Image of a Ruptured Tympanic Membrane

Image of a Ruptured Tympanic Membrane

ruptured TMIt is important to visualize and clean the ear canals in order to effectively manage cases of chronic otitis. The OtoPet-USA Video Vetscope may be used for visualization in conjunction with the OtoPet-USA Earigator, which may be used to lavage, suction and remove debris from the ear canals.

Excessive debris must be cleaned out for several reasons when managing cases of otitis.

Debris can block the penetration of topical agents to the affected tissue requiring treatment, and large deposits may prevent medication from reaching the deeper parts of the ear canal. Larger clumps of debris that remain in the ear canal may sequester organisms as well. Debris can also protect microbes that are attached to keratinocytes, and therefore, covered with a protective lipid layer. These organisms may survive therapy and then infect the ear again.  Retained debris may also contain pro-inflammatory substances, such as microbial byproducts and toxins. Additionally, purulent discharge may interfere with the effectiveness of some antibiotics. Finally, it is often necessary to clean the ear of debris simply to be able to properly to visualize the tympanum.

Below is a case study demonstrating the use of the Video VetScope and Earigator to visualize and clean an ear with chronic otitis.

A middle-aged dog presented with a unilateral chronic otitis for several months duration. He had a normal examination besides pain, erythema and purulent discharge from the affected ear. He was placed under general anesthesia, which was required to completely assess the ear canal and for a through otic flushing. An endotracheal tube was placed and the patient was positioned in lateral recumbency.

Initially, it was difficult to assess the tympanic membrane as there was discharge obstructing the view. With visualization using the Video VetScope, samples of the discharge were taken for cytology and culture and sensitivity prior to flushing the ear canal. Rods were visualized on cytology.

Using the Earigator, the ear canal was then copiously flushed with a warmed saline to remove the discharge. Alligator forceps inserted through the Video VetScope probe may be used to remove any excess debris if needed as well.

Finally, the ear was evaluated again with the Video VetScope to assess the tympanic membrane, which was found to be ruptured. An image of the ruptured tympanic membrane was captured and can be seen here.

The patient was sent home on oral Zenequin® pending the culture and sensitivity results, a tapering dose of steroids and a topical mixture of tris-EDTA, Dexamethasone SP and Baytril®.

The culture and sensitivity revealed Pseudomonas, which was sensitive to Zenequin®. The patient was continued on oral Zenequin®, tris-EDTA, Dexamethasone SP and Baytril® applied topically twice daily for 4 weeks, as well as instructed to finish the tapering dose of steroids that was initially prescribed. The plan was to repeat cytology and re-evaluate 3 weeks later but the patient didn’t return for follow-up.

If you have an interesting case that you would like to submit with pictures, please contact Dr. Jessica Melman Bhatia at jessvet3@aol.com.