Malassezia otitis externa - simple to treat or not?

Re: Malassezia otitis externa - simple to treat or not?

Andrew Mellor — Mon, 18 Oct 2010 10:22:10 GMT

I have to say I favour sancerum wash, with otomax but if stretched for cash distilled malt vinegar 1part to 10 of water is fabulous, I was told this by one of microbiologists at nationwide labs many years ago, works for pseudomonas and proteus too, seems to kill just about everything and because it costs nothing owners seem happy to use lots, all too often I have people coming back with chronic ears , been on drops for 1 month in a dog that the drops should have lasted a week at best ! because of cost they use far too sparingly.

The other thing I like to do is make sure the ears get a good clean before they leave the surgery right at the start. I now do this while talking to clients about underlying causes etc and the put first lot of drops in for them. Make sure the owners are watching as you do it, straighten canal by drawing pinna dorsocaudally, most owners are terrified of putting nosel too far into canal, so they end up delivering the drops to the pinna and if luck first part of vertical canal. It really is worth spending an extra minute or too with these people because lets face it you will be seeing them again with the ears in the future.

If canal is really inflammed or sore use preds or nsaids too, as vinegar will sting on broken raw flesh, otherwise it is non painful and safe with membrane rupture too. It leaves the canals dry rather than all greased up.

While on the subject of vinegar solution it is fabulous for atopic dogs ( particularly Westie) feet, when they lick and chew all the time malasezia usually just secondary invaders give itchy sometimes cheezy smelling feet foot bath twice daily and leave to dry and makes huge difference to most dogs, obviously less they lick, less sore and wet between pads and therefore less yeast grow.

Good luck with your clients.

Re: Malassezia otitis externa - simple to treat or not?

Jillian Hall — Sun, 17 Oct 2010 14:25:42 GMT

[quote user="Bob Russell"]

I equate it to hay fever in man - never cured but symptoms can be controlled with effort!!

[/quote]

I equate atopy to hay-fever in people too. The Malasezzia otitis I equate to Athlete's foot in people i.e. Everyones got the yeasts but some individuals are prone to problematic overgrowth. And that the yeasts really like moist dark places like between toes and down ears. I think it helps people realise that in the long term keeping the area clean and dry is important.

Re: Malassezia otitis externa - simple to treat or not?

Bob Russell — Thu, 14 Oct 2010 14:30:59 GMT

It never hurts to warn clients that in cases of allergy there is no cure and the condition can only be managed. It is surprising how many clients respond well to honesty. It also reduces the likelihood of jumping from one vet to another and gives you a chance to properly control things.

I equate it to hay fever in man - never cured but symptoms can be controlled with effort!!

Re: Malassezia otitis externa - simple to treat or not?

emerald — Thu, 14 Oct 2010 11:15:20 GMT

I also have a similar case of recurrent unilateral malassezia OE.

Have swabbed and flushed out ears then instilled aurizon. Also started on steroids.

Advised parasite control, food trial and serolofy for allergies.

Regular cleaning will be important once clear up infection.

Re: Malassezia otitis externa - simple to treat or not?

Ruth Bennett — Wed, 06 Oct 2010 17:07:28 GMT

I've got a very similar case at the moment, luckily with some very nice clients. I have to say flushing the ear really does help a lot and I used canesten solution (very cheap) for 2 weeks or so which worked very well along with low dose preds to control the discomfort.

Re: Malassezia otitis externa - simple to treat or not?

Kirsten Simpson — Wed, 06 Oct 2010 09:37:46 GMT

Great thanks for all your advice! I will speak to the owners when they are in tomorrow and advise adding in a small course of pred as well (hopefully they shouldn't mind as at least preds are cheap...) and will talk through the disease process and stuff. I have mentioned before that the longer infection goes on, the more damage is done and mentioned worst case scenario for some dogs is surgery etc but I think they just want a quick fix. I shall raise all these points with them, thanks!

Re: Malassezia otitis externa - simple to treat or not?

Rob Loxley — Tue, 05 Oct 2010 22:05:11 GMT

[quote user="Kirsten Simpson"]My boss is of the idea that there is most likely an underlying atopy.

I just want the best treatment to clear up the infection[/quote]

Definitely sounds like there's a primary problem (parasites, food, atopy etc.) that needs addressing else resolving the current OE may be tricky and it moreover it may all just flare up. The clients need this explaining, along with the importance of following instructions re treatment and follow-ups.

[quote user="Kirsten Simpson"]I don't think the owners will appreciate this...[/quote]

I'm not sure we can wave a magic wand and make atopy go away! Seriously, it seems like a lot of the anger from the client is maybe frustration at their dog having developed what may be a chronic, longterm, management problem.

[quote user="Kirsten Simpson"]decided on Malacetic Otic combined with Otomax[/quote]

Sounds reasonable, but maybe if there's marked inflammation a short course of systemic anti-inflammatories may help too. Have also used lots of Triz plus Ketoconazole. Occasionally systemic azoles for malasseszia but more for generalised skin problems, would probably stick with topical treatment for ears.

Re: Malassezia otitis externa - simple to treat or not?

toby travis — Tue, 05 Oct 2010 20:08:41 GMT

we've given up on malacetic otic as it often seems to irritate ears further but i'm not sure that what we've replaced it with - trizedta ultraketoconazole - is much more gentle although i like the name as sounds like it's a good yeast-killer! Dermatologist at Langford recently got me to use Sancerum for maintenance for a chronic malassezia ruptured ear drum atopic dog once i'd cleared up the acute stages and it has worked brilliantly.

Re: Malassezia otitis externa - simple to treat or not?

Michael Woodhouse — Tue, 05 Oct 2010 13:37:51 GMT

Epi-otic kills yeasts. I love the stuff. I think the flushing action of a larger volume really helps these sorts of dogs - underlying condition or not. I too would have put the dog on some pred to calm things down.

Re: Malassezia otitis externa - simple to treat or not?

Martin Atkinson — Tue, 05 Oct 2010 13:00:14 GMT

I had a similar case with an arkward client with a Ridgeback who was totally incapable of putting any drops in the dog's ear plus it was aggressive and he couldn't hold it or even muzzle it for me to do it and all he did was complain about how much it cost because it wasn't getting better. I told him to p**s off and never darken my doors again and felt much better for it....one of the benefits of being sole-charge! But back to the OP: is the otitis mainly confined to the vertical canal and pinna or is the whole ear canal involved? If the former the dog is almost certainly atopic so that is the line to follow with whatever your protocol is for atopy although the whole canal can become involved in atopic dogs if they've been neglected. In the shorter term I would probably use also Malacetic Otic and you may be able to get away with the wipes. Omega 6 supplement may help and Malaseb shampoo to reduce the yeast count on the coat. Whilst you may not wish to go as far as I did giving the client the sack, some home truths to these sorts of clients are sometimes needed to progress, maybe along the lines of: "I really want to help your dog but I need your understanding and co-operation to succeed, it may be a long haul but if you don't trust me then we are going no-where and it will cost a lot more in the long term". If your boss won't support you on that then maybe you should find another boss!!

Re: Malassezia otitis externa - simple to treat or not?

Mark Holmes — Tue, 05 Oct 2010 11:57:21 GMT

I often use some nizoral in these cases but that can get pricey, if you do flush him again make sure you fluch the bulla copiously with a jacksons catheter, I am not convinced this is always done thoroughly enough. Dermapet have a regimen which seems to work well.

Re: Malassezia otitis externa - simple to treat or not?

Vikki Halliday LLB — Tue, 05 Oct 2010 11:04:23 GMT

I think you have been patient in the extreme with these clients!

I think your boss is probably on the right track, I would definately be looking for an underlying allergy however I appreciate the owners may not be keen to do lots of testing. However one thing you should do is control the pain and inflammation, I woudl suggest putting the dog onto an NSAID, if cost is an issue you could use a short course of prednisolone which is very good for ear pain, but not ideal in the grand scale of things.

You may have to keep at these clients and explain why using some of the drops they got last time, and cotton buds is more than likely what has contributed to the problem in the first place, and they need to be aware that if the otitis is not addressed agressively enough now, they will more than likely have a dog with chronic otitis and possibly requiring surgery in a few years time.

You could try getting them to use malt vinegar diluted 1:10 with boiled water as a daily wash, this seems to help in cases where it is just malassezzia, however there is usually another reason for the yeast overgrowth, i.e. atopy

Good luck, and keep trying, the owners have a legal responsiblity to bring their pet for treatment, they may have to be "gently" reminded of that!