Clinical outcome of cats with suppurative otitis media and intact tympanum submitted to myringotomy: retrospective findings from 26 cases.

CASE SERIES SUMMARY: The efficacy of medical treatment associated with single myringotomy in cats with suppurative otitis media (OM) and intact tympanum was retrospectively evaluated. Patients' records were retrieved from cats with suppurative OM. Cats were included in this retrospective study based on fluid content within the tympanic cavity on imaging, intact tympanum on otoendoscopic examination and neutrophils on ear bulla exudate cytological examination. A total of 26 cats with middle ear suppurative otitis were included. Just over half of the cats (54%) presented bilateral involvement. Clinical signs included head tilt (13/26), otalgia (9/26), Horner's syndrome (7/26), external ear discharge (5/26), and nystagmus and facial paralysis (1/26). Cocci were identified on cytological examination in 18/40 samples and rods in 2/40. Bacterial culture results were positive in 15/40 samples, with Pseudomonas species (4/15), Pasteurella multocida (3/15), Staphylococcus felis (3/15), Staphylococcus schleiferi (2/15), Staphylococcus canis (2/15), Escherichia coli (2/15), Staphylococcus pseudintermedius (1/15) and Serratia marcesens (1/15) isolation. After myringotomy and gentle flushing of middle ear bullae (0.5-2 ml saline per ear), all cats were treated with oral corticosteroids and a 1-month course of systemic antibiotics according to sensitivity testing. In total, 19 (73%) cats were clinically healed 60-240 days after treatment. One cat was euthanased because of failure to eradicate a Pseudomonas species infection. Another cat died a few hours after the procedure. The five remaining cats were cured after ventral bulla osteotomy. RELEVANCE AND NOVEL INFORMATION: OM without an aural polyp is a frequent diagnosis in cats, but data on medical treatment are scarce. This simple therapeutic technique, single myringotomy procedure and mild ear flushing, offers a practical, safe and efficient first-line treatment of suppurative OM with an intact tympanum in cats with or without neurological signs.

Pilot study of dogs with suppurative and non-suppurative Malassezia otitis: A case series.

BACKGROUND: Rarely, Malassezia otitis presents as a painful, erosive otitis with an otic discharge containing Malassezia and neutrophils on cytology. There are no published reports of this type of suppurative Malassezia otitis (SMO). The role of Malassezia hypersensitivity in otitis is still unknown, and no association has been demonstrated with SMO. We compared Malassezia IgE levels, intradermal test and histology changes in SMO dogs with the more conventional Malassezia otitis (MO) presentation. RESULTS: Three dogs (case 1, case 2 and case 3) were diagnosed with SMO, one dog (case 4) was diagnosed with unilateral MO and unilateral SMO, and one dog (case 5) was diagnosed with MO. Only one case (case 4) with SMO/MO had a positive Intradermal Allergy Test (IDAT) and elevated IgE levels for Malassezia. Histopathology findings from SMO revealed: interface dermatitis (case 1 and 3), lymphocytic dermatitis (case 2) and chronic hyperplastic eosinophilic and lymphoplasmacytic dermatitis (case 4). Histopathology findings from MO showed perivascular dermatitis (case 4 and 5). All the cases were treated successfully. CONCLUSIONS: SMO presents with a distinct clinical phenotype in comparison with conventional MO. No consistent aetiology could be isolated. In these clinical cases it is possible that previous treatments could have influenced the results. More research is needed to understand the possible aetiologies and the pathogenesis of SMO.

Expansile, inflammatory middle ear disease causing nasopharyngeal obstruction in a cat.

A 7-year-old, entire female, domestic shorthair cat presented with recurrent upper respiratory tract problems. Infectious otitis media caused expansion of the middle ear which ultimately resulted in complete obstruction of the nasopharynx. A ventral bulla osteotomy was successful in relieving the clinical signs.

Medical and surgical management of otitis in captive bongo (Tragelaphus eurycerus).

Six cases of severe otitis media-interna, an uncommon problem in nondomestic ruminants, were diagnosed in five captive bongo (Tragelaphus eurycerus). The cases were geographically clustered at zoological facilities in Florida. A visible ear droop, head shaking, and otic discharge were common at clinical presentation. Medical management with prolonged systemic and topical antimicrobial therapy, combined with repeated manual removal of debris from the otic canal, was successful in resolving two cases and effectively controlled a third case. Two bongo with severe otitis did not respond to medical management and required surgical intervention. A bulla osteotomy and total ear canal ablation were performed on these animals (bilaterally in one bongo). Surgery was successful in providing complete clinical resolution of the otitis and is recommended for severe cases that fail to respond to less invasive management.

Comparison of ultrasonography, radiography and a single computed tomography slice for fluid identification within the feline tympanic bulla.

Evaluation of the tympanic bulla (TB) in cases of acute feline otitis media can be a diagnostic challenge, although a feature often associated with this condition is the accumulation of fluid or material within the middle ear cavity. A technique is reported allowing optimum imaging of the feline TB using ultrasound (US) and recording of the appearance of gas and fluid-filled TB. A random number of bullae in 42 feline cadavers were filled with lubricant and rostroventral-caudodorsal oblique radiographs, single slice computed tomography (CT) images and US images were created and interpreted by blinded operators. The content (fluid or gas) of each TB was determined using each technique and the cadavers were then frozen and sectioned for confirmation. CT remained the most accurate diagnostic method, but US produced better results than radiology. Given the advantages of US over other imaging techniques, these results suggest that further work is warranted to determine applications of this modality in the evaluation of clinical cases of feline otitis media.

A comparison of the rostrocaudal open mouth and rostro 10 degrees ventro-caudodorsal oblique radiographic views for imaging fluid in the feline tympanic bulla.

Fluid within the tympanic bulla is an indication of middle ear disease. Radiography has a relatively low accuracy for the detection of soft tissue opacification in the tympanic bulla, and the most useful radiographic projection, the rostrocaudal open mouth (RCd (open mouth)), is technically difficult to perform in dogs and cats. An alternative projection for the feline tympanic bulla, the rostro 10 degrees ventro-caudodorsal oblique (R10 degrees V-CdDO), was compared to the RCd (open mouth) in 41 feline cadaver heads with the tympanic bullae randomly filled with KY jelly. Computed tomography was used as the gold standard. Each tympanic bulla was recorded as being positive or negative for soft tissue opacification. Although there was no significant difference between the accuracy of the two views, the R10 degrees V-CdDO was subjectively more accurate and easier to perform, and in a live patient may be performed without the need for general anesthesia. The R10 degrees V-CdDO projection is a good alternative to the RCd (open mouth) projection for detecting otitis media in the cat.

Outbreak of otitis media caused by Burkholderia gladioli infection in immunocompromised mice.

An athymic nude mouse with severe head tilt due to otitis media was identified. Within weeks of identification of this first case, immune-deficient mice of various genotypes from the same facility were similarly affected, and cases from other facilities were found within two months. Culture of ear exudate specimens from affected mice yielded bacteria that were initially identified as Burkholderia cepacia, a plant pathogen considered an important opportunistic pathogen in persons with cystic fibrosis or chronic granulomatous disease. Several of these isolates, however, were subsequently identified as B. gladioli on the basis of results of biochemical analysis and a species-specific polymerase chain reaction (PCR) assay. Genotyping analysis revealed clonality among the isolates, indicating a shared strain among affected mice. A 16S rDNA-based PCR assay specific for the genera Burkholderia and Ralstonia, and a selective culture medium were used in efforts to characterize the epidemiology of this outbreak. In addition to culture of specimens from the oropharyngeal cavity of affected mice, samples were obtained from the environment, feces, sipper tubes, drinking water, and soiled bedding from cages of affected individuals. Burkholderia gladioli was most consistently detected in oropharyngeal swab specimens from affected mice. The PCR assay was equivalent to selective culture in identifying mice in the carrier state that did not have clinical signs of infection. However, neither detection method had sufficient sensitivity to reliably identify all carrier mice, causing the organism to persist at low levels unless entire colonies of immune-deficient mice were removed. The organism was highly resistant to antibiotic therapy. The source and epidemiology of this organism remain unknown. This epizootic serves as an important reminder that immunocompromised rodent colonies may harbor important human opportunistic pathogens.

Mycoplasma bovis-associated suppurative otitis media and pneumonia in bull calves.

Outbreaks of Mycoplasma bovis-associated otitis media and pneumonia occurred on four beef cattle farms in Hokkaido, Japan between 2000 and 2001. The morbidity and mortality were estimated at 8-40 and 30-100%, respectively. Eight calves with bilateral ear droop and exudative otitis media were examined bacteriologically and histopathologically. M. bovis was isolated post mortem from nasal swabs and from the ears, lungs, lymph nodes (cranial and pulmonary), brain and heart of all calves. At necropsy, suppurative exudates were observed in the tympanic bullae of all cases. Numerous abscesses were also found in the petrous portion of the temporal bone and lungs in seven cases. Histopathologically, the exudates within the tympanic bullae consisted of a mixture of neutrophils, necrotic cell debris and fibrin, and the tympanic mucosa was thickened with neutrophil and macrophage infiltration and proliferation of fibrous connective tissue. Pulmonary lesions included extensive foci of coagulative necrosis surrounded by numerous neutrophils. Hepatocytes or renal tubular epithelial cells were enlarged with hyaline cytoplasmic inclusions in four calves. Immunohistochemical labelling confirmed the presence of M. bovis antigen in the cytoplasm of the inflammatory cells in the middle ear, temporal bone and lungs, and was also demonstrated within the cytoplasmic inclusions of the hepatocytes and renal tubular epithelial cells. Ultrastructurally, mycoplasma-like organisms, 200-500 microm in diameter, were found within not only hepatocytes and renal tubular epithelia but also within axons of the facial nerves. The present results show that M. bovis spreads to multiple organs and is capable of invading various kinds of host cell. The intracellular localization may be favourable for evading host immune responses.

Inflammatory polyp in the middle ear with secondary suppurative meningoencephalitis in a cat.

A 15-month-old male Maine Coon Cat presented with persistent auricular discharge and progressive head tilt, ataxia, and loss of blink on the right side. Using computed tomography a hyperattenuating, contrast-enhancing material within a thickened right tympanic bulla and contrast enhancement of the adjacent cerebellum were identified. Marked suppurative inflammation was identified on cerebrospinal fluid analysis with no growth on bacterial culture. Ventral bulla osteotomy was performed to remove a soft tissue mass, and an inflammatory polyp with chronic severe suppurative inflammation was confirmed using histology. Staphylococcus auricularis was grown on aerobic culture and Fusobacterium necrophorum and Peptostreptococcus anaerobius were grown on anaerobic culture. The cat was treated for 10 weeks with amoxicillin/clavulinic acid and metronidazole. Dramatic improvement in body weight, appetite, energy level, balance, and resolution of right-sided facial paralysis were noted, but the cat retained a head tilt.

Otitis media in a llama.

A 7-month-old female llama was examined because of chronic otitis media and externa of 7 months' duration. Radiographically, the tympanic bullae appeared thicker than normal, and the ventral borders were poorly defined; the left external acoustic meatus (ear canal) appeared to be narrower than the right. The llama was treated with penicillin, and the ear canals were lavaged daily. Contrast radiography was performed on day 15 to determine the shape and size of the ear canals and evaluate the integrity of the tympanic membranes. Contrast medium was visible radiographically in the left tympanic bulla, indicating that the left tympanic membrane was ruptured, but the right tympanic membrane appeared to be intact. The left ear canal was narrower than the right, and the bony ear canals had a well-defined sigmoid shape. The right ear improved with medial treatment alone, but the left ear did not. Therefore, lateral ear canal resection was performed. After surgery, however, exudate was still evident in the left ear canal, and the llama became more lethargic and more reluctant to eat. Lateral bulla osteotomy was attempted, but no purulent material was obtained, and curettage of the bulla resulted in hemorrhage. Because of this and because of the llama's poor physical condition, a decision was made to euthanatize the llama. The sigmoid shape of the bony ear canal and the multicompartmental nature of the tympanic bulla make surgical treatment of otitis media and externa in llamas difficult. Further study of surgical treatments for otitis media in llamas is needed.

Chronic otitis externa/media with total ear canal ablation and bulla curettage in a North American bison (Bison bison).

An adult female North American bison (Bison bison) with a chronic otitis externa/media of the right ear was examined because of a 4-mo history of intermittent anorexia, apparent painful behavior, and auricular discharge from the right ear. Computerized tomography (CT) demonstrated osteolysis of the tympanic, petrous, and squamous aspects of the temporal bone with soft tissue replacement and sclerosis of the right bulla. A total ear canal ablation with bulla curettage was performed, and cefazolin-impregnated polymethacrylate beads were left within the right bulla and the remnant temporal bone. Six months after the surgery, the bison had no clinical signs of otitis media.

Retrospective study of diseases in a captive Lemming Colony.

Fifty-four ill or nonproductive lemmings (Dicrostonyx spp.) were evaluated for signs, lesions and causes of disease for 5 yr in a domestic colony. Parasitic granulomas caused by Encephalitozoon cuniculi were the most common finding and were seen in 22 lemmings. The disease was characterized by circling and torticollis with granulomas in many tissues, especially the central nervous system. Suppurative otitis occurred in 12 lemmings and was associated with Klebsiella pneumonia infection; circling was the common sign. Hepatic microabscesses were present in seven lemmings but a cause was not identified. Five lemmings had neoplasms and 14 had either suppurative processes, aspermia, or ovarian cysts.

A pathologic and bacteriologic study on otitis media in swine.

A pathologic and bacteriologic study on otitis media in swine was performed on 237 swine, ranging in age from 1 day to 1 year. These 237 swine from eight selected farms were slaughtered due to unfavorable prognosis associated with clinical signs of illness. One hundred sixty-three (68.8%) of the 237 swine were found to be affected with otitis, though only a few swine showed clinical signs characteristic of the disease. One hundred fifty-one (63.7%), 53 (22.4%), and 39 (16.5%) had lesions in the middle, external, and internal ear, respectively. Of the 151 cases with otitis media, bilateral and unilateral infection accounted for 114 (75.5%) and 37 (24.5%), respectively. Only 5/53 swine with otitis externa and 6/39 swine with otitis interna failed to show otitis media. All swine with infection in the tympanic cavity had inflammatory lesions in the auditory tube. Examination of the swine grouped by age revealed that, regardless of age, incidence of otitis media was 50-70%. In swine younger than 1 month old, otitis media tended to center on the auditory tube, where a mild infiltration of neutrophils into the mucous membrane was frequent. Thereafter, otitis media increased in degree and extent with age. Forty (26.5%) of the 151 swine affected with otitis media were accompanied by a substantial amount of inflammatory exudate in the tympanic cavity and bulla. Purulent exudate was found in 20/40 (50%) swine. Severe otitis media prevailed in swine between 1 and 4 months of age, showing inspissation of a suppurative exudate in the tympanic cavity and lysis of the underlying osseous wall of the tympanic bulla with subsequent fibrosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Streptobacillus moniliformis isolated from otitis media of conventionally kept laboratory rats.

Streptobacillus moniliformis (Sm) was isolated from the middle ear of two inbred albino rats (strain CAP/Kuv) suffering from murine respiratory mycoplasmosis and purulent bilateral otitis media. The animals were kept under conventional conditions and used for immunological studies. The biochemical pattern of the isolate was identical with that of four other Sm strains of different origin but differed in its ability to lyse erythrocytes in sheep blood agar. This is the first Sm strain with hemolysis described. Pathogenicity of the strain was demonstrated in C57BL/6Han mice known to be susceptible to streptobacillosis. Three of five mice inoculated orally developed characteristic signs of a septic lymphadenitis. In the homologous system and with Sm strain ATCC 49567 as antigen, all five sera showed positive titers in the indirect immunofluorescence assay. Possible improvements in the diagnosis and the role of this "forgotten pathogen" in laboratory animal medicine are discussed.

Otitis media/interna and suppurative meningoencephalomyelitis associated with Listeria monocytogenes infection in a llama.

Listeria monocytogenes was found to be the cause of fatal suppurative meningoencephalomyelitis in a 3.5-month-old cria. The cria initially had clinical signs of unilateral peripheral vestibular disease, but on the following day, the cria developed progressive signs of encephalitis. Treatment with antibiotics, flunixin meglumine, and anticonvulsant drugs failed to stop progression of the disease, and the cria was euthanatized. Post-mortem examination revealed otitis media-interna and diffuse suppurative meningoencephalomyelitis. Listeria monocytogenes was isolated from CSF and brain tissue.