Pseudomonas with ruptured tympanum

RE: Pseudomonas with ruptured tympanum

Charlie Lyon — Wed, 14 Dec 2016 18:50:48 GMT

Ooh I have one of these at the minute. Basset hound with a horrible pus filled smelly ear, no tympanic membrane, ulcerated ear canal and pseudomonas, proteus, staph and one more that I can't remember right now, apparently resistant/intermediate to everything.

I started weekly ear flushes under GA just using LOTS of saline (3 way tap, giving set, catheter and patient nurse to get right down there). Then a home made 2.5% baytril injectable in saline solution with a trizEDTA + 2ml dex cleaning solution to use inbetween visits. This plus oral baytril and pred is working - found it in one of our derm texts. Might be overkill but it's working and alternative was referral.

In house cytology has gone from swimming in rods to scanty so planning to culture again after flush number 5.

RE: Pseudomonas with ruptured tympanum

Evelyn Barbour-Hill — Wed, 14 Dec 2016 18:03:19 GMT

Chlorhexidine is notoriously ototoxic. Never flush an ear with hibitane, Hibiscrub, Savlon, etc., whether the tympanum is intact or not. I discovered this the hard way, about 36 years ago.

RE: Pseudomonas with ruptured tympanum

Anthony Todd — Wed, 14 Dec 2016 17:53:34 GMT

[quote user="Neil Wheadon"]Anything within reason[/quote]

[Groan] No I'll have to find the reference and get the chemical right but it's one of the antiseptics, Savlon I think, but will try and confirm.

Been on here before, a year or so back. Turned some Norwegians [people], and a colleague's alsatian stone motherless deaf!! So be careful!!

This'll do for starters:

http://www.tandfonline.com/doi/abs/10.1080/01652176.1986.9694018

RE: Pseudomonas with ruptured tympanum

Neil Wheadon — Wed, 14 Dec 2016 10:44:28 GMT

[quote user="Stephanie Fursland"]What is safe (and effective) to put down the ear? [/quote]

Anything within reason

I asked this at an Osurnia road show at Langford a few months ago as I have never seen an issue and realistically with debris filled ears, how many ear drums are seen?

I was backed up by another 'older' vet in the room and the speaker agreed that no cases were proved. The only case was nystagmus from lots of hibiscrub flushing.

Our son has had recurrent otitis with ruptured ear drums for 16 years. Genticin does it and he's now at Oxford studying engineering, so no harm there then

Neil

RE: Pseudomonas with ruptured tympanum

Emily Rainbow — Wed, 14 Dec 2016 07:32:04 GMT

Ditto Thomas, my mixture is 3ml baytril 2.5% with 1ml dexadreson in 12ml of TrizAural (the powder one you mix up).

if tympanic membrane intact I also sometimes use dilute Flamazine cream.

RE: Pseudomonas with ruptured tympanum

Thomas Johnson — Mon, 12 Dec 2016 11:51:54 GMT

[quote user="Stephanie Fursland"]Results - pseudomonas sensitive to amikacin, gentamycin, polymixin B, tobramycin. All of these seem to have quite bad possible side effects if used systemically, and I am reluctant to take the risk given at the moment she is essentially asymptomatic. What is safe (and effective) to put down the ear? [/quote]

I would consider using a topical fluoroquinolone even though it may not appear to be sensitive on the results from the lab, the sensitivities are based on serum concentrations and you will achieve much higher concentrations topically. We have Baytril injectable on the shelf so I would probably combine 3-4ml of that with an ear cleaner that contains TrisEDTA, I would also consider adding in 2-3 ml of dexamethasone. This should be safer to use than one of the licensed topical preparations when the tympanic membrane is ruptured. I would get them to use it once daily, check it weekly and re-swab after 4 weeks.