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A diagnostic approach to canine otitis
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Canine otitis is a frequent challenge for first opinion clinicians, and successful management is based on addressing the multiple causes and factors involved in its pathogenesis, as Hannah Lipscomb and Filippo De Bellis describe.
Hannah Lipscomb
BVet Med, MRCVS
Dr. Lipscomb gained her degree from London’s Royal Veterinary College in 2016 and was the first dermatology intern at Southern Counties Veterinary Specialists (SCVS), working alongside the specialist Filippo De Bellis. After qualification she initially worked in a first opinion small animal practice for 18 months – where she developed her interest in dermatology – and then progressed to a rotating internship at a private referral clinic before moving to SCVS to undertake a dermatology internship.
Filippo De Bellis
DVM, CertVD, Dip. ECVD, MRCVS
Dr. De Bellis qualified from the University of Bari, Italy in 2001 and moved to the UK to undertake a dermatology residency at the Royal Veterinary College in 2006. He gained the RCVS Certificate in Veterinary Dermatology in 2009 and a year later became a Diplomate of the European College of Veterinary Dermatology. He has a particular interest in ear diseases and allergies, and is currently Head of Dermatology Services at Davies Veterinary Specialists, Southfields Veterinary Specialists and London Vet Specialists.
Key points
- When seeing a patient with otitis for the first time, a thorough history should always be taken, followed by physical and dermatological examination, otoscopy and ear swabs.
- Routine microbiological culture of all otitis cases is not indicated, as it will not distinguish between resident commensal bacteria, overgrowth and infective organisms.
- Imaging modalities available for assessing the ear include radiography, sonography, computed tomography and magnetic resonance imaging.
Introduction
Otitis is seen in first opinion veterinary practice on a regular basis (1), representing some 10-20% of all canine cases presenting to practitioners (2). Otitis externa (OE) (inflammation of the external ear canal, or EEC) is typically complicated by secondary infection which can – along with other factors – lead to rupture of the tympanic membrane (TM) and the development of otitis media (OM). Over 50% of dogs presenting with chronic OE have concurrent OM (3), and without intervention the cycle of aural inflammation and infection will continue, resulting in pain and irreversible pathological changes. Successful management is based on addressing the multiple causes and factors involved in the pathogenesis of otitis (4). The causes can be primary (e.g., foreign bodies, ectoparasites, allergies, endocrinopathies, or immune-mediated diseases) or secondary (essentially infection from Gram-positive or Gram-negative bacteria and fungi) in nature, but other aspects are also important. These include predisposing factors (such as obstruction, conformation, aural environment, or topical treatment effects), and perpetuating factors (such as pathological changes resulting from chronic OE or OM). This article reviews the diagnostic approach to canine otitis and provides practitioners with a step-by-step guide to managing cases from first presentation.
Signalment and history
When first presented with a dog with either acute or chronic otitis it is important to be aware of the clinical history and to formulate a list of provisional primary causes. The consultation should start as normal, with thorough history taking to enable potential causes to be ruled in or out. To achieve this the following questions should be covered:
- What is the dog’s signalment? Various studies have shown that Cocker Spaniels, Poodles, Pyrenean Shepherds and Labrador Retrievers are all predisposed to developing otitis due to the conformation of their pinnae, EECs and/or hereditary susceptibility (5). In young dogs, otitis can be caused by Otodectes cynotis – although this is less common with the newer oral and spot-on ectoparasiticides – whereas in old dogs an underlying endocrinopathy is more likely.
- What are the owner’s concerns? They may describe head shaking, ear rubbing, aural discharge and malodor (6).
- When was the complaint first noticed? Abrupt and frenzied head shaking increases suspicion of an aural foreign body (6), whereas chronic cases are usually associated with clinical or subclinical disease.
- Is the otitis unilateral or bilateral? Acute unilateral otitis increases the likelihood of an aural foreign body; chronic bilateral otitis is more likely to indicate other etiologies (e.g., allergies) and can additionally be complicated by the ear anatomy.
- What is the pet’s lifestyle? Does the dog exercise in fields or go swimming? Water trapped in the EEC changes the aural environment and can cause dysbiosis (6).
- Does the dog suffer from seasonal flares of otitis? If so, this is highly suggestive of primary allergic skin disease, such as non-food-induced atopic dermatitis.
- Has any previous topical treatment been successful? If not, this could indicate either a resistant infection or an adverse drug reaction.
[...]
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