The following is a copy of the responses on the above subject from the VIN dermatology boards referring to the described case. It is a good example of practical approaches to both Malassezia and Pseudomonas otitis externa and media with a ruptured tympanum. Experts describe approaches using two DermaPet products, TrizEDTA and the Ear/Skin cleanser.
From: a VINer
7.5 y/o m/n cocker with chronic malassezia and ruptured tympanic membrance of 6 weeks duration of right ear. We have been unable to get the ears under control for 3 months. There is no narrowing of the canals or mineralization. The dog also is having seasonal skin problems at present. Additionally, I have done in vitro testing on this patient 2 times at one year intervals at the beginning of allergy season but nothing substantial results. Regarding the ears, we have cultured, flushed two times and used the vetscope. Additionally, we have used Dermapet@, Otomax@, etc for the ears but we continue to get heavy dark discharge. We have also used some oral prednisone which the dog is on now. What can be used in the ear that has the ruptured tympanic membrane? We have taken skull films and all is clear; honestly, I really could use some help;Thanking you in advance for your input...
From - a derm folder monitor
This dog could have inspissated wax in the middle ear that is leading to your failure to get response from your tx so far. It may well require bulla osteotome and curettage to resolve. If you are still getting only yeast on cytology, after the next MedRx vetscope cleaning, you may need to use oral antifungals. What do you see after the cleaning episode? Does you scope take digital photos? If so, can you send me the photo by private email? What do other consultants thank about this scenario?
From: a VINer
Dear monitor, Thanks so much for your input; yes, my MedRx vetscope does take pictures on a Sony MaviCap on a 3.5 floppy; regretfully, I did not take the pictures on it. I do have a still picture of it and could send it to you. What drug and what does would you use for the refractory yeast orally?
From - a derm monitor
What drug and what does would you use for the refractory yeast orally?
VINer
I would use ketoconazole at 10 mg/kg daily.
From: DRDOG, a derm monitor
Does this dog have the other common Cocker skin problems, such as seborrhea oleosa? Do you get anything else on the results of your cultures except for yeast? IF not,then I would suggest adding some steroid in with the DermaPet, which can be used in a ruptured tympanum. Otherwise,you may need to use oral antifungals. What is your procedure for the use of the DermaPet? How long are you leaving it in? Steve
From: a VINer
Dear Steve, Thanks for your response; what steriod should I use with the Dermapet? We have been leaving it in for 5 minutes. Did you say it is safe with a ruptured tympanic membrance? What oral antifungal would you recommend? The dog has classical signs of atopy but no seborrhea oleosa. Looking forward to hearing from you.... In the chronic Malassezia case I have been posting with a ruptured tympanic membrane unilaterally, I have now cultured Pseudomonas. Can I use TrizEDTA in this type ear?
From: DRDOG, a derm monitor
I'm not sure about the EDTA in that ear (hopefully Dr.Melman or Dr.Gotthelf will give an answer) but the DermaPet skin\ear flush will kill Pseudomonas.
From: a derm monitor
Hi, We use Tris EDTA as our tx of choice in Pseudomonas OE an OM. We find it makes a great deal of difference in the success of our medical TX. Use it as a flush 15 mins prior to instilling AB's and it not only helps kill bugs and cleanse, but sensitizes the bugs to aminoglycosides and polymixins.
From - Louis Gotthelf (LouEGee)
I, too choose TrizEDTA for Pseudomonas. The problem I see in this case is that the alkalinity of tris-EDTA (pH 8.0)is favorable to the growth of Malassezia. That's why the acetic/boric acids tend to work better against the Malassezia yeasts. After the Pseudomonas comes under control, the yeast should also be dealt with.
From: DRDOG, a derm monitor
Yes, the DermaPet is safe to use with a ruptured tympanum.I usually use dexamethasone NaPo4 3-8mg,depending on size of the animal. I normally go with Sporonox if using an oral antifungal. By leaving the solution in for 5 minutes,you should be getting the full effects of the acidic\boric acids.
Steve
Please send me the email address of (or forward this to) any other vets that you feel might be interested in this or further 'newsletters'.
| Steven Melman VMD DermaPet Animal Dermatology and Behavior Clinics Potomac, MD 20854 |
dermapet@aol.com http://www.dermapet.com 800-755-4738 fax 301-365-0191 |
8909 Iverleigh Court 
Potomac, Maryland 20854
301-983-8387 800-755-4738 Fax 301-365-0191
E-mail dermapet@aol.com