Malassezia and ruptured tympanic membranes!

Re: Malassezia and ruptured tympanic membranes!

Gillian Mostyn — Tue, 08 Dec 2009 19:36:41 GMT

[quote user="RAJAT MUKHERJEE"]I love preds for Otitis - and dont try and look down ears when inflamed. usually just do cytology till comfy enough to exam once theyve had a week or so of preds. [/quote]

I'd agree completely - wouldn't want someone to stick a scope down my ear if it was ulcerated - you can see nothing and you then get a dog that won't let anyone near its ears ever again!

Re: Malassezia and ruptured tympanic membranes!

Rajat — Tue, 08 Dec 2009 11:59:30 GMT

I vote for malacetic otic too. Havent used it with ruptured ear drums but is supposed to be v safe. Had excellent results with it in yeasty ears. There's lots of protocols on VIN re topicals in ruptured drums. You can use parenteral formulations of injectable drugs to tx otitis (dex baytril etc) - see VIN again for recipes.This off course is off label.

I love preds for Otitis - and dont try and look down ears when inflamed. usually just do cytology till comfy enough to exam once theyve had a week or so of preds. happy to prescribe epiotic(orother triz edta containing cleaner) in 99.9% of ears - never had any problems.I'd go with the malacetic otic here tbh.

I wouldnt use malasseb in ears d/t chlorhex content. check out the mims formulary - sure they will have TM friendly anti fungal drops somewhere.

Cheers

Raj

Re: Malassezia and ruptured tympanic membranes!

Fabian Kaelin — Mon, 07 Dec 2009 23:59:58 GMT

malasetic otic is supposed to be safer to use than some other ear cleners if ear drum is possibly damaged (even though not licensed) and should have good efficacy against malassezia

Re: Malassezia and ruptured tympanic membranes!

Rob Loxley — Sat, 28 Nov 2009 08:36:34 GMT

A few thoughts:

triz EDTA with baytril +/- dex; good recipes from Tim Nuttall in 2009 BSAVA proceedings
ear wicks?

doesn't itraconazole come higher up the cascade than ketoconazole

address the underlying hypersensitivity problems else you'll just be back here in 3/6/9 months. LWRs can help, but really only in early cases.

Re: Malassezia and ruptured tympanic membranes!

toby travis — Fri, 27 Nov 2009 18:14:04 GMT

It does sound like you have to find the cause of the underlying disease, but with regard to high numbers of malassezia and topical therapy not being possible, I have had some success with Itraconazole (Sporanox).

If the dog is truly head shy and refuses to let anyone touch or medicate the ears and the ears are very hairy then I have had 2 cases in which I have boldly performed lateral wall resections (one was a Tibetan Terrier belonging to a consultant dermatologist so I was quite nervous!). These are controversial but in a young dog with recurrent problems, with no secondary changes to the canals, I have found them to be very effective - both cases had very hairy ears that I just knew were going to end up being a disaster unless we did something radical.

Re: Malassezia and ruptured tympanic membranes!

Rebecca MacMillan — Fri, 27 Nov 2009 17:51:31 GMT

Is TrizEDTA (or any other cleaners for that matter) safe to use in rupture cases?

In your experience how long roughly would you expect it to take for the tympanic membrane to recover?

Thanks for your help!

Re: Malassezia and ruptured tympanic membranes!

Evelyn Barbour-Hill — Thu, 26 Nov 2009 23:13:53 GMT

[quote user="Dalya Koch"]2. Malaseb 1:30 dilution topically is anecdotally safe - this is way old advice from my first boss when I was a newbie in Australia, and I have used it a few times with good results. UK off-label rules make me wary however.[/quote]

I'd be shy of that. Chlorhexidine is most definitely ototoxic. The dog that wakes up deaf after "all we flushed the ears with was dilute Savlon" has been too regular an occurrence.

Re: Malassezia and ruptured tympanic membranes!

Dalya Livy — Wed, 25 Nov 2009 20:21:51 GMT

Forgot to mention...

On the assumption that these are chronic ears, consider allergy testing and food trials. I've seen quite a few of these dogs turn out to have a food allergy. Treating underlying allergic condition will greatly help minimise frequency of ear infections.

Hope that helps!

Dalya

Re: Malassezia and ruptured tympanic membranes!

Dalya Livy — Wed, 25 Nov 2009 20:19:16 GMT

With ruptured TM's, I tend to use TrizEDTA topically BID and systemic meds (ketoconazole/cephalosporin/fluoroquinolone/pred depending on cytology/oedema). So pretty much what you're already doing! :)

If they are really painful, I have used tramadol in addition, to good effect.

2 possible further options:

1. Otomax topically - Ewan Ferguson used this on one of our patients with ruptured TM for a 7 day course, after ear flushing. I'm a bit of a chicken though! With my luck the dog would end up deaf :(

2. Malaseb 1:30 dilution topically is anecdotally safe - this is way old advice from my first boss when I was a newbie in Australia, and I have used it a few times with good results. UK off-label rules make me wary however.

2p's worth :) Chronic ears can be so frustrating!

Good luck,

Dalya

Re: Malassezia and ruptured tympanic membranes!

Rebecca MacMillan — Tue, 24 Nov 2009 21:52:45 GMT

Argh! I've just today had a second case of malassezia and ruptured tympanic membranes!! This dog a bichon that's just over 2 years old and won't let anyone touch it's very hairy ears, so it came in for GA and ear pluck/exam. In house microscopy revelealed a large volume of malassezia.

On discussion with other vets in the practice the use of baytril to help the environment in the ear and allow membrane regrowth is a possibility which would in turn allow the use of some topical treatments in the ear (as well as short course of prednisolone for reducing inflamation/stenosis), but my concern is that I won't actually be able to assess membrane regrowth in this dog as it is so funny about people touching them.

I vaguely remember that on our dermatology rotation at college we were told that canesten is safe to use in ears with ruptured tympanic membranes for Malassezia infections, but I wondered if anyone knew if this is correct?

For the westie I am started her on a course of ketaconazole as the owners are keen to try it, at 5mg bid - based on reading some things on VIN and on recommendations from the lab. The bichon I am starting on baytril and preds, but I fear it may be a lost cause if it won't let me look down it's ears at re-exam.

Anyone have any suggestions or advice as to how to manage these cases better?