Affections/Diseases of ear Deafness Auricular hematoma Otitis externa Otitis media Otitis interna Differential diagnosis

1. AFFECTIONS OF EARS
Submitted to: Dr Awais Ghaffar
Submitted by: M.Mutahir Rehman
2017-DVMN-029

2. Ear Anatomy:
• outer ear
• middle ear
• inner ear

3. Round
window

4. Common Ear Affections
1. Deafness
2. Auricular hematoma
3. Otitis externa
4. Otitis media/interna
5. Arthropod bite pinnal dermatitis
6. Gotch ear
7. Insect bite dermatitis
8. Mites infestation
9. Aural contact dermatitis

5. Hereditary Deafness

6. Forms of Deafness
Inherited or acquired
Congenital or later-onset
Sensorineural or conductive

7. HERIDITARY DEAFNESS
Hereditary deafness can be cochleosaccular or neuroepithelial
in origin
Cochleosaccular deafness is usually seen in dogs with the piebald
or merle genes and in cats with white coat color
It produces deafness in one or both ears and is often associated
with blue eyes and white pigmentation

8. •The condition develops within 1-3 wk after birth secondary to stria
vascularis degeneration that results from the suppression of
melanocytes by the pigment gene, leading to cochleosaccular
neuronal degeneration
•Neuroepithelial deafness is not associated with pigment patterns,
is usually bilateral, and results from primary hair cell loss over the
same time course as cochleosaccular deafness
•Vestibular signs may also be present

9. CONGENITAL DEAFNESS
•Congenital deafness ( usually hereditary) has been reported in -
100 dog breeds and is especially prevalent in the piebald carrying
breeds of Dalmatian, Bull Terrier, Australian Cattle Dog, English Setter,
English Cocker Spaniel, Boston Terrier, and Parson Russell Terrier,
and in the different merle-carrying breeds
•The prevalence of deafness in white cats ( dominant white gene),
especially those with blue eyes, is high, but blue-eyed cats from
Siamese breeds do not appear to be affected

11. CONDUCTION DEAFNESS
•Conduction deafness results from obstruction or reduction of sound
reaching the cochlea, usually from otitis media , chronic otitis externa
or excess cerumen, and less commonly from tympanum rupture or
ossicle damage
•Resolution of the obstruction or tissue damage usually restores hearing
•Recovery after otitis media may require weeks while the body
phagocytizes the infection residue, accompanied by progressive
recovery of hearing

12. SENSORINEURAL DEAFNESS
•Sensorineural deafness results from loss of cochlear nerve cells and is
not reversible in mammalian species
•Acquired sensorineural deafness may result from intrauterine infection
or toxins, otitis interna or meningitis, mechanical or noise trauma,
ototoxicity, anesthesia, neoplasms, or aging (presbycusis)
•Loss can be bilateral or unilateral, and partial or complete

13. •Hunting or military dogs exposed to loud percussive sounds such as
gunfire experience cumulative losses that may initially go unnoticed
•This is often observed in hunting dogs, in which the distance at which
a trained dog responds to commands shrinks by half or more
•A variety of drugs and chemicals are ototoxic and vestibulotoxic,
especially the aminoglycoside antibiotics (gentamicin, amikacin ),
antineoplastic drugs ( cisplatin ), salicylates, diuretics
(furosemide),general anesthesia and antiseptics (chlorhexidine)

14. Hearing Testing
 Behavioral testing - sound stimuli produced outside of
the animal's visual field
cannot detect unilateral deafness
animals quickly adapt to testing
stimuli detected through other sensory modalities
 Electrodiagnostic testing - brainstem auditory evoked
response (BAER, BAEP, ABR)
objective, non-invasive
detects unilateral deafness
limited availability

18. AURICULAR HEMATOMA
An aural hematoma is a collection of blood within the
cartilage of the ear and the skin
•It usually arises as a self-inflicted injury from your pet’s
scratching and head shaking
•The underlying causes include all conditions that result in otitis
externa

19. Hematoma formation has also been associated with
increased capillary fragility
•Aural hematoma is the most common result of physical
injury or trauma to the pinna (the “flap” of the ear)
•The condition is common in dogs with chronic otitis
externa and less common in cats

20. Sources of irritation to the ear linked to the development
of an aural hematoma include:
1. Inflammation
2. Immune mediated diseases
3. Allergies
4. Parasites
5. Foreign bodies
6. Trauma (bite wound or blunt trauma)

21. SIGNS AND SYMPTOMS
•Swelling associated with an aural hematoma is most apparent on
the concave inner surface of the pinna
•The swelling is soft and warm in the early stages
•With time, scar tissue will thicken and deform the ear, resulting in a
cauliflower contracture

22. TREATMENT
•After draining and flushing, several mattress sutures can be placed
to eliminate the "pocket.“
•The addition of a drain made out of a teat tube, piece of soft
urinary catheter, or IV catheter increases the success rate of
Surgery
•Drainage and glucocorticoid instillation are successful in -50% of
cases
•Glucocorticoids are instilled to fill the cavity without causing
skin distention
•A short course of a low anti-inflammatory dosage of oral
glucocorticoids is commonly added to this treatment

24. Otitis Externa
•Otitis externa is inflammation of the external ear canal and is a
common problem in dogs and cats
•Otitis externa may be acute or chronic, and unilateral or bilateral
•It can be seen in rabbits (psoroptes cuniculi)
•Uncommon in large animals

26. Etiology
1. Allergy (adverse food reaction, atopic dermatitis, contact)
2. Parasites (Otodectes, Demodex, Sarcoptes)
3. Autoimmune/immune-mediated
4. Endocrine disease (hypothyroidism, hyperadrenocorticism)
5. Epithelialization disorders (sebaceous adenitis, zinc-responsive
dermatitis)
6. Foreign bodies
7. Glandular disorders (sebaceous gland hyperplasia)
8. Fungal (Aspergillus)
9. Viral (distemper)

28. Predisposing factors
•Conformation (pendulous pinna, stenotic canals, hairy concave pinna,
excessive hair in canals)
•Excessive moisture (environment, swimming)
•Obstructive ear disease (neoplasia, polyp, feline apocrine
cystadenomatosis)
•Primary otitis media
•Systemic disease (immune suppression, catabolic states)
•Treatment effects (changes in normal flora, trauma)

29. Signs & symptoms
•Head shaking
•Pain with ear manipulation
•Malodor
•Exudate
•Erythema
•Erosion
•Ulceration
•Swelling
•Ceruminous gland hyperplasia

31. Diagnosis
•After a complete physical and dermatologic evaluation, the ears should
be examined (least affected/painful first)
•Extremely painful cases may require sedation or systemic
glucocorticoids for several days before an otoscopic evaluation is
performed
•Palpation of the ear canals and pinna will help to identify the presence
of swelling, mineralization (due to chronicity), and pain
•The pinnae should be evaluated for erythema, crusting, erosion,
ulceration, lichenification, hyperpigmentation and the presence of
exudate

32. Treatment
1. Identify the primary cause of the otitis and manage it
2. Remove the exudate via irrigation of the ear canal
3. Identify and treat concurrent otitis media
4. Select an appropriate antibiotic from the results of
culture
5. Treat topically and systemically until the infection
resolves (weeks to months)

33. Tramadol @5mg/kg for first 5-7 days
Prednislone @1mg/kg
Ceruminolytic solutions such as carbamide peroxide or DSS
Oral ketoconazole @5mg/kg/day for 15-30days
Polymyxin B and fluoroquinolones have shown the best
success

34. Otitis Media/Interna
Otitis media, inflammation of the middle ear structures, is seen in
small and large domestic animals, including dogs, cats, rabbits,
ruminants, horses, pigs, and camelids
It can be unilateral or bilateral and can affect animals of all ages
Otitis media usually results from extension of infection from the
external ear canal through the tympanic membrane or from
migration of pharyngeal microorganisms through the auditory tube

35. Clinical findings
•Signs of otitis media include head shaking, rubbing or
scratching the affected ear, and tilting or rotating the head
toward the affected side
•Self-trauma can lead to aural hematoma
•Animals with otitis media may exhibit signs of facial nerve
paralysis and/or Horner syndrome on the same side as
the affected ear
•Exposure keratitis and corneal ulceration may develop

41. •Signs of otitis interna are those typically associated with peripheral
vestibular syndrome and include a head tilt, circling, falling, or
rolling toward the affected side
•Horizontal or rotatory nystagmus with the fast phase away from
the affected side; and asymmetric ataxia with strength preserved
•Extension of infection from the inner ear to the brain leads to
meningitis, meningoencephalitis or abscess

42. Treatment
The goals of treatment are to clean the external and middle
ear; remove infected, inflammatory, or foreign bodies
• Perform under general anesthesia
• Soak the ear canal for 10 minutes with a ceruminolytic ear
cleaner, then flush using warm saline
• Once the exudate and debris are removed from the ear canal,
evaluate the tympanic membrane with an otoscope or video
otoscope

43. •Once the ear has been cleaned and flushed, begin systemic
and topical antimicrobial/antifungal treatment
•The most common coccoid bacteria isolated from the middle
ear of dogs with otitis media is S. intermedius; appropriate
antibiotic choices include:
• Cephalexin, 22mg/kg PO q12h
• Amoxicillin and clavulanate, 13.75 to 22mg/kg PO q12h

44. The most common rod bacteria is Pseudomonas aeruginosa
A fluoroquinolone such as:
• Enrofloxacin, 5 to 20 mg/kg PO q24h
• Marbofloxacin, 2.75 to 5.5mg/kg q24h PO
• Certain systemic antibiotics (primarily aminoglycosides)
are ototoxic and should be used cautiously
Use ketoconazole or itraconazole at 5mg/kg PO q24h for
yeast otitis media
• Anti-inflammatory agents such as prednisolone 1mg/kg PO
q24h

46. The importance of
hearing: