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7 steps for a full ear workup
Overheard at CVC: Dr. Paul Bloom, DACVD, DABVP (canine and feline), highlights the steps for a complete ear disease exam, including the vital role veterinary technicians play. (Hint: It's about finding the what and the why.)
Ear disease is only a description, which is no more specific than pruritus, said Paul Bloom, DVM, DACVD, DABVP (canine and feline), at a recent CVC. In fact, he says, according to Dr. James Noxon, DACVIM, the challenge is not only to find the “what” that's causing the otitis, but also to investigate the “why” behind the patient's otitis. Technicians play an important role in this diagnostic process. Read on to learn the steps to a complete otic workup.
Click here to download this form.1. Start by taking a detailed history. Click here for a downloadable otic history form. In addition to the otic history, technicians should also note the dog's age, breed and sex in the record, and whether the dog has had previous ear or skin problems. This includes getting a copy of the pet's record from its previous veterinarian if applicable. You can expedite treatment, Dr. Bloom says, by reviewing the previous treatments and tests prescribed and the patient's response.
Evaluate the patient's level of pain.
If you've ever had an ear infection, you know how painful it is, Dr. Bloom says. Patients with otitis should be evaluated for pain and receive proper pain management. Dr. Bloom has seen dogs that were unmanageable during ear exams become agreeable and allow an examination and treatment once the pain was gone. He says pain associated with otitis is an undertreated aspect of the condition.
2. Have the veterinarian do a complete physical exam and dermatologic exam. Sometimes there are systemic signs associated with otitis that need treatment. And, because ears are really just skin attached to the skull, Dr. Bloom says, many diseases that affect the ears frequently will affect the rest of the skin, and vice versa.
3. Pursue diagnostics and treatment. Technicians are invaluable when it comes to running the laboratory tests necessary in otitis cases, Dr. Bloom notes. A complete blood count, a serum chemistry profile, a urinalysis, skin scrapings, a fungal culture, endocrine testing and skin biopsies may be necessary, depending on the differential diagnoses for the patient. Any discharge should be swabbed and given a cytologic examination. The number and type of bacteria, yeast and inflammatory cells should be quantitated.
4. Perform an ear cleaning in the clinic. If, upon initial examination, the patient's ear canals are swollen and painful, ear cleaning may not be performed, Dr. Bloom says. Instead, topical glucocorticoids and systemic glucocorticoids may be administered for 10 to 14 days to decrease the swelling. Then you can perform the cleaning.
5. Complete an otoscopic examination. To ensure the ear canal is adequately clean, the veterinarian or technician should perform an otoscopic examination.
6. Evaluate the appearance of the cleaned ear. Note whether the tympanic membrane is visual and intact. If it isn't, why not?
7. Dispense topical agents. Dr. Bloom prefers to use ointments over drops, because he says the ointment delivers more of the drugs to the tympanic membrane region.
8. Schedule follow-up appointments. Follow-up exams will dictate long-term management of the disease and treatment progress.