The Good (Cocker Spaniel), the Bad (Pseudomonas) and the Ugly (Ears).

RE: The Good (Cocker Spaniel), the Bad (Pseudomonas) and the Ugly (Ears).

Bob Russell — Tue, 06 Aug 2019 11:04:49 GMT

I can think of two cases in the last five years that should have had it done but did not!

Not sure it is something that needs to be done often.

RE: The Good (Cocker Spaniel), the Bad (Pseudomonas) and the Ugly (Ears).

Alistair Graham-Evans — Tue, 06 Aug 2019 04:45:52 GMT

[quote user="Anthony Todd"]

How often is surgery [resections, canal ablation] needed these days?

[just curious]

[/quote] In my experience probably more often than it is done!

RE: The Good (Cocker Spaniel), the Bad (Pseudomonas) and the Ugly (Ears).

Anthony Todd — Mon, 05 Aug 2019 16:09:43 GMT

How often is surgery [resections, canal ablation] needed these days?

[just curious]

RE: The Good (Cocker Spaniel), the Bad (Pseudomonas) and the Ugly (Ears).

Anthony Dennison — Mon, 05 Aug 2019 16:04:02 GMT

[quote user="Francisco Gomez"]

[quote user="Emily Rainbow"]

Sometimes will use 50:50 saline/Flamazine in the middle of the day too.

[/quote]

How frequently would you use this and how much. Also, how long will it work once mixed? Do you give it to the owners or is it a one time thing?

[/quote]

Give it to the owners to do with a 1ml syringe, once daily at home.

RE: The Good (Cocker Spaniel), the Bad (Pseudomonas) and the Ugly (Ears).

Mark Hedberg — Mon, 05 Aug 2019 14:00:33 GMT

Also, Animalcare do a topical steroid only ear drop, might be helpful for a localized high dose antiinflammatory effect. (Recicort).

(I don't work for them, i promise!)

RE: The Good (Cocker Spaniel), the Bad (Pseudomonas) and the Ugly (Ears).

Francisco Gomez — Mon, 05 Aug 2019 13:57:46 GMT

[quote user="Emily Rainbow"]

Sometimes will use 50:50 saline/Flamazine in the middle of the day too.

[/quote]

How frequently would you use this and how much. Also, how long will it work once mixed? Do you give it to the owners or is it a one time thing?

RE: The Good (Cocker Spaniel), the Bad (Pseudomonas) and the Ugly (Ears).

Anthony Dennison — Mon, 05 Aug 2019 13:10:20 GMT

Another vote for topical flamazine and oral prednisolone.

I've had quite a few with bad ears that have a nasty bacterial infection which then get a malasezzia overgrowth, so it's worth possibly adding in some canesten to the flamazine mix.

RE: The Good (Cocker Spaniel), the Bad (Pseudomonas) and the Ugly (Ears).

Emily Rainbow — Sat, 03 Aug 2019 09:06:41 GMT

Flush under GA followed by 12ml trizEDTA with 1ml baytril injectable and 3ml dexadeson mixed together. Apply 0.5ml to eat twice daily.

Often PO preds too to help with inflammation/pain/getting canals open.

Sometimes will use 50:50 saline/Flamazine in the middle of the day too.

Surolan does not work in exudative/waxy or purulent wars without cleaning prior to each dose - painful as hell in these cases!

RE: The Good (Cocker Spaniel), the Bad (Pseudomonas) and the Ugly (Ears).

Anthony Todd — Sat, 03 Aug 2019 07:50:19 GMT

There are much more potent Csteroids than pred, particularly oral and in the usual light dosage that is fashionable today.

I think there are many really potent topical preps too which must be a better option in this case, and worth a try, particularly if tried early rather than late when secondary infection is well established, and with exudate and reaction well established too.

I can't remember ever getting a chronic, or any infection in the soft tissue after a lateral wall resection, or not always getting resolution in the external canal. They were surprisingly complication free if the resection continued low to the level of the horizontal canal to allow drainage, Obviously the hair around the area has to be kept short and the area clear and clean.

Surgery is always curative [or was] if done before you had a chronic middle ear infection and was pretty well routine with chronic ears, ie over a month or so.

RE: The Good (Cocker Spaniel), the Bad (Pseudomonas) and the Ugly (Ears).

Alistair Graham-Evans — Sat, 03 Aug 2019 06:58:51 GMT

I don’t think soft tissue residual infection should be a problem in an adequately performed TECA-LBO. I think it is the only solution for the animal and economically the best long term as well, although any underlying skin issues will obviously have to be addressed as well.

RE: The Good (Cocker Spaniel), the Bad (Pseudomonas) and the Ugly (Ears).

Liz w — Fri, 02 Aug 2019 23:00:23 GMT

The last one we had like this was hypothyroid (diagnosed when referred) and only startedimproving when this was treated as well:

RE: The Good (Cocker Spaniel), the Bad (Pseudomonas) and the Ugly (Ears).

Dinu Catilina — Fri, 02 Aug 2019 22:44:20 GMT

TECA-LBO. I can't see what else can sort this mess out.

RE: The Good (Cocker Spaniel), the Bad (Pseudomonas) and the Ugly (Ears).

Beats — Fri, 02 Aug 2019 20:56:28 GMT

[quote user="Francisco Gomez"]'Surolan usually sort it'... but this time this Pseudomonas will not respond to any antibiotic in the IDEXX panel. [/quote]

Is that surolan no longer "sorts it", or you don't think surolan will sort it based purely on the Idexx panel assessing whether the bacteria would be classed as sensitive to the doses of polymixin that could safely(ish) be given intravenously, at expected tissue concentrations gained? If the latter, then Surolan probably will still "sort it".

Whether you consider it appropriate to pour a useful systemic antimicrobial [of last resort in a human healthcare] into an ear full of multi-resistant pseudomonas that you don't expect to eliminate is of course a different question...

RE: The Good (Cocker Spaniel), the Bad (Pseudomonas) and the Ugly (Ears).

Beats — Fri, 02 Aug 2019 20:50:20 GMT

Whilst I personally hate TECA's, i also personally think that the best option. I get your concern re if you get a surgical site infection afterwards - unhelpfully, I can suggest that doing a TECA before inducing fluroquinolone resistance by washing the bacteria in it means you can at least give 5 days of that at decent dose after pre- and post-op. Spending time flushing thoroughly with hibiscrub before surgery and through flushing and suction once you've cut away everything nasty is also worthwhile. Sometimes cost if a concern, but generally it is less than has been spent on the ears in the last 12 months (and therefore less than what can be expected to be spent on the ear in the next 12 months...)

Alternatives, for me, would be aggressive medical treatment (flushing under GA every 3 to 7 days, usually weekly, including middle ear where appropriate for average of 3 flushes, until happy with it, systemic steroids at adequate dose to remove any reversible thickening, appropriate topical antimicrobial+/-steroidal product [I'll not tangent into what I consider appropriate to be].

...or the budget option for £7, admit defeat and clean it out with hibiscrub daily at home.

[NB: culture results are useful for identifying the bug to be a pseudomonas, helpful for choosing systemic antibacterials where that is indicated, but unlikely to be of much use for deciding on whatever topical bacterial-killing-agent you wish to employ beyond knowing what the bug is]

RE: The Good (Cocker Spaniel), the Bad (Pseudomonas) and the Ugly (Ears).

Julian Earl — Fri, 02 Aug 2019 20:44:40 GMT

I think copious lavage with sterile saline, to remove as much debris and necrotic tissue as is physically possible. The Easotic or even Dermisol is a slightly acidic solution that Pseudomonas do not appreciate. But physically cleaning the site is top of the list, Carefully swab afterwards to dry the canal as much as possible at the end, then apply suitable antibiosis. I cannot see the point of applying antibiotics down an ear fill of pus and necrotic debris. I am sure that they work best in a clean ad dry environment. I am only happy with steroids if an alleric aetiology is the underlying trigger in the first place.

P.S. I found that Dermisol tends to sting if applied whilst there are open ulcerated areas present. I also tend to use a lot of NAIDs for these ulceratd ears. They are always very painful and very inflamed so NSAIDs it is. Less immunosuppression that prednisolone in the face of a massive bacterial otitis?

RE: The Good (Cocker Spaniel), the Bad (Pseudomonas) and the Ugly (Ears).

cathvet — Fri, 02 Aug 2019 18:46:50 GMT

You could consider using flamazine, 1.5ml in 13.5ml saline. If you're worried about biofilm then trizNAC ear flush is useful.

We tend to use otodine/trizchlor to clean ears followed by trizNAC flush and then flamazine mixture above with 4ml dexadresson also added.

This vet record article has info on flamazine

https://veterinaryrecord.bmj.com/content/182/4/109

RE: The Good (Cocker Spaniel), the Bad (Pseudomonas) and the Ugly (Ears).

Kate Richardson — Fri, 02 Aug 2019 17:25:54 GMT

Although not working with dogs now, used to see a lot of these, definitely need pred for these, the inflammation is what allows the pseudomonas to take hold, anti-inflam doses, not immunosuppressive doses. Plus I liked easotic, once daily, easy to apply in most cases, and whatever the lab says, gentamicin usually works in vivo