5 tips to tackle otitis externa
This CVC educator and Iowa State University faculty member breaks down some ear-cleaning basics every general practitioner can put to work today.
Jim Noxon, DVM, DACVIM (small animal), had an audience laughing and learning in a recent CVC session. Here are a few of the takeaways he dished out for folks on making sure you and your clients get the most bang for your buck out of your dermatologic treatment.
Clean the ears
Remove debris that causes irritation. Remove debris that prevents your medicine from getting deep enough. Remove debris that interferes with the ear's natural self-cleansing mechanism. Remove debris that can actively interfere with ingredients in your ear medicine, like pus. Dr. Noxon is all about getting a better head start to give your therapy a better chance to be effective.
Get the hair out
Dr. Noxon is not advocating for pulling hair for routine grooming or preventive care, but when there's a lot of hair, you know the medication may not be getting deep enough to be effective. In most cases, plucking the hair with hemostats works fine. His advice? Just make sure you're only grasping hair when you pull!
Pick a good tool
What's Dr. Noxon like for ear cleaning tools? Here are his thoughts:
> Be careful with the bulb? "I'm not a fan of the bulb syringe. I've had to go in and tell people their dogs' eardrums are ruptured," Dr. Noxon says. "If you create a seal, pushing fluid in or pulling fluid out, pop-that eardrum's gone."
> Be leery of the loop? "I love ear loops, and I use them all the time, but they carry a steep learning curve," Dr. Noxon says. Your depth perception is minimal because you're working in a very small, relatively deep hole (the ear canal). Remember to advance the loop very slowly and carefully to avoid rupturing the tympanic membrane.
> Edge toward the elephant? "I recommend a thorough deep flushing or cleaning technique," Dr. Noxon says, "but that always requires general anesthesia.” A compromise to avoid general anesthesia, he says, is to use a system like the elephant ear cleaner or the rhino ear cleaner. They're messy as stuff gets pumped out of the ear, so he uses absorbent diapers to clean up that mess.
Be careful with your pumping
You've settled on your water-blasting tool, but Dr. Noxon says it's the art of medicine when you judge how aggressive to be: "It's all done by feel," he says. "I'm really gentle, and if the dog is tolerating it, I might start being a little more aggressive." He's a fan of keeping the temperature as close to body temperature as possible, not hot water or chilled-from-your-plumbing iciness.
Get it on video
"The video otoscope is more fun," Dr. Noxon says, especially if you're trying to remove a solid plug down deep. And he absolutely uses general anesthesia, not just sedation-"I've never found a sedation protocol that works for getting out deep plugs of material, but if you've got one, I'll try one."