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PetsLivingLonger.com

Keith A Hnilica DVM, MS, MBADiplomate ACVD

Bigdog@itchnot.com(865) 405-4203

Goals

Provide a real life perspectiveDiscuss problemsDiscuss an efficient planDiscuss an efficient planReview feline otitis

Unique Considerations

Feline OtitisEasy vs extremely frustrating

Waxy material is normalWaxy material is normalTumors are common

Very Very EASY to make things WORSE!

Step 1A Pattern Approach

2o InfectionsPyoderma AllergiesDemodex Atopy

Dermatophyte Food

Yeast Dermatitis Scabies

OtitisPododermatitis Endocrine

HypothyroidCushing’s

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Find and Control the Primary disease!

Step 2The 3 Slide Technique

Every derm patientOne fee $45Techs canTechs can

Hnilica itchnot.com

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The Patient

In

The

The Patient

In

The Roomtech

techtech

Doctor

Doctor

SS ear tape

3 Slidestechnique

TheRoom

The Room

tech

techDoctor

Easier Faster BetterItchnot.com

Step 3

Hnilica Atlas of Small Animal Dermatology

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Hnilica Atlas of Small Animal Dermatology

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CT Scan Bulla Osteotomy

Step 4

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Otitis Everything good

in life is messy ….

Management of Specific Disorders

Ear MitesMalassezia otitisBacterial otitisBacterial otitisPseudomonas otitisAllergic otitisOtitis media

Pseudomonas

AntibioticsBased on cultureGentamicin, amikacinEnrofloxacinPolymixinTicarcillin Why is it there?

Malassezia Otitis

Treatmenttopical

antifungalslti h /multi-pharmacy w/

steroidchlorhexidene containing washes

acetic acid

systemicitraconazoleketoconazole

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Otitis Treatment4 steps : 6 products

1. Control the primary disease3. Use high volume2. Use high antibiotic concentration 4 Don’t just stop but PREVENT!4. Don’t just stop but PREVENT!

1. Vet Solutions – swimmers2. Epiotic Advanced3. Mometomax4. T8 Solution with 5. 1% Baytril6. Steroids

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Necessary Ear MedsPick only 1 product for each spot

AntibacterialAnti-yeastw/ steroid

Pseudomonas TxTris EDTA 4oz

w/ LA Baytril 12cc

l

Alcohol flushfor swimmers

EpiOticAdvanced

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Mometomax

Vet Solutions

T8 Keto Solution

Ear Mitacide

AcarexxMilbemite

Recurrent Otitis

T8 solution with Baytril

10mg/ml fill the canal bid

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12 cc LA BaytrilIn 4 oz bottle

Dropper Bottles are Essential

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Step 5

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Change to another OTC

Atopica

CyclosporineTacrolimus

Atopica in Cats

Currently off Label5-10mg/kgUseful for many diseasesUseful for many diseasesFewer side effects+/- faster response

Atopica in Cats

Toxo risk“Super absorbers”Titers not useful – negative more riskyTiters not useful negative more riskyKeep inside to limited exposure

Felv/FIV negativeOther infectionsSafer than steroids

Allergy Testing

http://www.cvm.ncsu.edu/docs/dermat_allergyclinic.htm

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Perseverance

To go on resolutely despite difficulties.

"Salsa"

"Salsa"3 month old, M, Domestic short hair"rescued" from Wal-Mart1 month history of progressive otitis1 month history of progressive otitis

Resistant to topical therapies

Concurrent upper respiratory tract infection

"Salsa" "Salsa"

Otitis started with a black "coffee grounds" exudate

Owner treated with "Every" topical ear medication known to veterinary medicine

Owner finally resorted to packing the ears with "medicinal clay"

"Salsa"Diagnostics

CytologyOtoscopyCultureDeep otic lavageTherapeutic trialsRadiology

Bulla x-rayCT

"Salsa"

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"Salsa" "Salsa"Cytology – BAAAD = mixed bacteriaCulture – mixed Otic lavageOtic lavage

Everything good in life is messy

Ear CleaningSalsa 2

"Salsa"

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"Salsa"Treatments

Clean ears every other dayevery other dayBased on Cultures

Oral antibioticsTopical antibiotics

"Salsa"

Typical Therapeutic planCleaning

Flush ear every other dayFlush ear every other dayFlush ear every 3-7 days

Topical AntimicrobialOtomax bid for 15-30 daysOtomax after each cleaning

Salsa 2

Baytril MICsStaph = 2–5 ug/ml Pseudomonas = 32-40 ug/ml

The termsStaph = 2–5 ug/ml Pseudomonas = 32-40 ug/ml

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Pseudomonas

Tris EDTAChelates ionsPerforates cell wall/coatAllows antibiotic to penetrateLowers mic levels

Otic CleanersLower mic levels

"Dead bugs don't mutate". Boothe

T8 solution with Baytril

10mg/ml fill the canal bid

4 Month recheck"Salsa"

Excellent response

- to a point

"Salsa"Otitis in cats

Primary

Otodectes

polyps

neoplasia

Food allergy

Secondary infections

bacteria

yeast

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"Salsa"Find and Control the Primary disease!

"Salsa"The infections are secondary

Culture and SensitivityAggressive topicals

OtomaxBaytril, Ticarcillin, polymyxin

Antimicrobial flushesHexadene or Malaseb flushT8 solution with Baytril

Maintenance therapySurgery – TECAs only

"Salsa"

Learning issueFind and control the underlying cause!

After 6 months of chronic therapyFood trial – owner initiatedComplete resolution

"Salsa" A Pattern Approach

2o InfectionsPyoderma AllergiesDemodex AtopyDemodex Atopy

Dermatophyte Food

Yeast Dermatitis Scabies

OtitisPododermatitis Endocrine

HypothyroidCushing’s

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PetsLivingLonger.com

Keith A Hnilica DVM, MS, MBADiplomate ACVD

Bigdog@itchnot.com(865) 405-4203