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OTITIS Causes, Treatment & Management

Otitis externa and otitis media are two common ear problems in pooches. Here are the causes, symptoms and treatment for these ear problems.

Otitis externa is defined as an acute or chronic inflammation of the epithelium of the external ear canal which Otitismay also involve the pinna. The condition is characterised by erythema and increased discharges or desquamation of the epithelium with varying degrees of pain or pruritus. Contributing predisposing and primary factors for otitis externa must be evaluated or the condition is likely to become chronic, ultimately resulting in an end-stage ear with surgery the only viable option.
Otitis externa often results when a change in the normal environment of the ear canal causes the glands lining the canal to enlarge and produce excessive wax. Gradually, the outer skin (epidermis) and the inner skin (dermis) produce excessive fibrous tissue (fibrosis) and the canal becomes narrowed. It is normally a secondary symptom of another underlying disease, such as an infection.
While, otitis media is defined as inflammation of the middle ear and is an important perpetuating cause of otitis externa. Otitis media typically occurs as an extension of otitis externa, causing a ruptured membrane (tympanum) that separates the external ear and the middle ear.
Otitis externa and otitis media affect dogs and cats of any age and breed. As responsible pet parents, we can protect our canines from these ear problems.

Symptoms to look out for!

  • Pain
  • Head shaking
  • Scratching/itching at the external ear flaps
  • Bad odour
  • Redness and Swelling of the external ear canal
  • Scaling skin or obstruction of the ear canal
  • Tilting the head
  • Anorexia
  • Un-coordination and
  • Occasional vomiting

Causes of otitis
Foreign bodies: Plant material, dirt, sand, dried medicaments, cross-lodged hairs can cause otitis.  Diagnosis is more complicated if bilateral or if the condition has progressed with the appearance of a purulent discharge which may be confused with a primary bacterial disorder.
Ear tumours and polyps: Patients with ear canal tumours or polyps will present with unilateral otitis externa and possibly otitis media. Common tumours include sebaceous gland adenomas and adenocarcinomas, ceruminous gland adenomas and adenocarcinomas, carcinomas of undetermined origin, and squamous cell carcinomas. All masses within the ear canal should be surgically removed as soon as possible and positively diagnosed by biopsy.
Bacterial: Cytology is very important to estimate numbers of organisms. More common pathogens include Staphylococcus intermedius, Pseudomonas aeruginosa, Enterococcus spp, and Proteus spp. ‘Swimmer’s Ear’ can be a problem in dogs resulting from a combination of water retention, epidermal maceration and secondary infection with Pseudomonas spp.
Mycotic infections: In otitis, fungal organisms isolated are candida spp and rarely dermatophytes.

Diagnosis of otitis
Techniques like otoscopy, pneumotoscopy, bulla radiographs, otic endoscopy and magnetic resonance imaging (MRI) may be used to identify the accumulation of fluid or soft tissue growth in the middle ear. Otitis media was diagnosed in over 80 percent of these ears with chronic otitis.
Vets also need to know the history of the pet and will conduct a complete physical examination as well as otic examination (pinna, otoscopic examination of the external ear canal). Gram negative bacteria  is indicated by purulent, pale yellow, thick, tenacious, sweet smelling exudates while gram positive bacteria  is indicated by  light brown, creamy exudates. Ear mites  symptoms include dark brown to black crumbly exudates while those for yeasts include dark brown sweet smelling exudates.
Vet will perform a cytological examination, bacterial culture and sensitivity and additional diagnostic, testing like skin scrapings, fungal cultures, thyroid evaluation, allergy testing (skin or serum testing for inhaled allergens), ear canal biopsy, CT scan and hemogram and serum biochemistry profile.

Treating otitis
Treatment for otitis externa and otitis media usually involves outpatient care, unless the inflammation or infection has moved into the inner ear. In most cases of otitis externa, a topical therapy following a complete cleansing of the external ear is an effective resolution to the problem.
The topical therapy may consist of antibacterial, corticosteroid, anti-yeast, and antiseptic drops. In severe cases of otitis externa and otitis media – where the presence of infectious organisms has been confirmed – oral antibiotics and antifungal may be prescribed. Corticosteroids may also be used to reduce the animal’s pain and swelling.
Systemic antibiotics are prescribed for severe, chronic, or recurrent bacterial otitis externa and for all cases of otitis media. While, systemic antifungal agent Ketoconazole at 5-10 mg/kg/day should be considered along with topical therapy for treatment of yeast otitis media for 3-4 weeks, but should be continued until follow-up cytology confirms that the infection is cleared. Also, Zeps surgery can be performed for the correction of otitis media in dog.

Living and management
Follow-up treatments for otitis externa and otitis media involve repeat examinations of the ear discharge and control of any underlying diseases. With the proper therapy, most cases of otitis externa will resolve within three to four weeks, whereas otitis media takes a considerably longer time to treat it and up to six weeks to be resolved. If these conditions persist over long periods of time and are not treated, they may lead to deafness, facial nerve paralysis, otitis interna, and (rarely) meningo-encephalitis. So, take care of your pooch’s ears!
(Dr Vikash Sharma is MVSc & AH (surgery) at Animo Pet Care & Research Center, Patna.)

Dog Training

Anger management

What does the word ‘Dog’ brings to your mind? A loyal, loving and sweet canine! Nobody likes an aggressive pet dog and it is one of the leading reasons of abandonment. But dog aggression can be prevented, let’s see how.

Aggression is one of the most dangerous and misunderstood of all dog behaviours. It is also the leading reasonDog Training why so many dogs end up in shelters or euthanised each year. But, aggression can be prevented if you start early socialisation and basic obedience training for your dog. However, aggression can be controlled at a later stage as well.

Watch out for…

If your dog shows aggressive tendencies—usually displayed through growling, bared teeth, biting and lunging—you need to determine the root of the problem.

Aggression acumen…

There are many reasons a dog may become aggressive, and the solutions to each are unique. Therefore, it is important to pay close attention to your dog’s environment when he behaves aggressively so as to determine the most appropriate course of action. A dog may become aggressive for any of the following reasons:

  • Dominance: Normally displayed towards other dogs, your pooch might become aggressive towards humans if he views them as part of his pack. He is actually trying to establish himself as the ‘Alpha’ dog or pack leader.
  • Territory: Many dogs consider their homes and families their possessions and will defend them vigorously if they feel they are being threatened.
  • Fear: Fear will trigger the “fight or flight” response pre-programmed into all living beings. If he cannot flee, he will fight.
  • Predatory: Hunters by nature, dogs with a high hunting instinct may view children, cats, and small dogs as prey.
  • Redirected: A dog who cannot assert his aggression on the trigger of his fear, protectiveness, or anger may take it out on a nearby dog or human.
  • Medical: A female dog’s maternal instinct may trigger aggression when she is nursing, pregnant, or in heat.
  • Sudden aggression: Medical causes such as hypothyroidism and brain tumours can trigger sudden aggressive behaviour. If your dog suddenly becomes aggressive, consult your veterinarian immediately.

A training tune-up…

Fear and dominance are the two most common causes of aggression. Consistent positive training will do wonders for dogs in these situations:

  • Training the dominant dog: With the dominant dog, you must assert yourself as the ‘Alpha’ in the pack, having control over everything in his life. He must understand the need to ask for permission. Food, treats, walks, toys and affection are all under your careful control. Make your dog sit before being given any of these items, and praise him tremendously when he behaves. He will quickly understand he must mind his manners to get what he wants.
  • Training for the fearful dog: If fear is your dog’s trigger, slowly and carefully desensitise him by exposing him to his fear in small increments. Reward him with a treat or toy and give huge praise when his behaviour warrants. Gradually increase his exposure to the stimulus and he will learn not to lash out. Avoid crowded places and always keep your dog on a leash. Don’t let others taunt your dog, and slowly introduce new people to him both at home and in public until he readily learns to accept strangers.
  • Feeding alone: At feeding time, ensure your dog has his own bowl and does not feel like he has to compete for food. If necessary, feed him in a separate room.
  • Spaying/neutering: Spaying or neutering your dog can eliminate hormonal fluctuations that could trigger aggression.

With patience and training, the aggressive dog can be reprogrammed to make him your loving and well-behaved companion. Since aggression is a serious behaviour issue that is difficult to overcome, enlisting the assistance of a skilled dog trainer is recommended.

Pooch fracture management

Like kids, naughty pooches are also prone to accidents. They need vigilance, all time; a small negligence can end up in a troublesome situation, viz bone fracture or sprain. God forbid! But if it occurs, one needs to have ample information and knowledge to handle the situation tactfully. Here’s a complete overview about the fracture management for pets. Pets have been an integral part of our society since time immemorial. Pets at home are wonderful companions, great stress busters and provide unsolicited love and affection. Keeping pets has gained immense popularity in the last decade. Hence, there has been an increased demand for advanced and specialized health care especially in the field of ‘Small Animal Orthopedics and Neurology.’

Numerous pets have been rendered lame or paraplegic for their entire lifetime either due to lack of expertise or facilities in this field. Compassionate pet owners are most eager to consult with specialists in this field to obtain the best possible treatment options for their ailing pets. Specialized small animal orthopedics and neurology services have now become a priority for pet owners.

Milestones… so far

Primary aim of fracture treatment is to restore anatomical shape of the fractured bone and to restore the function of the affected limb. Until the early fifties, treatment of fractures in pet animals was confined mainly to casts and splints, which did not prove successful in complex fractures, and resulted in fracture disease. Fracture disease is characterized by non-union/mal-union of fractures, osteoporosis, joint stiffness, limb deformity, arthritis and muscle wasting. In 1958, a study group of Swiss surgeons formed ‘The Association For The Study of Internal Fixation’ (AO/ASIF) and developed new techniques, devices and implants for treatment of fractures. The philosophy of the organization was “Life is movement-movement is life”. The aim of the AO technique is a rapid return to full function of the affected leg.

In the late sixties, veterinarians adapted the principles of the internal fixation group, made modifications better suited to the needs of animals, carried out research, developed new and versatile equipment and implants to produce maximal stability of fracture with minimal reaction to facilitate early and pain free return to full limb function and permitting full range of motion of the joints. The benefits of this technique include early return of normal limb function compared to conservative therapy; little or no pain at the fractured site compared to conservative therapy; and no limb deformity or lameness compared to conservative therapy.

The technique used for fracture management was based on the configuration of the fracture and the type of forces that needed to be counteracted to promote stability. The age temperament, health status of animal and owner compliance influence decisions on fracture management.

Medical boons for pooches

Dynamic compression plate (DCP): The dynamic compression plate developed by the association for the study of internal fixation probably represents one of the most innovative developments in orthopedic surgery in the last two decades (British Small Animal Veterinary Association). Combining the plate with an intra-medullary pin (placing a pin through the bone) increases the strength of the plate multifold. Specially devised ‘T’ plates are used to manage distal radial fractures (fractures of the end of radius bone), as they do not heal easily. External fixators (Ex-Fix) : Ex-Fix and intra-medullary pins are used in combination for management of open infected shaft fractures/comminuted fractures (broken into many pieces).

The ‘hanging limb method’ and the OBDNT (open but do not touch procedure) technique of external fixator application for fracture fixation fulfill the principles of minimally invasive orthopedic surgery and promotes biologic fracture healing. External fixators with stainless steel connecting rods and clamps (dogs weighing > 15 kg) or locally available epoxy (dogs weighing <15kg) as connecting column have been used with success. Healing times were reduced and complications were minimized.

A “tie-in” procedure combining the intramedullary pin and external fixator for management of complicated fractures of long bones.

The advantages of the External Fixators system include

  • Closed or minimally invasive open application.
  • Fracture alignment can be adjusted during or after surgery.
  • Fixation can be removed without performing major surgery.
  • Relatively affordable with many reusable components.
  • Indicated for highly comminuted shaft fractures, open infected fractures mandibular fractures, bone deformities.

Other useful techniques include?:

  • Tension band wiring technique for avulsion fractures of olecranon process of ulna, tibial tuberosity and calcaneus (fractures caused by pull of the muscles in the opposite direction).
  • Combination of intramedullary pin and cerclage wiring (when the length of the fracture exceeded twice the diameter of bone) in fractures of long bones.
  • Intramedullary pinning in combination with cross pinning for supra condylar (fractures occurring near the end) fractures of femur.

Curing common orthopedic disorders

  • Femoral head and neck ostectomy (removal of the head and neck of femur bone) and placement of a muscle flap in the defect has been used successfully as a salvage procedure in the management of painful chronic osteoarthritis of the hip joints which occur in severe cases of hip dysplasia. Clinical studies indicate that this procedure provides early and pain free weight bearing on operated limb and improved quality of life of the animal.
  • Nutritional bone disorders have been diagnosed early using biochemical and radiological evaluation and successfully managed. Imbalance in nutrition and overzealous supplementation with calcium, especially in rapidly growing giant breeds, is the primary reason.
  • Growth deformities in dogs (bow legs) have been successfully managed with removing a portion of the ulna bone and using a fat graft or by performing corrective bone surgeries using a bone plate or an external fixator system.
  • Correction of patellar luxation in dogs (knock knees) have been performed successfully.

(Dr Ayyappan with over 16 years of experience is a PhD and Associate Professor in veterinary surgery from Madras Veterinary College. He did a Clinical Postdoctoral fellowship at the Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Purdue University, USA (2000-02). He specializes in small animal orthopedic surgery and neurology. He also completed the basic, advanced and special training in small animal orthopedic surgery at AO-International, Davos, Switzerland (1994,1995 and 1999). He can be contacted at: 9841249129/ 26475988; or email: jujups61@hotmail.com)