recurrent chronic otitis

Re: recurrent chronic otitis

Arlo Guthrie — Thu, 27 Aug 2009 12:17:10 GMT

[quote user="Martin Jones"]All useful stuff above - I always learn something on this forum, it's like travel-free CPD[/quote]

That comment made my week! (seriously). Makes my very long days worthwhile.

Re: recurrent chronic otitis

elisa — Thu, 27 Aug 2009 11:16:42 GMT

Hi David,

thank you very much indeed for your useful answer!!!!

Re: recurrent chronic otitis

Martin Jones — Thu, 27 Aug 2009 09:49:12 GMT

Reply to Elisa

All useful stuff above - I always learn something on this forum, it's like travel-free CPD

But the question was 'what do I tell the owner?' And I think that one's beyond the abilities of all us 'experts'. Clients expect something when they pay for a lab test, and for some reason a negative answer infuriates them, as though somehow the money was wasted and the test unnecessary.

Always expound on the good news of a negative test; be direct with the client and get them to agree that it's far better not to have bad news, and that you can now maybe cut out a lot of the expensive and aggressive treatment that a resistant bug would have demanded. That it suggests other reasons for the problem, and you can get on and tackle those. Time for a fresh start with diet, ear cleaning etc etc....

And then scribble the word 'thornit' on some scrap paper and suggest they go google it.....

Re: recurrent chronic otitis

Niall Taylor — Thu, 27 Aug 2009 09:16:31 GMT

[quote user="Evelyn Barbour-Hill"]

Oestrogen? Norandrolone?

[/quote]

Ahem, point taken!

What I intended to mean was "give it glucocorticoids" - or better still, don't! (Now we really need a "sarcasm" smiley!).

Cheers,

Niall

Re: recurrent chronic otitis

Evelyn Barbour-Hill — Wed, 26 Aug 2009 23:49:35 GMT

[quote user="David Scarff"]Bit long-winded but hope that contributes to the discussion![/quote]

No, that's good.

But if they find something or other - Pseudomonas say, or beta-haemolytic streptococcus - do you assume that you need to kill that (chemically), with or without other lines of treatment, in order to cure the ear?

Re: recurrent chronic otitis

Evelyn Barbour-Hill — Wed, 26 Aug 2009 23:42:44 GMT

[quote user="Niall Taylor"]Or just give it steroids!!![/quote]

Oestrogen? Norandrolone?

Re: recurrent chronic otitis

Niall Taylor — Wed, 26 Aug 2009 21:17:30 GMT

[quote user="elisa"]

Does anyone know the feeling into receiving a swab lab result negative with a recurrent otitis ? what can I tell to the owner?

[/quote]

Can you explain what you mean by 'negative' - no bugs at all (did you use transport medium?) or bugs that were sensetive to meds you were already using?

Tell the owner that you need to treat the animal, not the lab results. Not every laboratory test gives the definitive diagnosis, it may be necessary to repeat the test or to treat empirically. Sometimes it is just the mechanical properties of the ear cleaner that does the trick (breaking up dry wax), not the pharmaceutical properties.

It could be a genuinely sterile ear canal, maybe previous treatments have wiped out all bugs, including commensals. Maybe you need to look for other causes of itching - impacted anal glands, fleas or (whole world of pain) atopy.

One lab test is just the start of the investigation, not a magic answer and if it doesn't give the clues you need then you have to move to the next stage - repeat tests, examination under GA for polyps, small growths, investigation of generalised allergy etc... Of course it helps to have explained all this in advance of taking the swab!

Or just give it steroids!!!

Cheers,

Niall

Re: recurrent chronic otitis

David Scarff — Wed, 26 Aug 2009 20:52:17 GMT

Hi Evelyn

There are several issues that affect the usefulness of microbacterial culture from ear canals: assuming the lab cultures everything in the swab, and reports on all the organisms found, and there is no contamination from the environment or staff in the lab, the organisms can still be amplified by culture to appear important; culture media are all selective to some extent, particularly with regards to Malassezia.

My general approach is to assess cases for other dermatological disease, to examine the canals for foreign bodies, parasites and conformational defects. I will then take samples for direct examination, and if I have a Gram -ve population of bacteria, or a pure Gram +ve population that has not responded to appropriate medication, then I will send samples for culture. I would expect to assess yeast populations on direct examination, as finding these in culture samples is unreliable. Chasing the bacteria with ever more exotic antibiotics rarely resolves the problem, as the appearance of multi-resistant Pseudomonas for example often points towards underlying immunosuppression or uncontrolled allergy, coupled with long term topical antibacterial usage.

Bit long-winded but hope that contributes to the discussion!

Re: recurrent chronic otitis

Evelyn Barbour-Hill — Wed, 26 Aug 2009 16:36:42 GMT

I'd be interested if a dermatologist or aural medicine enthusiast or two could give some opinions on this question: to what extent does the range of organisms that may be cultured from an ear in the lab reflect the cause of the chronic otitis? Or, to be a little more precise, to what extent does it reflect the organisms whose eradication will improve the chronic otitis?

Re: recurrent chronic otitis

David Scarff — Wed, 26 Aug 2009 15:13:30 GMT

My feeling is that swabs should always be interpreted with the aid of a direct smear or stained tape strip sample; labs vary with the accuracy of cultures, and sometimes don't grow malassezia very well. Easy to stain with RapiDiff and helpful then as an assessment of response to therapy.

Re: recurrent chronic otitis

Richard Carter — Wed, 26 Aug 2009 14:39:49 GMT

try preds!!!!

Re: recurrent chronic otitis

Anonymous — Tue, 25 Aug 2009 11:51:04 GMT

I'd recommend doing in-house cytology before sending the swab away...

Re: recurrent chronic otitis

sophia guymer — Mon, 24 Aug 2009 21:00:43 GMT

[quote user="elisa"]the feeling into receiving a swab lab result negative with a recurrent otitis [/quote]

Like wanting the ground to open up and swallow you! I had it not so long ago! I had taken the swab on concsious dog, told o I had prob not been able to get deep enough so we would have to redo it under sedation if the current tx didn't solve it either,as after taking the swab I had changed to aurizon. (actually reminds me, I haven't seen them back after that, may be I should give them a ring to see what the reason for that is, cured??)