2016 18:16:39 GMT

[quote user="Stephanie Fursland"]Anybody with any bright ideas for topical (or otherwise) treatments that might be better than the otodine (and safe for a ruptured eardrum)?[/quote]

Canesten solution topically for the malassezia, dexamethasone topically for inflammation. Consider running thyroid profile.

RE: Ear not improving...

Anthony Todd — Fri, 25 Mar 2016 17:29:13 GMT

[quote user="Stephanie Fursland"]We have been using prednisolone for the irritation,[/quote]

It's a "local" problem so I always used one of the potent human topical steroid creams or lotions.

Can't see the point of a systemic steroid when you can get higher concentrations and less of the ["terrifying"] systemic effects with a topical prep.

RE: Ear not improving...

Stephanie Wellings — Fri, 25 Mar 2016 13:53:09 GMT

Just to resurrect this thread...

I have just inherited a 7yo MN Labrador, bilateral malassezia otitis and bilateral tympanic membrane rupture. He isn't excessively itchy elsewhere, and is on a hypoallergenic diet already.

Anybody with any bright ideas for topical (or otherwise) treatments that might be better than the otodine (and safe for a ruptured eardrum)? He has been under treatment for over a month now :-(

Thanks in advance!

Re: Ear not improving...

Lindsey Edwards — Fri, 26 Jun 2015 21:34:57 GMT

+1 topical cortavance now it's improving. Would investigate hypothyroidism and really push for hydrolysed food trial, if successful then simply feeding dog daily is much more rewarding for owner. Have had unilateral ear cases 'cure' with diet change, but takes leap of faith from owner to invest in food trial - especially in a lab, not just for finance but to be strict/cruel enough for long enough in a food driven dog!

Re: Ear not improving...

Stephen Courtney — Fri, 26 Jun 2015 21:05:17 GMT

I don't get this - you are actually getting somewhere! you can't cure this dog but you can control its signs up to a point. Make sure the owner gets this. If the tympanum ruptures the only chance for control/ cure will be a TECABO

I would continue the sporanox long term , and if the ears aren't ulcerated, consider malacetic otic ear cleaner which is a good yeast killer. Very sore if ears are ulcerated though!

If the ears are inflamed a good way to control that is cortavance at 0.5ml down each ear every 2-3 days

You can also consider canesten liquid 1ml daily into each ear

But most of all you need to educate the client to come for regular checks as requested, and that the condition is not curable.

Re: Ear not improving...

Rob Loxley — Fri, 26 Jun 2015 20:23:41 GMT

My thoughts would be re current infection/flareup: I'd continue topical treatment as it seems to be improving - not necessarily changing drops but Posatex seems really good for Malassezia - with systemic preds.

Once current flare settled need to consider longer-term plan: Given the age at onset I'd suspect an underlying primary itchy skin dx - fleas/food/atopy etc, - but would have in the back of my mind for an obese lab with recurring OE a low thyroid level.
Without other derm issues I'd look at: good parasite control, potentially a food trial (but hard to assess if no generalised pruritis I find), and look at longterm cleaner using say Malacetic Aural with Dexamethasone. Where I've had breakthroughs on this I'd consider twice weekly Posatex [please can someone make ear drops without the antibiotic for these situations...].

Allergy testing/immunotherapy might be worth consideration, but IIRC less effective in older dogs (and the owners may not be up for this?). Not sure I'd be going for the atopica longterm as I tend to find topical steroids suffice for sole OE manifestations.

In my mind the place for surgery would be if this dog has secondary chronic canal changes that don't respond to a good course of preds.

Re: Ear not improving...

Evelyn Barbour-Hill — Fri, 26 Jun 2015 19:39:15 GMT

[quote user="K Burton"]

- seen by myself today (another two weeks) having been on above meds (pred at tapering dose); ear looks much improved compared to notes from last visit but small amount browny discharge near TM. Inflammation much reduced

- still Malassezia on in house cytology today, no bacteria evident

[/quote]

Doesn't sound like a surgical case.

Pardon me, I'm a surgeon not a dermatologist, but don't you just need to continue a bit longer with topical medication?

Re: Ear not improving...

Neil Wheadon — Fri, 26 Jun 2015 16:54:36 GMT

[quote user="K Burton"]- seen by myself today (another two weeks) having been on above meds (pred at tapering dose); ear looks much improved compared to notes from last visit but small amount browny discharge near TM. Inflammation much reduced[/quote]

You're winning? (Cue Anthony) much improved on steroids, only had 2 weeks and I bet over half was a tapering dose.

David Lloyd on a webinar described 10 days (and that was full dose as far as I recall) and I have increasingly seen other vets reach for the preds with remarkable results. As one said 'It was a stinking ear and it was a real leap of faith'

Personally I wouldn't reach for the scalpel and simply cannot recall the last time anyone did an ablation on any ear I've seen

I'd use another 10 days steroids then swab again

I might be wrong and hopefully someone will correct me, but if the skin integument heals itself then the Malassezia disappear?

Neil

Re: Ear not improving...

Martin Atkinson — Fri, 26 Jun 2015 16:42:06 GMT

Culture. Flush with Otoprof. Educate owner on how to apply drops correctly. Use antimicrobial agent(s) indicated. Maintain with Otodine twice weekly. Lateral wall ablation. TECA. In that order!

PS after reading the OP properly again and Neil's reply add: provided you've eliminated this as atopic dermatitis!