Today's Veterinary Practice

MAY-JUN 2017

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70 DERMATOLOGY DETAILS PEER REVIEWED option. In a pilot study, 16 5 client-owned dogs were treated with cyclosporine at 5 mg/kg q12h for a minimum of 12 weeks. All dogs were evaluated clinically every 4 weeks to monitor progress; they all showed significant clinical improvement based on owner and clinical assessments. Individual owners also commented on improved disposition, hearing, and quality of life. I have seen limited benefits with oral cyclosporine in end-stage disease ( Figure 8 ), but the drug may be considered in cases when surgery cannot be performed. CLIENT EDUCATION AND FOLLOW-UP VISITS It is very important to talk to clients about the lengthy process of managing otitis, including the need for proper home therapy and frequent follow- up visits, pain management, quality of life, long- term prognosis, and medical costs. Clients must also be taught how to clean the ears and place ear medications. Dogs with otitis should be reevaluated with otic examination and cytology every 2 to 4 weeks, depending on severity, to assess response to therapy. It is important to treat ear infections until 1 week past clinical improvement and negative ear cytologic results for most bacterial and yeast infections. For multidrug-resistant and Pseudomonas ear infections, I usually recommend treatment until 1 week past negative cytologic and culture results. MAINTENANCE/PREVENTIVE EAR CARE AT HOME Some type of maintenance otic therapy is usually required, such as a cleaning and drying agent (to keep the ear canal free of wax buildup), antimicrobial ear cleaners (eg, for recurrent ear infections), and sometimes topical glucocorticoids (for severe hyperplasia or stenosis, when surgery is not an option). SURGICAL MANAGEMENT Surgical management may be recommended ( Table 3 ), particularly in cases of otic tumors and chronic end-stage otitis, when all medical therapeutic attempts are made, after detailed discussion of potential benefits, risks, and postsurgery complications. Histopathology and bacterial culture of removed tissue or masses should always be performed. Advanced imaging before surgery is ideal. References 1. Harvey RG, Patterson S. Otitis Externa: An Essential Guide to Diagnosis and Treatment. Boca Raton, FL: CRC Press; 2014. 2. Gotthelf LN. Small Animal Ear Diseases: An Illustrated Guide. 2nd ed. Philadelphia, PA: Elsevier Saunders; 2004. 3. Saridomichelakis MN, Farmaki R, Leontides LS, et al. Aetiology of canine otitis externa: a retrospective study of 100 cases. Vet Dermatol 2007;18(5):341-347. 4. Griffin CE. Otitis externa and media. In: Griffin CE, Kwochka KW, MacDonald JM, eds. Current Veterinary Dermatology, The Science and Art of Therapeutics. St Louis, MO: Mosby–Year Book; 1993:245-262. 5. Ginel P, Lucena R, Rodriguez JC, Ortega J. A semiquantitative cytological evaluation of normal and pathological samples from the external ear canals of dogs and cats. Vet Dermatol 2002;13(3):151-156. 6. Defalque V, Rosser EJ Jr, Peterson AD. Aerobic and anaerobic bacterial microflora of the middle ear cavity in normal dogs. 20th Proc North Am Vet Dermatol Forum 2005:159. 7. Graham-Mize CA, Rosser EJ. Comparison of microbial isolates and susceptibility patterns from the external ear canal of dogs with otitis externa. JAAHA 2004;40(2):102-108. 8. Cole L, Kwochka KW, Kowalski JJ, Hillier A. Microbial flora and antimicrobial susceptibility patterns of isolated pathogens from the horizontal ear canal and middle ear in dogs with otitis media. JAVMA 1998;212(4):534-538. 9. Patterson S, Tobias KM. Atlas of Ear Diseases of the Dog and Cat. Ames, IA: Wiley-Blackwell; 2012. 10. Rosychuk RAW. Management of otitis externa. Vet Clin North Am Small Anim Pract 1994;24(5):921-952. 11. White PD. Medical management of chronic otitis in dogs. Compend Contin Educ Pract Vet 1999;21:716-722. 12. Paterson S. Topical ear treatment—options, indications and limitations of current therapy. J Small Anim Pract 2016;57(12):1-11. 13. Koch SN, Torres MF, Plumb DC. Canine and Feline Dermatology Drug Handbook. Ames, IA: Wiley-Blackwell; 2012. 14. Patterson S. Ototoxicity. Proc WCVD 6 2008:227-230. 15. Papich MG. Ciprofloxacin pharmacokinetics and oral absorption of generic ciprofloxacin tablets in dogs. Am J Vet Res 2012;73(7):1085- 1091. 16. Hall J. Oral cyclosporine in the treatment of end state ear disease: a pilot study. Proc 18th Annu Meeting Am Acad Vet Dermatol Am Coll Vet Dermatol 2003:217. Sandra Koch Sandra Koch is an associate professor of veterinary dermatology at the College of Veterinary Medicine, University of Minnesota. She is primarily involved with clinical service and teaching. Dr. Koch's special interests include allergic and infectious skin diseases, particularly multidrug- and methicillin- resistant Staphylococcus skin and ear infections and dermatologic therapies. She is the primary author of a therapeutic drug book, Canine and Feline Dermatology Drug Handbook.

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