2 year old dogs with recurrent otitis - generalised case

RE: 2 year old dogs with recurrent otitis - generalised case

Virginia Campbell — Sun, 20 Nov 2016 23:06:51 GMT

[quote user="Anthony Todd"]

Jeepers, how old are you""

[/quote]

Old enough to remember the song! I saw a pair of Shih tzu last week whose ears suddenly flared up like Rudolph's nose- no recent trip to groomer, no new food...asked the owner about carpet cleaner and bingo...poor dogs, it doesn't put the freshness back into skin! IMO is always worth asking about this, Febreze, scented candles etc as sometimes there is a vicious circle whereby the owner is trying to mask the smell of Malassezia and makes matters worse.

RE: 2 year old dogs with recurrent otitis - generalised case

Rob Loxley — Sat, 19 Nov 2016 19:06:16 GMT

[quote user="Robin Grimmer"]That's why I'm a big fan of Osurnia in these cases[/quote]

It's interesting if you read some of the trial studies for osurnia - in one the cleaning is very important to the point that 44% of dogs in the placebo group (cleaning only and no osurnia) got better, and adding osurnia only increased that to 65%. In another it was (cleaning, 2 doses and 28 days later) only as good as 5 days of Easotic which I find as a product very effective with excellent owner compliance; YMMV

RE: 2 year old dogs with recurrent otitis - generalised case

Anthony Todd — Sat, 19 Nov 2016 13:08:48 GMT

[quote user="robloxley"]Then you were treating a flea allergy not atopy nor food 'allergy'! [/quote]

But the signalment was for atopy or food allergy as I was trying to allude to, ie ears only

RE: 2 year old dogs with recurrent otitis - generalised case

Robin Grimmer — Fri, 18 Nov 2016 20:19:10 GMT

Compliance with some ear cases must be pretty poor. How many dogs do you know that won't tolerate or are extremely fearful of an auroscopic exam? That's why I'm a big fan of Osurnia in these cases.

RE: 2 year old dogs with recurrent otitis - generalised case

Rob Loxley — Fri, 18 Nov 2016 18:53:37 GMT

[quote user="David Mills"]How many clients do you think follow the cleaning advice?[/quote]

I prefer a good clean in the surgery then home just with drops, and mainly use the cleaners for longerterm control be it atopics/ waxy spaniels etc. I wonder if not done properly - eg loads of cleaner left behind then drops put in - whether they may reduce how effective the ab drops are in some cases?

RE: 2 year old dogs with recurrent otitis - generalised case

Rob Loxley — Fri, 18 Nov 2016 18:39:43 GMT

[quote user="Anthony Todd"] every time I got the fleas controlled the atopy and food allergy seemed just to go away as if by magic....[/quote]

Then you were treating a flea allergy not atopy nor food 'allergy'!

RE: 2 year old dogs with recurrent otitis - generalised case

Anthony Todd — Fri, 18 Nov 2016 17:19:58 GMT

[quote user="Virginia Campbell"]Shake N Vac [/quote]

Jeepers, how old are you""

RE: 2 year old dogs with recurrent otitis - generalised case

Martin Atkinson — Fri, 18 Nov 2016 15:49:07 GMT

[quote user="David Mills"]I'm sure there is sound theory behind it.[/quote]The theory is that the bugs (especially pseudomonas) cover themselves in a protective film which the antibiotic drops have difficulty penetrating. The cleaning stuff breaks this down so you put that in a couple of hours prior (not at the same time or it may dilute the active ingredients in the therapeutic medication). It does mean you double the number of times the owner has to apply treatment and I can see that it may lead to lack of compliance if you don't pick your owners.

RE: 2 year old dogs with recurrent otitis - generalised case

David Mills — Fri, 18 Nov 2016 11:07:42 GMT

[quote user="Martin Atkinson"]That's what dermatologists tell us to do! There's a lot of logic in using an ear cleaner with trisEDTA before antibiotic drops if there is a pseudomonas infection.[/quote]

I'm sure there is sound theory behind it. But to expect owners to do it to their dog with sore ears is a triumph of hope over reality. Sure, give them a good clean them out in the clinic when they present, but I despair at the amount of ear cleaners dispensed without an apparent thought to the practicalities.

RE: 2 year old dogs with recurrent otitis - generalised case

Martin Atkinson — Fri, 18 Nov 2016 09:38:34 GMT

[quote user="David Mills"]I'm always surprised how many vets dispense ear cleaners for use in OE before abx drops. [/quote]That's what dermatologists tell us to do! There's a lot of logic in using an ear cleaner with trisEDTA before antibiotic drops if there is a pseudomonas infection.

[quote user="Anthony Todd"]So you can always rule out a food allergy and atopy if the dog only has itchy swollen inside ears.[/quote]No the exact opposite. Sometimes the only presenting symptom of atopic dermatitis is itchy red ears but the characteristic that differentiates this from an infective cause of OE is that only the pinna and outermost part of the vertical canal are affected with little or no discharge. It may however still be possible to treat this locally with steroid ear drops. [quote user="Virginia Campbell"]

[quote user="Anthony Todd"]Also ear mites must almost be extinct now! [/quote]I still see then commonly in pups from dealers/dodgy breeders. For some reason its nearly always Yorkies and Westies and I often wonder why.

[quote user="Anthony Todd"]What I still wonder is whether the signalment of food allergy is specific, ie just the inside of the ears?????[/quote]

Not foolproof but if the ears are redder the further down the canal you go, I concentrate more on talking about food, if the medial pinna and round the outside of the canal are affected and the canal doesn't look as bad as you expect, I tell them to consign the Febreze and Shake N Vac to a fiery pit in hell.

[/quote]I really don't think that you can differentiate atopy from food allergy that easily, I'm impressed if you can.

PS I really can't see why someone one starred me for stating that the signalment of FAD is different to atopy - it is a fact not a theory. A good reason for Arlo to scrap the star system.

RE: 2 year old dogs with recurrent otitis - generalised case

Anthony Todd — Fri, 18 Nov 2016 00:19:02 GMT

[quote user="Beats"]I see avg of case a week I reckon. [/quote]

What's the %age use of spot-on flea control like?

RE: 2 year old dogs with recurrent otitis - generalised case

Beats — Fri, 18 Nov 2016 00:15:05 GMT

[quote user="Anthony Todd"]Also ear mites must almost be extinct now![/quote]

I see avg of case a week I reckon. More dogs than cats (reflecting caseload probably), about quarter of cases in adult dogs (both chronic from pup and recently acquired), some having been treated for otitis for staggering time - one dog last month was 11 years old with ears that have "always been dirty" since a pup. Might be a local plague.

RE: 2 year old dogs with recurrent otitis - generalised case

Virginia Campbell — Fri, 18 Nov 2016 00:09:40 GMT

[quote user="Anthony Todd"]What I still wonder is whether the signalment of food allergy is specific, ie just the inside of the ears?????[/quote]

RE: 2 year old dogs with recurrent otitis - generalised case

Anthony Todd — Thu, 17 Nov 2016 23:54:41 GMT

[quote user="Neil Wheadon"]

8-12% are food allergies and this is referral practice. I quantify this by the observation by a certified dermatologist that the cases she saw often had poor flea control, so this statistic won't be overly inflated as fleas have been ruled out.

Yes fleas are high but not 99%

[/quote]

That surprises me, but with modern flea treatments so effective and so user friendly, flea allergy must be much much less than the days of even Nuvan Top.

Also ear mites must almost be extinct now! I'll bet the incidence of otitis externa in dogs has dropped too.

What I still wonder is whether the signalment of food allergy is specific, ie just the inside of the ears?????

[I'm thinking of the red wine reaction on the lower neck of women]

RE: 2 year old dogs with recurrent otitis - generalised case

Neil Wheadon — Thu, 17 Nov 2016 23:13:03 GMT

[quote user="Anthony Todd"]If it didn't then, and only then, look for your rare 1% [to be corrected] food or atopy.[/quote]

Yes fleas are high but not 99%

Look at it another way

One case a day as I am seeing at the moment have no evidence of fleas, coat brushings are clear and 'apparently good flea control', that'll be 1 dog a fortnight that has a dietary allergy. I freely admit that I thought it was less significant but this post and reading about the subject has changed my opinion

Neil

RE: 2 year old dogs with recurrent otitis - generalised case

Anthony Todd — Thu, 17 Nov 2016 21:00:05 GMT

[quote user="Beats"]For typical (allergic-looking) case with just ears affected, I use topical steroids in ear and instruct owner to use for 3 days or so if notices ears being red / pruritic. Often pred-forte eye drops, but I've always felt there must be something better available (but they work fine and as not viscous go down really easily into ear canal rather than sticking on hair at top etc).[/quote]

+1 [Some of the human steroid creams or ointments work well too.

RE: 2 year old dogs with recurrent otitis - generalised case

Anthony Todd — Thu, 17 Nov 2016 20:56:13 GMT

[quote user="Martin Atkinson"]The signalment for FAD is completely different from atopy or food allergy, there should be no confusion. True however that I will emphasise the importance of parasite control to reduce the overall antigenic load.[/quote]

So you can always rule out a food allergy and atopy if the dog only has itchy swollen inside ears.

Flea control or, better, elimination just lessens the antigenic load?

Crikey, every time I got the fleas controlled the atopy and food allergy seemed just to go away as if by magic....

If it didn't then, and only then, look for your rare 1% [to be corrected] food or atopy.

RE: 2 year old dogs with recurrent otitis - generalised case

Anthony Todd — Thu, 17 Nov 2016 20:48:59 GMT

[quote user="Anthony Dennison"]Not many - if they're atopic it will come back again. As they will once the steroid wears off. A good dose of steroid doesn't cure atopy...[/quote]

At last ,of course, my point exactly, but, with intermittent dosage and concurrent flea and other allergen elimination if possible the atopy won't occur 'cos the allergen is eliminated or, in the cases of seasonal grasses etc. treated as and when.

RE: 2 year old dogs with recurrent otitis - generalised case

Beats — Thu, 17 Nov 2016 19:30:53 GMT

[quote user="Neil Wheadon"]OK I'm going to try to start a number of posts on 'common things are common' so what are you doing?[/quote]

Great idea!

[quote user="Neil Wheadon"]

A generic 2 year old Labrador. It has flare ups of reddened ears every couple of months that have settled with canaural/surolan but keeps coming back.

I've taken a swab and there are cocci and malassezia, what do you do?

[/quote]

For typical (allergic-looking) case with just ears affected, I use topical steroids in ear and instruct owner to use for 3 days or so if notices ears being red / pruritic. Often pred-forte eye drops, but I've always felt there must be something better available (but they work fine and as not viscous go down really easily into ear canal rather than sticking on hair at top etc).

RE: 2 year old dogs with recurrent otitis - generalised case

David Mills — Thu, 17 Nov 2016 18:01:10 GMT

I'm always surprised how many vets dispense ear cleaners for use in OE before abx drops. Having had dogs with OE, it's enough of a struggle in most to get anything down the ears, never mind cleaning and waiting 2x a day. How many clients do you think follow the cleaning advice?

RE: 2 year old dogs with recurrent otitis - generalised case

Anthony Dennison — Thu, 17 Nov 2016 11:59:01 GMT

[quote user="Anthony Todd"]

How many normal ears give the same findings, although not so many?

How many get better if you only treat these alleged "pathogens"?

How many will get "otitis" if you squirt a culture of whatever down a normal ear?

[/quote]

That's the whole point in doing in house cytology - if the ears are red but there's nothing really down there except debris, no need for antibiotics and an anti-pruritic only is required.

If there are mainly yeasts on a sample compared to mainly cocci I would probably use different meds. If it was mainly rods I would go for culture.

Can also check for the presence of degenerate neutrophils which would indicate something that needs more than just an ear cleaner and some topical meds.

[quote user="Anthony Todd"]How many get better if you only treat these alleged "pathogens"?[/quote]

Not many - if they're atopic it will come back again. As they will once the steroid wears off. A good dose of steroid doesn't cure atopy...

RE: 2 year old dogs with recurrent otitis - generalised case

Martin Atkinson — Thu, 17 Nov 2016 09:19:50 GMT

[quote user="Anthony Todd"]

[quote user="Martin Atkinson"]You've got to feed the dog anyway so why not feed it an exclusion diet, it may cost more than Bakers but it will less than the vet's fees and meds'![/quote]

Trouble is it diverts the owner from the probable, certainly more usual, fleas which are social anathema.

[/quote]The signalment for FAD is completely different from atopy or food allergy, there should be no confusion. True however that I will emphasise the importance of parasite control to reduce the overall antigenic load.

RE: 2 year old dogs with recurrent otitis - generalised case

Robin Grimmer — Thu, 17 Nov 2016 08:37:00 GMT

[quote user="Anthony Todd"]

[quote user="robloxley"]I'd suspect that many people are quite happy to stain their own slides and check if cocci/rods/yeasts in-house (in minutes and for pennies) without having to send everything off for a culture?[/quote]

How many normal ears give the same findings, although not so many?

How many get better if you only treat these alleged "pathogens"?

How many will get "otitis" if you squirt a culture of whatever down a normal ear?

[/quote]

A normal healthy ear has a self cleaning mechanism and won't get otitis. The bugs only proliferate in an unhealthy far, I'm willing to bet putting bugs in a normal ear wouldn't result in infection .

The reason why cytology is useful is that if yeasts or cocci are found these have a predictable response to anti microbials. If you get rods however these can often be resistant so culture is indicated .

RE: 2 year old dogs with recurrent otitis - generalised case

Robin Grimmer — Thu, 17 Nov 2016 08:26:28 GMT

I stand to be corrected, but I thought flea allergy would be fairly unlikely to cause otitis externa. Atopy and food allergy more likely.

RE: 2 year old dogs with recurrent otitis - generalised case

Anthony Todd — Wed, 16 Nov 2016 23:36:06 GMT

[quote user="Neil Wheadon"]I think you are saying that as soon as allergic signs appear the owner treats with steroid ear drops/uses a dose of pred and if they do this quick enough the secondary effects don't get out of hand?[/quote]

Exactly, but continue the sometimes fruitless task of identifying the allergen or allergens dosing with steroids topically or systemically only in single doses as necessary. Thank goodness fleas were, back in the day of ineffective unpleasant powders and sprays, the usual one.