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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EMost difficult problems in managing canine otitis are the result of inadequate treatment, chronic inflammation, or failure to identify and control the underlying cause. This article discusses two key concepts are important to appropriate management of otitis. First, appropriate standard-of-care topical therapy must be used and any infections cleared, not just suppressed. Second, long-term maintenance is necessary to prevent recurrence.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EDermatologic \u0026amp; Otic Diseases\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInfectious Diseases\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EVeterinary Medicine\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECompanion Animals\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EDermatologic \u0026amp; Otic Diseases\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInfectious Diseases\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECompanion Animals\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EMost difficult problems in managing canine otitis are the result of inadequate treatment, chronic inflammation, or failure to identify and control the underlying cause. According to James O. Noxon, DVM, Iowa State University, Ames, Iowa, USA, 2 key concepts are important to appropriate management of otitis. First, appropriate standard-of-care topical therapy must be used and any infections cleared, not just suppressed. Second, long-term maintenance is necessary to prevent recurrence.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EOtitis treatment involves thorough cleaning and administration of medication to the entire ear canal. Oil-based ointments penetrate the skin better than do aqueous solutions but should be based on a light oil so that the medication can reach the entire length of the canal. The amount of medication to apply depends on the size of the ear canal, which varies according to weight. According to Dr. Noxon, the volume recommended on most ear products is too low and is a major source of treatment failure. He recommended applying medication by volume (mL) rather than drops but cautioned that too much can cause systemic effects. Once-daily administration is sufficient for most conditions. To completely clear otitis, medication should be applied for 30 days.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EAfter treatment is completed, the patient should be rechecked. Maintenance therapy involves client education and intermittent use of antiseptics, therapeutics, and mild glucocorticoids until the primary cause is identified and controlled.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003E\n         \u003Cem\u003EPseudomonas\u003C\/em\u003E infections, ceruminous otitis externa, and hyperplastic ear changes can be difficult to treat. \u003Cem\u003EPseudomonas\u003C\/em\u003E should be strongly suspected when a single population of gram-negative rods is seen on cytology. The identification can be confirmed with culture and susceptibility testing. Antibiotics are the primary treatment for \u003Cem\u003EPseudomonas\u003C\/em\u003E infection (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E). \u003Cem\u003EPseudomonas aeruginosa\u003C\/em\u003E can form a biofilm in the ear, increasing resistance to treatment; in such infections, the concentration of medication should be increased [Pye CC et al. \u003Cem\u003EVet Dermatol\u003C\/em\u003E 2013]. Tromethamine edetate disodium dihydrate (Tris-EDTA) is synergistic with some antibiotics, clearing antibiotic-resistant \u003Cem\u003EPseudomonas\u003C\/em\u003E infections. Tris-EDTA significantly potentiates the bactericidal activity of silver sulfadiazine against multidrug-resistant \u003Cem\u003EP aeruginosa\u003C\/em\u003E [Buckly LM et al. \u003Cem\u003EVet Dermatol\u003C\/em\u003E 2012 (abstr FC-20)].\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/15018\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/15018\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15018\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003ETreatment of \u003Cem\u003EPseudomonas\u003C\/em\u003E Infection, Ceruminous Otitis, and Hyperplastic Ears\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-7\u0022\u003ECeruminous otitis most often accompanies familial seborrhea and may involve various infectious agents. The ear wax thickens and is difficult to remove. Progressive hyperplastic changes occur. Treatment consists of cleaning and control of infections (\u003Ca id=\u0022xref-table-wrap-1-2\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E). Hyperplasia (lichenification) promotes a microclimate favoring microbial growth and prevents distribution of topical medications. Swelling may be due to inflammation and edema or fibrosis, including cartilage ossification. Diagnostic evaluation includes palpation of the ear canals and bullae for calcification or fibrosis; pain indicates bullae involvement. Otoscopic examination and imaging studies can help determine the extent of involvement. Hyperplasia and any infections should be treated as described in \u003Ca id=\u0022xref-table-wrap-1-3\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EDr. Noxon concluded that most difficult otitis cases develop when there has been a breakdown in communication or a failure to strictly adhere to the best ear management practices. Thorough ear cleaning and control of infections are necessary.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/25\/10.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzozop\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzozop\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}