Otitis Externa Case Study
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Swimmer’s Ear (Otitis Externa) - Risk Factors, Causes, Signs \u0026 Symptoms, Diagnosis, Treatment
Spaniel types had 1. Skull shape was not associated with otitis externa Table 4. This is the largest study of dogs under primary veterinary care to date that provides epidemiological evidence on the frequency of diagnosis of otitis externa and its predisposing factors. Following some prior published evidence [ 8 , 26 , 35 ], the current study explored the odds of otitis externa between canine breeds with differing forms of ear carriage as a predisposing factor. In this rather large current cohort of cases, our results show that breeds with pendulous pinnal carriage had 1.
However, the results also provided some novel insights to show that dogs with V-shaped drop pinna have similar risk of otitis externa as breeds with pendulous ears OR 1. Conversely, no difference in odds was detected between dogs with erect compared to dogs with semi-erect pinnae. Pendulous pinnal carriage has long been reported as a predisposing factor for otitis externa [ 8 , 26 , 35 ] with the suggestion that this conformation can result in heat and moisture retention within the ear canal [ 26 ] and may be more likely to retain foreign material than other ear carriage types Griffin , Miller However, the identification of V-shaped drop pinna as a predisposing factor for otitis externa with a similar effect to pendulous ears is a novel finding.
Future studies to explore possible differences between the pathogenetic pathways for otitis externa in pendulous and V-shaped pinnal conformations are warranted, particularly to link this novel predisposing factor information with primary e. It should be noted that ear carriage and breed are closely linked concepts and therefore it is challenging to unravel the relative contributions of predisposing factors such as ear carriage from primary factors such as allergic dermatitis in breeds with a propensity to both. Hence the current study took a quantitative study design approach with multivariable modelling to report overall effects of predisposing factors at a population level but acknowledges that there will be additional nuance at the individual animal level that breeders, welfare scientists and veterinarians will need to additionally consider.
However, notwithstanding these considerations about crossover of effects between differing PSPP factors, the current study provides strong epidemiological evidence that pinnal carriage per se acts as a predisposing factor for otitis externa. This information could support the Kennel Club Breed Health and Conservation Plans, which aims to identify, prioritise and advise on breed health concerns [ 11 ]. After accounting for confounding effects, Basset Hound OR 5.
Basset Hounds have previously been reported at higher risk of otitis externa due to their highly pendulous pinnae, a phenotype that was selected supposedly to lead scents to their noses [ 36 , 37 ]. Although without a firm evidence base, it is also possible that the long and deep ear canal in Basset Hounds may also act to delay resolution of infections once started, and lead to higher probability of otic chronicity in this breed.
The current study reported prevalence i. Basset Hounds are reported to harbour more Malassezia spp. This may manifest clinically as dark staining of the skin with or without discharge in their ear canals and skin folds and can be verified by cytology [ 39 , 40 ]. This highlights the importance of thorough examination of the ear canal in combination with the pinna and the overall body skin as well as assessing for clinical signs e. Beagles and Golden Retrievers have dropped pendulous or V-shaped pinnae which, as identified in the current study, may increase the risk of these breeds for otitis externa [ 41 ].
Chinese Shar Pei, however, have semi-erect ears, suggesting an alternative pathogenesis in this breed. Following selective breeding to achieve the Chinese Shar Pei breed standard, hyaluronic acid accumulates in their dermis resulting in folded and narrowed ear canals, predominantly of the vertical part [ 42 , 43 , 44 ]. Breed health plans for breeds at high risk of otitis externa could consider prioritising control of otitis externa as a priority health goal [ 11 ] while owners and veterinarians should be especially vigilant about ear examination and care in such predisposed breeds.
For the first time, we report here on protection i. To date, the veterinary literature has focused mainly on breed predisposition to disease [ 45 ]. However, there is an increasing awareness of the value of exploring protection to disorders within breeds with a view to elucidating novel genetic, conformational and aetiopathogenetic pathways for reduced disorder occurrence [ 10 , 21 ]. Discovery of protected breeds could also support plans to improve breed health and reduce disorder incidence in at-risk breeds by outcrossing programmes [ 46 , 47 ]. Chihuahua was the breed with the lowest risk to otitis externa, potentially due, in part, to their erect pinnal conformation [ 8 , 41 ], low body weight smallest dog breed and low tendency to primary skin disease in general [ 48 ].
The presence of guard hairs at the entrance to the ear canal in Chihuahuas may also contribute to a low risk of otitis externa. However, there is controversy about whether guard hairs act more to protect ear canals from the ingress of foreign material or to prevent the egress of foreign material from the ear canal. Preventing egress would likely delay resolution of otitis externa. For example, although German Shepherd Dog and Siberian Husky breeds both have plentiful guard hairs at the entrance of the ear canal, the former appears to be more often affected by otitis externa than the latter, suggesting that the role of guard hairs in otitis externa may be quite complex [ 49 ].
Other than Border Collies, it is notable that the breeds identified as significantly protected were all small breed dogs, suggesting that small body size and therefore shorter ear canals [ 4 ] in addition to pinnal conformation may be contributory protective factors [ 41 ]. The current study is one of the first to explore disorder occurrence across a range of designer breed-types. A hybrid vigour effect has been previously proposed whereby designer dogs with greater outbreeding are expected to show better general health than pedigree dogs that are more inbred [ 50 ].
However, this effect is not supported by the current study for a polygenic disorder such as otitis externa where some common designers types even showed predispositions to increased disorder risk. Designer breeds overall showed 1. The higher odds identified may be less to do with being designer per se and more to do with the poodle or spaniel component that is common among popular designer types. In line with this, Labradoodles OR 2. Poodle-types OR 1. Increased risk for otitis externa in poodles may in part be due to their pendulous pinnal carriage, excessive curly hairs in the external ear canal [ 1 , 26 , 51 ], aural microclimate and the proposed need for repeated ear plucking that is under heavy controversy [ 25 ].
In addition, poodles are commonly affected by allergic skin disease that can act as a primary cause of otitis externa [ 52 ] and especially prone to Malassezia overgrowth in the ear canals [ 22 ]. This poodle predisposition may even be increased by crossing a poodle with a spaniel which is another predisposed breed type with pendulous pinnal carriage, or with a breed such as the Labrador Retriever that is prone to primary skin disease contributing to aural atopic disease [ 53 , 54 , 55 ]. Therefore, breeders of designer-types need to be wary to avoid selecting towards a phenotype that combines differing risk factors from parental breeds and therefore could increase disease risk in the first generation of puppies often called the F1 hybrids [ 56 , 57 ].
The wider variability in the phenotypes of progeny from planned hybridisation between different breeds may also lead to greater variability in the health status across individual dogs from these hybridisation breeding programmes. It is worth noting that the current study was based on dogs that are under veterinary care in the UK [ 34 ]. Similarly, there may be variation in typical breed conformations, genetics and canine lifestyle factors between countries and therefore extrapolation of the results in the current paper should be taken cautiously [ 59 , 60 , 61 ].
Breed and bodyweight are highly correlated, therefore these two factors were not included in the same models [ 62 ]. However, this increased risk with increasing absolute bodyweight is also reflected in the current results by an increased risk in higher weight-carrying dogs within the same breed. Dogs weighing at or above the breed mean bodyweight had 1. It is possible that increased risk of otitis externa in heavier dogs may in part be related to obesity and neutering state, but further studies are needed to elucidate this mechanism more fully.
Nonetheless, these suggestive findings that obesity may be linked to higher odds of otitis externa should further promote the importance of maintaining a moderate body condition score in dogs [ 63 ]. Sex was identified as a weak but still predisposing factor for otitis externa in the current study, with males at 1. A report based on dogs presenting to teaching and referral hospitals in India similarly identified higher prevalence of otitis externa in male dogs compared to females [ 24 ]. Several UK breed-based reports failed to identify sex-related differences for otitis externa [ 15 , 17 , 55 , 64 ].
However, a significantly higher prevalence of otitis externa in males compared to females has been reported in the West Highland White Terrier [ 16 ] and Chihuahua [ 65 ]. Androgen hormones may increase sebum production, which is a predisposing factor to flare up of latent otic infections as well as favouring Malassezia spp. Conversely, oestrogens elicit an opposite response of drying the skin that may promote secondary infections, especially in allergic dermatitis cases [ 7 , 24 , 25 ].
The current study provides some evidence of an increased risk in males overall but further research is required to determine if this is universal across breeds or whether this effect varies between breeds and is moderated by other factors. No substantial associations were identified between variants of skull conformation and otitis externa in the current study. Some increased risk may have been expected in brachycephalic breeds from a biological perspective because the external ear canal of brachycephalic dogs is often folded and narrowed due to the skull shape, which would be expected to promote reduced air flow and increased humidity in the ear canal, thus promoting and prolonging otitis externa [ 66 ]. Consistent with this rationale, the current study showed that breeds with more extreme brachycephaly, such as French Bulldogs, English Bulldogs and Pugs, had greater odds of otitis externa than crossbreeds.
There is conformational variation both within, and between, brachycephalic breeds [ 67 ] and therefore it may be that skull shape acts as a predisposing factor only for the more extreme brachycephalic breed types. This effect may act as another reason to support the increasing calls to reduce the degree of extreme exaggeration in many brachycephalic breeds [ 68 , 69 ]. This study focused on predisposing factors that centre on breed and other demographic characteristics. However, there are other categories of risk factors that could have also been considered and that would have added additional useful inference from other perspectives. There is little information available at a population level about the relative proportional contributions of other underlying conditions e.
Exploration of the comorbid presence of a range of potential clinical risk factors in each of the otitis externa cases in the current dataset could provide some information on the relative importance of each of these to the overall occurrence of otitis externa in dogs and therefore constitutes a useful concept for future study [ 74 ]. Extraction of detailed data on veterinary clinical management and therapy offers another research approach that could build on the current data to contribute to a deeper understanding of the pathophysiology of these otitis externa cases at a population level [ 77 ].
Elucidation of proportional usage of antibiosis, for example, could provide evidence of a bacterial role in the otitis externa process while evidence from bacterial culture and antimicrobial sensitivity testing could provide deeper insights into the most commonly associated bacteria and their common antibiograms [ 78 , 79 ]. There is also currently high interest in exploring aspects related to antimicrobial stewardship in companion animals and therefore benchmarking of current first opinion therapeutic patterns to offer additional scientific benefits [ 75 , 80 ]. A deeper understanding of breed as a risk factor for otitis externa could take into account the severity of the disorder phenotype experienced by these dogs as well as a range of temporal characteristics including the duration of individual events, recurrence and chronicity.
Analysis of these features has been applied previously to compare welfare impact across common disorders in dogs but this approach could also be taken to compare between breeds in future studies [ 29 ]. Research based on primary-care data offers novel opportunities to better understand common and less complicated disorders [ 14 ] but the methodology does have some important limitations which have been previously documented [ 14 , 81 ]. In addition to these, the current study may have under-estimated the true prevalence of otitis externa because some owners of affected dogs may not have sought veterinary attention e.
Additionally, some owners may not have acknowledged the existence of otitis externa in their dog because of limited awareness of the clinical signs or the welfare significance of aural pain and hearing alterations [ 28 , 29 , 30 , 31 ]. Dissemination of information from veterinarians on the need for increased aural vigilance by owners of breeds with known predisposing factors for otitis externa may therefore assist with earlier recognition and higher levels of presentation for veterinary care of affected dogs.
Additional breeds to the ones included in the current study have previously been reported with predisposition to otitis externa [ 8 , 82 ] but there were insufficient numbers for many of these rarer breeds in the current study for reliable assessment. This large study using primary-care veterinary data reports a 7. Conformational predispositions were identified, with dogs with pendulous and V-shaped drop pinnal carriage at higher risk of otitis externa than dogs with erect pinnal carriage.
Strong breed effects as predisposing factors were identified, with Basset Hound, Chinese Shar Pei, Labradoodle, Beagle and Golden Retriever showing greatest predisposition to otitis externa. In addition, designer breed types had higher odds of otitis externa compared with crossbreeds. Awareness of these risk factors could assist veterinary practitioners and owners to reduce the contribution of aural disorders to the overall welfare burden in dogs by improved selection of dogs for breeding and ownership, and by earlier recognition of clinical events of otitis externa. Greater understanding on how breed itself and breed-associated ear carriage conformation factors affect the probability of otitis externa in dogs can help veterinary practitioners to promote cautious and low-harm approaches to preventing otitis externa e.
Breed health plans could consider inclusion of otitis externa as a priority condition in predisposed breeds and conformations. The study population included all dogs under primary veterinary care at clinics participating in the VetCompass Programme during Dogs under veterinary care were defined as having either a at least one electronic patient record EPR free-text clinical note, treatment or bodyweight recorded during or b at least one EPR recorded during both and VetCompass collates de-identified EPR data from primary-care veterinary practices in the UK for epidemiological research [ 34 ]. Data fields available to VetCompass researchers include a unique animal identifier along with species, breed, date of birth, sex, neuter status and insurance.
Clinical information from free-form text clinical notes, summary diagnosis terms [ 83 ], bodyweights and treatment with relevant dates were also available. A cohort study design was used to estimate the one-year period prevalence of otitis externa and to explore associations with signalment and conformation as predisposing factors. Sample size calculations estimated that 13, dogs would need to be assessed to estimate prevalence for a disorder occurring in The case definition for otitis externa cases required evidence in the clinical records that otitis externa was diagnosed to exist as a clinical condition at some point during The clinical decision-making process was completely at the discretion of the attending veterinary surgeons.
The clinical records of a randomly selected subset of dogs from the sampling frame of unique dogs in the overall study population were reviewed manually in detail to identify all dogs that met the case definition for otitis externa [ 84 ]. This study aimed to identify and extract information on the diagnosed cases rather than to question how these diagnoses were made. No additional information was extracted on laterality, chronicity or comorbidity with other conditions. No distinction was made between pre-existing and incident cases of otitis externa. Breed descriptive information entered by the participating practices was cleaned and mapped to a VetCompass breed list derived and extended from the VeNom Coding breed list that included both recognised purebred breeds and also designer breed terms [ 83 ].
This approach was taken to facilitate statistical power for the individual breed analyses [ 86 ]. Crossbreeds were used as the comparator group because they were the largest single group. Breeds were characterised by ear carriage based on pinnal phenotypes typically described for each breed [ 60 , 87 , 88 ]. The categories of ear carriage included erect also known as prick or upright e. Based on various kennel club breed descriptions [ 59 , 89 ], breeds were also characterised by skull shape dolichocephalic, mesocephalic, brachycephalic, not categorised , spaniel spaniel, non-spaniel, not categorised and poodle poodle, non-poodle, not categorised status for analysis.
Neuter and insurance status were defined by the final available EPR value. The CI estimates were derived from standard errors based on approximation to the binomial distribution [ 90 ]. Predisposing factor analysis included dogs with otitis externa as cases and all remaining dogs as non-cases. Because breed was a factor of primary interest as a predisposing factor, variables derived from breed information were considered as correlated with breed ear carriage, skull shape, spaniel, poodle, purebred, Kennel Club recognised breed and Kennel Club breed group and were excluded from initial breed multivariable modelling.
Instead, each of these variables individually replaced the breed variable in the main final breed-focused model to evaluate their effects after taking account of the other variables. Model development used manual backwards stepwise elimination. Clinic attended was evaluated as a random effect and pair-wise interaction effects were evaluated for the final model variables [ 20 ]. The area under the ROC curve and the Hosmer-Lemeshow test were used to evaluate the quality of the model fit and discrimination non-random effect model [ 20 , 91 ]. Google Scholar. Practical otic anatomy and physiology of the dog and cat. Vet Clin Small Anim Pract. Article Google Scholar.
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BMC Vet Res. Impact of a terbinafine—florfenicol—betamethasone acetate otic gel on the quality of life of dogs with acute otitis externa and their owners. Nuttall T, Bensignor E. A pilot study to develop an objective clinical score for canine otitis externa. Primary secretory otitis media in the cavalier king Charles spaniel: a review of 61 cases. Etiopathogenesis and classification of otitis externa. Ames: Ear diseases of the dog and cat; Occurrence and population size of Malassezia spp. Coatesworth J. Causes of otitis externa in the dog. UK Vet Companion Anim. Craig M. Disease facts: otitis externa. Companion Anim. Paterson S. Malassezia otitis — frequently asked questions. Malassezia otitis externa in the dog: The effect of heat-fixing Otic exudate for cytological analysis.
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Can Vet J. Breed predispositions to disease in dogs and cats. Wiley-Blackwell: Chichester; Book Google Scholar. Signs of this illness are visible vesicles either in the lips or adjacent skin. Symptoms include tingling or itching in the affected area. These vesicles and sores have a fluid that should not be touched since it is highly contagious. In children orolabial herpes is often the first herpes simplex infection. This is a combination of gingivitis infection in the gums and stamatits or inflammation in the.
The skin around the sores becomes dry and flakey and sometimes even becomes ulcerated like the skin was eaten away Carson-Dewitt. Along with the signs, the symptom of itchiness almost always appears. The itchiness contributes to the spreading because the patient will feel the urge to scratch the sore, and when the bacteria get under the nails it spreads to whatever else the patient touches. A patient can also develop a fever, pain, and swelling if the infection spreads and worsens Scholten. If the Impetigo is left untreated it has the potential to worsen and develop into: ecthyma, black scabs around ulcers; glomerulonephritis, a kidney disease; osteomyelitis, a bone infection;sepsis, a systemic infection; scarlet fever; streptococcal disease or pneumonia Carson De-Witt, Scholten.
Preterm births and low birth weight affect different states in the USA in a variety of ways. For example, research done in proved that preterm births are common among non-Hispanic African Americans women at The rate of low birthweight among non-Hispanic African Americans are also considerably high compared to the non-Hispanic white. Low birth weight among children brings creates a lot of problems. What are the symptoms and signs of cystic fibrosis? Cystic fibrosis causes protean manifestations, but the most common include lung and gastrointestinal symptoms.
Respiratory symptoms often involve recurrent cough that eventually becomes persistent and productive of mucus. Patients also typically have wheezing and may complain of shortness of breath. The infection of the middle ear can spread to the mastoid and cause the mastoid to break down www. This occurs mostly in children, especially when the child has several reoccurring ear infections or a history of ear infections www. These symptoms include: pain behind the ear, swelling of the ear lobe, recent ear infection, fever, irritability, redness or swelling of the bone behind the ear mastoid process , drainage from the ear, headache, and hearing loss www.
Every person may experience these symptoms or different ones since every body is different and reacts differently to this condition. However, it is likely due to an abnormal response of the immune system. Food or bacteria in the intestines, or even the lining of the bowel may cause the uncontrolled inflammation associated with Crohn 's disease. Signs and Symptoms: The symptoms of Crohn 's disease depend on where the disease occurs in the bowel and its severity.
These are some symptom examples Chronic diarrhea, often bloody and containing mucus or pus Weight loss Fever Abdominal pain and tenderness Feeling of a mass or fullness in the abdomen Rectal bleeding. Eczema may be inherited, from a family member who has eczema or who has asthma or hay fever. Doctors think eczema causes are coorrelated to allergic disease, such as hay fever or asthma. This is what doctors call the atopic triad.
Some other factors that may cause Eczema are irritants soaps and disinfectants , ceratin allergens pets, pollens, molds,dandruff, and dust mites , foods, stress, or temperature. Then I would order a topical antibiotic to repair the redness and inflammation of the external ear. I would also order a systemic antibiotic because the patient is a diabetic. Fluoroquinolones are very effective in treating both P.
Because the patient is a diabetic and prone to peripheral neuropathy, I would order instead an aminoglycoside, Neomycin with polymysin B that will cover both P. Moreover, if the patient 's hearing loss does not return to normal, I would refer the patient to an otolaryngologist for further evaluation of possible perforated tympanic. When untreated, it may lead to recurrent ear infections Chronic Otitis Externa and even extend to the bony ear canal and the soft tissues deep to the bony canal Malignant Otitis Externa.
The incidence is increased towards the end of the summer especially in the 5- year-old age range; and is common in warmer temperatures and high-humidity conditions. Precipitating factors of Acute Otitis Externa are excessive moisture and trauma, both of which impair …show more content… Occasionally, patients may experience fever and itching especially if fungal in etiology and chronic in presentation. Moreover, common symptoms and signs include otalgia, itching, aural fullness, tenderness of the tragus and pinna, ear canal edema, hearing loss, erythema, and otorrhea McWilliams,In Practice. Treatment Otitis Externa Case Study to remove the object. BMC Write An Essay On Pagets Disease Res. Some side effect are Autistic Sixth Grader Essay, diarrhea and anaphylaxis ED: Martin Margiela Analysis exposure to tobacco smoke to prevent worsening of the symptoms. The Otitis Externa Case Study is more eczematous in nature Martin Margiela Analysis more itching than pain. Macbeth act 4 design: Case series with chart macbeth act 4.