Management of Chronic Pseudomonas Ear Infections

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1 The Vet Education International Online Veterinary Conference 2013 Management of Chronic Pseudomonas Ear Infections With Dr Peter Hill Specialist in Veterinary Dermatology July2013 Vet Education is proudly supported by Hill s Pet Nutrition (Australia) and Merial Animal Health

2 Management of chronic Pseudomonas ear infections in dogs Dr Peter Hill BVSc PhD DVD DipACVD DipECVD MACVSc School of Animal and Veterinary Sciences Life Impact The University of Adelaide

3 Development of ear infections Infection with commensals Staph pseudintermedius Streptococcus canis Malassezia pachydermatis 2

4 Development of ear infections Infection resolves 3

5 Development of ear infections Mixed infection Staph and E. Coli Infection resolves 4

6 Development of ear infections Mixed infection Staph and Pseudomonas Resistant to Neomycin 5

7 Development of ear infections Pure infection Neomycin resistant Pseudomonas Resistant to gentamycin 6

8 Development of ear infections Pure infection Neomycin and Gentamycin resistant Pseudomonas Resistant to fluoroquinolones 7

9 Development of ear infections Pure infection Neomycin, Gentamycin and Fluoroquinolone resistant Pseudomonas 8

10 Development of ear infections Pure infection Neomycin, Gentamycin and Fluoroquinolone resistant Pseudomonas 9

11 Lab Report Pseudomonas aeruginosa Neomycin Polymyxin B Gentamycin Enrofloxacin Ticarcillin Cephalexin TMS Amoxy / clav Ampicillin R R R R R R R R R 10

12 Development of otitis media Semicircular canals Cochlea Ossicles Tympanic bulla 11

13 Development of otitis media Incus Malleus Stapes Oval window Round window Proteases Collagenases Elastases Lysozymes Tympanic bulla 12

14 13

15 Diagnosis and Management Step 1 - Cytology culture and sensitivity testing Step 2 - Otoscopy and evaluation of the tympanic membrane (Step 3 - Diagnostic imaging - Radiography/CT/MRI) (Step 4 - Middle ear flushing) Step 5 - Selecting appropriate systemic and topical antibiotics Step 6 - Dealing with the underlying causes Step 7 - Follow-up rechecks 14

16 Diagnosis and Management Cytology culture and sensitivity testing Evaluation of the tympanic membrane Otitis externa Otitis media Radiography/CT/MRI Middle ear flushing Selecting appropriate antibiotics/anti-fungals Identifying and treating the underlying cause

17 Diagnosis and Management Step 1 - Cytology culture and sensitivity testing Step 2 - Otoscopy and evaluation of the tympanic membrane (Step 3 - Diagnostic imaging - Radiography/CT/MRI) (Step 4 - Middle ear flushing) Step 5 - Selecting appropriate systemic and topical antibiotics Step 6 - Dealing with the underlying causes Step 7 - Follow-up rechecks 16

18 Cytology 17

19 Cytology 18

20 Cytology + culture and sensitivity testing 19

21 Diagnosis and Management Step 1 - Cytology culture and sensitivity testing Step 2 - Otoscopy and evaluation of the tympanic membrane (Step 3 - Diagnostic imaging - Radiography/CT/MRI) (Step 4 - Middle ear flushing) Step 5 - Selecting appropriate systemic and topical antibiotics Step 6 - Dealing with the underlying causes Step 7 - Follow-up rechecks 20

22 Otoscopy and evaluation of the tympanic membrane 21

23 Otoscopy

24 23

25 Evaluation of the tympanic membrane 24

26 Evaluation of the tympanic membrane Canine 25

27 Evaluation of the tympanic membrane Feline 26

28 Evaluation of the tympanic membrane 27

29 28

30 29

31 30

32 Evaluation of the tympanic membrane 31

33 Diagnosis and Management Step 1 - Cytology culture and sensitivity testing Step 2 - Otoscopy and evaluation of the tympanic membrane (Step 3 - Diagnostic imaging - Radiography/CT/MRI) (Step 4 - Middle ear flushing) Step 5 - Selecting appropriate systemic and topical antibiotics Step 6 - Dealing with the underlying causes Step 7 - Follow-up rechecks 32

34 Radiography 33

35 Radiography Rostro-caudal (open mouthed) view 34

36 Radiography 35

37 Radiography Ventro-dorsal view 36

38 Radiography Lateral view 37

39 CT CT/MRI 38

40 Diagnosis and Management Step 1 - Cytology culture and sensitivity testing Step 2 - Otoscopy and evaluation of the tympanic membrane (Step 3 - Diagnostic imaging - Radiography/CT/MRI) (Step 4 - Middle ear flushing) Step 5 - Selecting appropriate systemic and topical antibiotics Step 6 - Dealing with the underlying causes Step 7 - Follow-up rechecks 39

41 Middle ear flushing 40

42 Middle ear flushing 41

43 Middle ear flushing 42

44 Middle ear flushing 43

45 Middle ear flushing 44

46 Middle ear flushing 45

47 Middle ear flushing 46

48 Middle ear flushing 47

49 48

50 Diagnosis and Management Step 1 - Cytology culture and sensitivity testing Step 2 - Otoscopy and evaluation of the tympanic membrane (Step 3 - Diagnostic imaging - Radiography/CT/MRI) (Step 4 - Middle ear flushing) Step 5 - Selecting appropriate systemic and topical antibiotics Step 6 - Dealing with the underlying causes Step 7 - Follow-up rechecks 49

51 Selecting appropriate systemic and topical antibiotics C&S C&S 50

52 Selecting appropriate systemic and topical antibiotics 1. Gentamycin Mometamax / Otomax 2. Polymyxin B Surolan / Dermotic 3. Fluoroquinolones Baytril injectable / otic 4. Ticarcillin/clavulanic acid Timentin 5. Tris EDTA - Dermapet 6. Silver sulfadiazine cream 51

53 Selecting appropriate systemic and topical antibiotics 52

54 Selecting appropriate systemic and topical antibiotics 53

55 Selecting appropriate systemic and topical antibiotics 54

56 Diagnosis and Management Step 1 - Cytology culture and sensitivity testing Step 2 - Otoscopy and evaluation of the tympanic membrane (Step 3 - Diagnostic imaging - Radiography/CT/MRI) (Step 4 - Middle ear flushing) Step 5 - Selecting appropriate systemic and topical antibiotics Step 6 - Dealing with the underlying causes Step 7 - Follow-up rechecks 55

57 Dealing with the underlying causes The Three P s Predisposing factors Primary causes Ear infection Perpetuating factors 56

58 Predisposing Factors Pendulous pinnae Hairy ear canals Narrow ear canals Excessive wax production Swimming 57

59 Predisposing factors 58

60 Primary Causes Foreign bodies (esp. grass seeds) Otodectes cynotis infestation Atopic dermatitis Food allergy Ear canal tumours Adverse reaction to ear medication Hormonal diseases Otic demodicosis 59

61 Primary causes 60

62 Perpetuating factors Bacterial resistance (esp. Pseudomonas, Proteus) Otitis media Progressive narrowing of the ear canals Ear canal fibrosis Ear canal calcification Bulla osteomyelitis 61

63 Ear canal narrowing 62

64 Dealing with the underlying causes 63