Canine Dermatology Case Study module 7

1. z
Case study
module 7
Anita Patel, BVM, DVD, FRCVS
RCVS Recognised Specialist in Veterinary Dermatology

2. z
Case history
 5 year old male Labrador
 Presented with history of head shaking and pawing at the ear
 Acute onset with no previous ear disease
 Otherwise healthy

3. z
Clinical examination

4. z
What can you
establish from the
Pictures

5. z
Established from the examination
 Inflammatory changes consistent with acute onset
 Erythema
 Stenosis
 Thick brown exudate
 Established from further examination
 Unilateral disease
 Other dermatological signs absent

6. z
What is your single best answer
and why?
A. Cytology, clean ear in clean and attempt otoscopic examination
B. Prescribe ear drops and arrange to see the dog in 5 days
C. Prescribe systemic antibiotics and prednisolone and ear cleaner
D. Cytology, clean ear canal, attempt otoscopic examination and prescribe
glucocorticoid and re-examine in 3-5 days
E. Admit for sedation, flush ear canals and send it home on ear drops

7. z
Best steps in
this case
 Obtain sample for cytology
 Clean the ear to get a better view with the otoscope
 Look for stenosis of horizontal canal and tympanic membrane
 If unable to do otoscopic examination give oral prednisolone for
5-7 days or give dexamethasone injection and recheck
 This reduces stenosis
 Allows otoscopic examination
 Less painful
 Also will allow owner to apply topical treatments

8. z
z
Follow up
 View of ear after 2 days after
dexamethasone injection and in clinic
cleaning
 Cytology revealed Malassezia organisms
 Based on acute onset and stenosis and
just visible tympanic membrane topical
treatment with high potency steroid
prescribed

9. z
How long would you treat for?
 For 7 days?
 For 10 days?
 For 14 days ?
 Until beyond negative cytology?
 Until the epithelium is smooth and pale

10. z
Follow up after 3 weeks of treatment
 Smooth epithelium
 Pale
 Cytology negative

11. z
At this stage what would you do and
how would you justify your decision?
 Book dog in for allergy testing?
 Start a food trial?
 Warn the owner of potential underlying causes and
monitor?

12. z
Decision in this case at the follow-up
appointment
 Warn the owner of potential underlying causes and monitor
 Justification
 Dog had unilateral disease
 First time episode
 No other dermatological signs at this stage
 Owner warned of allergic otitis with out without skin disease
 Malassezia hypersensitivity
 Adverse food reaction
 Atopic dermatitis