ISSN 2398-2950      

Otitis media

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Synonym(s): Middle ear disease


Introduction

  • Inflammation of the middle ear.
  • Cause: sequel to otitis externa, following iatrogenic damage to tympanum, or in association with neoplasia or inflammatory polyps. Hematogenous spread of infection is a rare cause. Otitis media with effusion in cats associated with auditory tube dysfunction secondary to nasal or respiratory disease
  • Signs: aural pain, otorrhea, head shaking, Horner's syndrome, concurrent otitis internal, facial nerve involvement.
  • Diagnosis: history, clinical signs, otoscopy, radiography, video-otoscopy, advanced diagnostic imaging (CT)
  • Treatment: medical if irreversible change not present, topical flushes and antibiotics, ventral bulla osteotomy if chronic irreversible change.
  • Prognosis: often poorly responsive to medical therapy as middle ear divided into large ventral and smaller rostrolateral cavity by a bony septum which can trap infection. Guarded if vestibular signs or neoplasia.
    Print off the owner factsheet on Chronic otitis to give to your client.

Pathogenesis

Pathophysiology

  • Neoplasia of the external ear or para-aural abscess may lead to secondary otitis media.
  • Occasional sequel to otitis externa Otitis externa, or iatrogenic damage to tympanum during irrigation.
  • Inflammatory polyps Nasopharyngeal polyp commonly cause chronic otitis in the cat, often seen in cats with a prevoius history of viral respiratory disease. Most polyps appear to arise from the auditory tube (Eustachian tube).
  • Otitis media secondary to otitis externa Otitis externa can occur as a result of neoplasia of the external ear canal and/or para-aural abscessation. Infection triggered by allergic otitis externa can lead to descending bacterial infection.
  • The most common cause of chronic otorrhea in the cat is the extension of inflammatory polyps from the middle ear cavity through the tympanum into the horizontal canal.
  • Otitis externa → debris accumulation in contact with eardrum → eardrum weakened by infection and ruptures → medial extension of inflammatory process → hyperemia and thickening of mucoperiosteal lining → accumulation of exudate in tympanic bulla → thickening/sclerosis of bulla → medial spread to cause otitis interna or, rarely, bulla osteomyelitis.
  • Iatrogenic damage to tympanum → access to middle ear of pathogens → inflammatory response → otitis interna.

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Deleporte S &  Prelaud P  (2021) Single myringotomy for the treatment of otitis media in cats: a retrospective study.  Vet Dermatol 32,  419- 433.
  • Swales N,  Foster A &  Barnard N  (2018) Retrospective study of the presentation, diagnosis and management of 16 cats with otitis media not due to nasopharyngeal polyp. J Feline Med Surg 20 (12), 1082-1086 PubMed
  • Detweiler D A,  Johnson L R,  Kass P H &  Wisner E R  (2006)  Computed tomographic evidence of bulla effusion in cats with sinonasal disease: 2001-2004.  J Vet Int Med  20 (5),  1080-1084 PubMed.
  • Allgoewer I, Lucas S & Schmitz S A (2000) Magnetic resonance imaging of the normal and diseased feline middle ear. Vet Rad Ultra 41 (5), 413-418 PubMed.
  • Bruyette D S & Lorenz M D (1993) Otitis externa and otitis media: diagnostic and medical aspects. Semin Vet Med Surg (Small Anim) (1), 3-9 PubMed.
  • Trevor P B & Martin R A (1993) Tympanic bulla osteotomy for treatment of middle-ear disease in cats: 19 cases (1984-1991). JAVMA 202 (1), 123-128 PubMed.
  • Boothe H W (1991) Surgery of the tympanic bulla (otitis media and nasopharyngeal polyps). Probl Vet Med (2), 254-269 PubMed.

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