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Otitis Media

Otitis media is a recognized cause of recurrent otitis externa. The presence of bacte­ria in the middle ear acts as a source of reinfection of the outer ear canal. The pres­ence on examination of an intact tympanum does not rule out the possibility of previous rupture and repair of the tympanic membrane in the presence of otitis media.

Conversely, the most common cause of otitis media is infection extending through a compromised tympanic membrane from an infected external ear canal. Hematogenous spread of bloodborne pathogens to the middle ear and extension of infection from the nasopharynx through the auditory tube to the tympanic bulla are rare. Obstruction of the eustachian tubes in cats and dogs has been shown experi­mentally to result in a middle ear effusion. Cats can develop otitis media via exten­sion through the auditory tubes as a sequela to an upper respiratory infection, but this also occurs infrequently. Foreign bodies, trauma, and tumors may also induce otitis media.

Middle ear defense mechanics include a mucociliary system and a cellular defense system. The epithelium in the middle ear can function actively in clearing foreign material. In addition, these cells also secrete lysozymes to aid in defense mechanisms. Fibroblasts, when activated, secrete increased amounts of collagen and ground substance, which participate in protection and repair. A surfactant that lowers surface tension has been found in the auditory tubes of dogs. This substance may be Text continued on p. 200.

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TABLE 9-1 Summary of Microbial Flora (% Incidence) Isolated from the External Ear Canal of Dogs with no Evidence of Ear Disease

STUDY

#

NUMBER

OF

EARS

NO GROWTH COAGULASE­POSITIVE STAPHYLO­COCCUS COAGULASE­NEGATIVE STAPHYLO­COCCUS CORYNE-

Bacteria

SPP.

OR

BACILLUS

STREPTO­

COCCUS SPP.

PROTEUS SPP. PSEUDO­MONAS SPP. COLI- FORMS MALAS-

SEZIA

1 156 40 42.9 Combined 0 0 0 0 Either not done, not recorded, or not specifically recorded (e.g., no genus species given in certain studies; recorded only as gram-negative or gram-positive coccobacilli).

SMALL ANIMAL EAR DISEASES

1. Gustafson B: Otitis externa hos hund, Nordic Veterinaermedicin 6:434-442, 1954.

2. Fraser G: Factors predisposing to canine external otitis, Vet Rec 73:55-53, 1961.

3. Grono LR, Frost AJ: Otitis externa in the dog, Aust Vet J 45:420-422, 1969.

4. Sharma VD, Rhodes HE: The occurrence and microbiology of otitis externa in the dog, J SmAnim Pract 16:241-247, 1975.

5. McCarthy G, Kelly WR: Microbial species associated with the canine ear and their antibacterial sensitivity pattern, Irish Vet J 36:53-56, 1982.

6. Marshall MJ, Harris AM, Horne JE: The bacteriological and clinical assessment of a new preparation for the treatment of otitis externa in dogs and cats, J Sm Anim Pract 15:401-410, 1974.

7. Chengappa MM, Maddux R, Greer S: A microbiological survey of clinically normal and otitic ear canal, Pet Pract 78:343-344, 1983.

8. Dickson DB, Love DN: Bacteriology of the horizontal ear canal of dogs, J SmAnim Pract 24:413-421, 1983.

9. Fraser G, Gregor WW, MacKenzie CP, et al: Canine ear disease, J SmAnim Pract 10:725-754, 1970.

10. Gedek B, Brutzel K, Gerlach R, et al: The role of Pityrosporumpachydermatis in otitis externa of dogs: evaluation of a treatment with miconazole, Vet Rec 104:138-140, 1979.

11. Marshall MJ, Harris AM, Horne JE: The bacteriological and clinical assessment of a new preparation for the treatment of otitis externa in dogs and cat, J Sm Anim Pract 15:401-410, 1974.

12. Sampson GR, Bowen RE, Murphy CN, et al: Clinical evaluation of a topical ointment, VMSAC 68:978-982, 1973.

13. Matsuda H, Tojo M, Fukui K, et al: The aerobic bacterial flora of the middle and external ears in normal dogs, J SmAnim Pract 25:269-274, 1984.

co

TABLE 9-2 Summary of Microbial Flora (% Incidence) Isolated from the External Ear Canal of Dogs with

Otitis Externa

STUDY

#

NUMBER

OF

EARS

NO GROWTH COAGULASE­POSITIVE STAPHYLO­COCCUS COAGULASE­NEGATIVE STAPHYLO­COCCUS CORYNE- Bacteria SPP. STREPTO­

COCCUS SPP.

PROTEUS SPP. PSEUDO­MONAS SPP. COLI- FORMS MALAS-

SEZIA

1 19.3 Combined ND 56.0 3.4 3.4 3.4 ND
2 62 ND 80.6 ND 19.4 6.5 12.9 12.9 7.7 ND
3 716 9.9 30.9 8.0 3.1 12.6 20.8 34.6 7.3 35.9
4 115 18.3 32 ND 1.0 1.0 9.0 9.0 4.0 54.2
5 69 ND 22.6 1.9 1.8 4.2 3.9 18.1 5.6 34.8
6 116 ND 37.9 20.7 6.0 8.6 3.4 16.4 2.5 82.8
7 160 26.2 19.0 ND ND ND ND ND ND 14.3
8 60 ND 51.8 Combined ND 29.6 14.8 3.7 25.9 63
9 371 ND 66.6 Combined ND 25.8 14.8 11.3 15.6 51.5
10 87 ND 32 ND 1 1 9.0 9.0 ND 56
11 669 22.3 16.3 Combined ND ND ND ND ND 19.3
12 389 ND 32.1 0.5 0.5 9.0 13.4 20.1 ND 2.1
13 59 ND 47.5 3.4 1.7 25.4 13.6 5.1 ND ND
14 293 ND 33.8 Combined ND 6.5 3.1 3.8 ND 35.8
15 36 ND 41.6 Combined ND 25 19.4 25 13.8 50
16 49 2 53 ND ND 6 ND ND ND 86
17 47 ND 34 27.7 ND 8.5 19.2 14.9 ND ND
18 500 ND 61 Combined ND 22 16 13 13 44
19 158 0 17.7 3.1 0 6.8 0.6 12.6 1.2 56.9
20 68 ND 35 Combined ND 6 5 5 2 23

ND, Either not done, not recorded, or not specifically recorded (e.g., no genus species given in certain studies; recorded only as gram-negative or gram-positive coccobacilli).

SMALL ANIMAL EAR DISEASES

1.

Gustafson B: Otitis externa hos hund, Nordic Veterinaermedicin 6:434-442, 1954.

2. Fraser G: Factors predisposing to canine external otitis, Vet Rec 73:55-53, 1961.

3. Grono LR, Frost AJ: Otitis externa in the dog, Aust Vet J 45:420-422, 1969.

4. Sharma VD, Rhodes HE: The occurrence and microbiology of otitis externa in the dog, J SmAnim Pract 16:241-247, 1975.

5. McCarthy G, Kelly WR: Microbial species associated with the canine ear and their antibacterial sensitivity patterns, Irish Vet J 36:53-56, 1982.

6. Marshall MJ, Harris AM, Horne JE: The bacteriological and clinical assessment of a new preparation for the treatment of otitis externa in dogs and cats, J Sm AnimPract 15:401-410, 1974.

7. Chengappa MM, Maddux R, Greer S: A microbiological survey of clinically normal and otitic ear canals, Pet Pract 78:343-344, 1983.

8. McKellar QA, Rycroft A, Anderson L, et al: Otitis externa in a foxhound pack associated with Candida albicans, Vet Rec 127:15-16, 1990.

9. Fraser G, Withers AR, Spreull JSA: Otitis externa in the dog, J SmAnim Pract 2:32-47, 1961.

10. Baxter M, Lawler DC: The incidence and microbiology of otitis externa of dogs and cats in New Zealand, New Zealand Vet J 20:29-32, 1972.

11. Krogh HV, Linnel A, Knudsen PB: Otitis externa in the dog: a clinical and microbiological study, Nordic Veterinaermedicin 27:285-295, 1975.

12. Blue JL, Wooley RE: Antibacterial sensitivity patterns of bacteria isolated from dogs with otitis externa, JAm Vet MedAssoc 171:362-363, 1977.

13. Nesbitt GH, Schmitz JA: Chronic bacterial dermatitis and otitis: a review of 195 cases, JAmAnim Hosp Assoc 13:442-450, 1977.

14. Rycroft AK, Saban HS: A clinical study of otitis externa in the dog, Can Vet J 18:64-70, 1977.

15. Hallu RE, Gentilini E, Rebuelto M, et al: The combination of norfloxacin and ketoconazole in the treatment of canine otitis, Canine Pract 21:26-28, 1996.

16. Blanco JL, Guedeja-Marron J, Hontecillas R, et al: Microbiological diagnosis of chronic otitis externa in the dog, J Vet Med B 43:475-482, 1996.

17. Webster FL, Whyard BH, Brandt RW, et al: Treatment of otitis externa in the dog with Gentocin Otic, Can Vet J 15:176-177, 1974.

18. Fraser G, Gregor WW, MacKenzie CP, et al: Canine ear disease, J SmAnim Pract 10:725-754, 1970.

19. Gedek B, Brutzel K, Gerlach R, et al: The role of Pityrosporumpachydermatis in otitis externa of dogs: evaluation of a treatment with miconazole, Vet Rec 104:138-140, 1979.

20. Sampson GR, Bowen RE, Murphy CN, et al: Clinical evaluation of a topical ointment, VMSAC 68:978-982, 1973.

CHAPTER 9 Microbiology of die Ear of the Dog an d Cat 1 99

important in decreasing cohesive forces between the coapting walls of the auditory tube. In otitis media, the auditory tubes may be more resistant to opening during the act of swallowing, which results in a lack of aeration of the middle ear.

When otitis media is present, the lamina propria of the middle ear cavity often thickens and forms loose vascular and edematous granulation tissue, sometimes maturing into dense connective tissue. Occasionally spicules of bone can be found within the connective tissue. New bone or bone remodeling can be seen on the intra­luminal and extraluminal aspect of the tympanic bulla.

Microbiology of the Middle Ear

Cytology and culture should be performed from exudate retrieved from the middle ear. The exudate can be retrieved via myringotomy or the more invasive bulla osteotomy. The most common pathogens cultured from the middle ear include Staphylococcus intermedius and Pseudomonas aeruginosa. Streptococcus spp., Escherichia coli, Proteus mirabilis, Enterobacter spp., Pasteurella spp., Corynebacterium spp., Enterococcus spp., Klebsiella spp., Citrobacter spp., Lactobacillus spp., Clostridium spp., and anaerobes have also been cultured from the middle ear. Yeast (Malassezia, Candida) and Aspergillus spp. have also been cultured from the diseased middle ear. Otodectes cynotis will occasionally cause middle ear disease.

In a study comparing the microbial flora of the horizontal ear canal and middle ear of dogs with otitis media, a difference in types of isolates and/or susceptibility patterns between the horizontal ear canal and middle ear was found 89.5% of the time.5 Therefore, it is important that specimens for bacterial culture be taken from the horizontal ear canal and the middle ear in dogs with chronic otitis externa in which otitis media is suspected.

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