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Treating twenty-five cases of chronic resistant otitis externa with fluticasone propionate (Flixonase®): a case series Utilising Flixonase® in treatment of chronic otitis externaKey points:Chronic cases of otitis externa, resistant to conventional treatments are notoriously difficult to treat, with resolution in these cases challenging.Guidelines suggest the use of corticosteroid in chronic otitis externa, however, there is no specific advice on which corticosteroid to utilise.Our case-series demonstrates the potential benefit of fluticasone propionate in patients who have previously failed a multitude of conventional management options.Despite the limitations of our study, our experience highlights a gap in the literature and suggest fluticasone propionate as an exciting and potentially important tool in the arsenal of the otolaryngologist.

OTITIS externa is a common disease in dogs, and Proteus and Pseudomonas species are frequently cultured from chronic cases ([Welch Fossum 2002][1], [Krahwinkel 2003][2]). Otitis media in dogs is usually preceded by a bacterial infection of the external ear canal. The signs of otitis media, such as a

Hearing function was measured in normal dogs and in dogs with otitis using brainstem auditory evoked response testing. Data were obtained from 86 normal ears and from 105 ears with otitis, categorised into four degrees of severity. The data were analysed to illustrate the differences between the hearing function in the normal and abnormal ears and to estimate the degree of impairment associated with differing degrees of pathology. While severe hearing loss seemed to be present in the dogs with more severe otitis, only two individuals were identified as being totally deaf in the affected ears and no dogs were identified in which the cleaning and examination processes had caused damage to hearing function. Cleaning the ear canal produced measurable improvements in hearing in several dogs, indicating the profound effect of physical obstruction of the external ear canal by debris. It is concluded that most dogs with chronic otitis externa are not totally deaf and that the hearing impairment that does occur has the characteristics of conductive hearing loss.

THIS, the third in a series of articles on otitis externa in the dog and cat, briefly reviews the pathological changes which occur in chronic otitis to explain the rationale for surgery, and then goes on to discuss a variety of surgical approaches which aid the management of the condition. The previous articles covered the primary causes and investigation of otitis externa (January 1996, pp 9-16) and medical treatment (February 1996, pp 66-71).

Ventral bulla osteotomy was combined with total ear canal ablation for the treatment of chronic otitis externa and otitis media in 13 dogs (14 ears) that had been refractory to medical and surgical treatments. Resolution of disease occurred in 11 dogs (12 ears). One dog with unilateral disease underwent a second operation before achieving a good result. One dog was euthanatized for persistent unilateral disease after three surgical procedures. The recurrence of disease in these two dogs (15%) was associated with remnants of ear canal integument within the osseous horizontal canal or tympanic bulla. Facial paralysis occurred in four dogs (31%) and there were no complications in eight dogs (62%). This technique shows no advantage over lateral bulla osteotomy combined with total ear canal ablation for the treatment of chronic otitis externa and otitis media.

Problem: The aim of this study was to evaluate the problems encountered in the development of a Bone Anchored Hearing Aid (BAHA) program in a district general hospital, over a period of 11 years. Patient satisfaction was also assessed. Methods: Patient records and a patients’ database were evaluated retrospectively. Demographics, pre- and postoperative audiogram, surgical technique, and surgical and skin complications were recorded and analyzed. Patient satisfaction was assessed prospectively using a visual analog questionnaire. Results: BAHAs have been fitted to wide age group of patients (ranging from 7 to 80 years). Indications for surgery are congenital abnormalities in children and following mastoid surgery/CSOM (74%) in adults. The remainder is due to chronic otitis externa or otosclerosis. Half of these patients were tertiary referrals. Intially surgery was carried out in 2 stages (43%), Now all are performed in 1 stage with a local skin flap. Complications requiring further surgery (18%) have been due to trauma, primary failure to integrate, or as a result of late infections. Forty-one percent of patients have had no complications, including skin reactions. Review of patient questionnaires showed that 91% express their complete satisfaction with their device. Over 88% use their BAHA every day and for more than 8 hours. Ninety-five percent felt that one-on-one conversation was better with a BAHA. Most were pleased with the cosmetics of the abutment, ease of use of aid, with only 15% expressing difficulty cleaning the abutment. We had no nonusers in the study. Conclusion: Surgical complications were higher than other published data in the early stages of program development. Patient satisfaction was generally high, but improved significantly with the introduction of a multidisciplinary team approach. Significance: The BAHA service has developed steadily over the years. Surgical techniques have improved. Complications, especially skin problems have been reduced by the development of a specialized team approach involving the surgeon, nurse, audiologist, and patient. Support: None reported.

This article describes a surgical technique for the treatment of chronic stenosing otitis externa. A retrospective survey of the post-operative course in eight patients (10 ears) showed this to be a satisfactory treatment with no recurrence of symptoms.

— An aged dog with a chronic, bilateral, bacterial otitis externa developed bilateral squamous cell carcinomas of the pinna. The tumours were located where the pinna would cover the external auditory meatus and probably were induced by the chronic infection. Resume— Un chien age souftrant d'otite externe bacterienne chronique bilaterale presenta un epithelioma spinocellulaire bilateral des pavilions auriculaires. Les tumeurs etaient situees la ou les pavilions auraient recourvert le meat auriculaire et furent sans doute provoques par l'infection chronique. Zusammenfassung— Ein alter Hund mit einer chronischen, bilateralen, bakteriell bedingten Otitis externa entwickelte Plattenepithelkarzinome en beiden Ohrmuscheln. Diese Tumore traten an der Pinna exakt an der Mundung des auseren Gehorgangs auf, und sind moglicherweise durch die chronische Infektion induziert worden. Resumen Un perro de edad avanzada que presentaba una otitis externa bilateral bacteriana cronica desarrollo unos carcinomas de celulas escamosas bilaterales del pabellon auditivo. Los tumores estaban localizados en la entrada del meato auditivo y probablemente fueron inducidos por la infeccion cronica.

BACKGROUND Hearing loss is important when assessing the suitability of dogs with otitis externa/media for medical or surgical therapy. HYPOTHESIS/OBJECTIVES To assess an owner-completed questionnaire as an indicator of hearing loss and a canine hearing loss scoring system in chronic canine otitis. ANIMALS One hundred hospital population dogs referred for chronic otitis investigation. METHODS Owners completed a questionnaire to assess their dog's response to common household noises. The presence of otitis externa or media was determined and brainstem auditory-evoked response measurements were performed on each dog. The minimal hearing threshold (MHT) in decibels normal hearing level (dB NHL) was recorded and categorized according to the human World Health Organization grading system into five grades from 0 to 4 with cut-off values of ≤25 dB NHL, 26-40 dB NHL, 41-60 dB NHL, 60-80 dB NHL and ≥81 dB NHL. RESULTS The questionnaire correctly determined normal hearing in grade 0 cases, but did not reliably detect unilateral or grade 1 bilateral hearing loss. For dogs with bilateral hearing loss ≥ grade 2, questionnaire sensitivity was 83% [24 of 29, 95% confidence interval, (CI) 64-94%] and specificity was 94% (67 of 71, 95% CI 86-98%). Higher grades of hearing loss were significantly associated with the presence of otitis media (P

Objectives In select hosts fungal species may become invasive and opportunistic, resulting in severe morbidity and mortality. We report a rare case of invasive Aspergillus, diagnosed on initial presentation as chronic fungal otitis externa.

Between January 1985 and May 1987 53 ears of 35 dogs and five cats with chronic otitis externa were operated on using the pull-through technique for vertical canal ablation. Their postoperative follow-up is analysed, evaluated and described in detail.

Chronic otitis externa may be a sensitivity (dermatophytid) reaction from a distant pathogenic superficial fungal infection, eg, tinea pedis and monilial vaginitis, which are often difficult to eradicate. Skin testing is done with a combined antigenic extract of TOE (Trichophyton; Oidiomycetes, ie, Monilia or Candida albicans; and Epidermophyton). The serial dilution titration method of skin testing is done, and the end point of reaction is determined. Treatment is begun on a weekly basis, with subcutaneous administration of 0.3 cc of a TOE extract two dilutions weaker than the end point. Symptomatic improvement is usually noted within two to four weeks, with objective improvement within eight weeks. After a variable maintenance period, the injections are spaced at less frequent intervals.