She prescribed ear wash and gentisole drops for ten days. Although we will do a comprehensive physical examination and look into your pet’s ears with an otoscope we can only ‘see so much’. Although cytology can demonstrate the presence, number, and relative significance of cocci or rods, it cannot be used to determine the species of bacteria. Determining the significance of bacteria seen on cytology depends on several factors: morphology, numbers, and concurrent leukocytes. Based on the results reported by Ginel et al,22 fewer than five bacteria per high-powered dry field (40× objective) should be considered normal; more than 25 bacteria per field supports the diagnosis of an abnormally increased population. If we happened to have not issued an examination report form in a case, a copy of the medical record could still be issued to share the results with the client. Microorganisms can grow in stain solutions which can lead to artifact of bacterial overgrowth on slides. Continuing with my focus on diagnostic tips, today I’ll share my approach to ear canal cytology in dogs and cats. When the blood dries, it would start to resemble coffee grounds. Chinese Drywall Fumes Affecting Dog’s Ear? are not common pathogens in cases of otitis externa. Cytology is the examination and study of blood or tissue cells under a microscope that can be done in dogs and other animals. The best sample for cytologic evaluation of a mass or polyp can be obtained by using a more traumatic surgical curette, using the same method described previously. Dogs with long and hanging ears like Bloodhound or Basset Hound are more likely to be affected by ear infections. This usually costs in … An important concept in determining the clinical significance of bacteria seen on cytology is the distinction between bacterial “overgrowth” and bacterial “infection.” In general, overgrowth refers to increased numbers of resident bacteria in the debris and on the epithelial surface of the external canal. She did a exam, got a sample of material from ears using a q tip and did a cytology test in a shirt amount if time. The curette can be placed within the disinfected otoscopic cone positioned in the deep horizontal canal; the curette is advanced beyond the cone and gently scraped along the epithelium, collecting the exudate within the curette head. Of these, M. sympodialis is believed to be a normal resident of the feline ear canal.15. In most cases of dog ear … Ear cytology is performed using a separate cotton-tipped swab for each ear. Both ketoconazole and itraconazole have been used in dogs for the treatment of yeast otitis. No written results just verbal? Label each slide to identify correctly which ear was sampled. Systemic glucocorticoids are used to decrease stenosis, edema and hyperplasia of the vertical and horizontal ear canal to allow a complete otic examination as well as proper cleaning of the ear. These cases often require high-dose, long-term systemic antibiotic therapy for successful resolution. ear cytology where cocci are common[19,20,21]. TABLE 3-1 Recommended Breakpoints for Numbers of Organisms Identified Cytologically. Using higher magnification, fewer than two bacteria per high-oil field (100× objective) is normal, and more than 10 bacteria per field is abnormal. The combination of wax and dried blood create the look of coffee grounds in the ears. A recent comparison of cytologic specimens from normal and diseased ears demonstrated that up to an average of two yeast per high-dry field (40× objective, 400× magnification) in the dog and cat should be considered normal.22 Mean counts greater than 5 yeast per field in dogs, and 12 yeast per field in cats are abnormal. Cytology can also help us find cancerous cells growing in the ear … ear cytology where cocci are common[19,20,21]. More specifically in everyday use cytology is used to study cells placed on a microscope slide from a body source. 10 Malassezia pachydermatis is widely recognized as the predominant commensal yeast of dogs. Swab with brown debris came from the right ear. Cytology is the most useful tool for differentiating between normal resident colonization and overgrowth. Make sure you have the following equipment: Cotton tipped applicator/swab, clean glass slides Diff-Quik stain, oil, cover slips, pencil, microscope. Unlike humans that have a very short ear canal, dogs have a long narrow ear canal that makes almost a 90 degree bend as it travels to the deeper parts of the ear. Reported as Mean Number of Organisms per High-Dry Field (40× Objective). Normal cornified squamous epithelial cells are seen on microscopic examination as sheets of lightly stained, basophilic keratin. In general, morphologically coccoid bacteria found in the ear canal are gram-positive organisms (e.g.. In our practice, we keep cytology results in the medical record. In tropical climates, coliform bacteria may be considered a normal finding. Dogs with yeast-related ear infections often have dark brown or black debris in the ears. Today we will be performing the common ear cytology. Instead, decision making should be based on cytologic evidence established by careful microscopic evaluation. Paterson S. Otitis externa. Signs can include head shaking, pain, malodor, erythema, erosion, ulceration, swelling, and/or ceruminous gland inflammation. Cytologic samples can be collected from the lumen of … 9 Photos Female reproductive tract . The cells may roll up on themselves during smear preparation, resulting in a deeper staining, shardlike appearance. I paid $50 for the test and was not given a report. In patients with bilateral disease, clinically relevant differences in bacteria and yeast are common when comparing the two sides.8,9 Without independent evaluation, documentation, or monitoring of each ear separately, veterinarians may fail to make appropriate management decisions. When evaluating otitis media, a separate cytology should be performed from the tympanic cavity. Artifacts (cytology) ... (dog, cat) 5 Photos Synovial fluid (large animal) ... 8 Photos Eye . As you know already, this is a simple, but valuable test that should be recommended whenever otitis externa is suspected, and on follow up examinations for those pets. Infectious organisms such as yeast and larger bacteria are also easily recognized. Only the amount of hair influenced temperature and Malassezia concentration in healthy canine Also, practices are regulated differently in each state. Apply several drops of mineral oil to a clean glass slide. It is of low cellularity, containing only an . In order to maintain consistency in cytologic evaluation, each specimen should be specifically evaluated for the presence, estimated number, and morphologic characteristics of three specific features: yeast, bacteria, and leukocytes. Only the amount of hair influenced temperature and Malassezia concentration in healthy canine Figure 1: Press and roll a cotton swab along the affected ear or skin. Compared with Malassezia, Candida spp. Rod bacteria can be seen intracellularly (phagocytosis) and extracellularly. The presence of yeast, bacteria, or both confirms an ear infection diagnosis. The epithelial lining of the normal ear canal is coated with a thin layer of cerumen, the combined product of secretions by modified apocrine glands (ceruminous glands) and sebaceous glands. Under appropriate circumstances, Candida can become an opportunistic pathogen. Cytologic estimation of numbers can provide a guideline for the clinician; in the end, however, the decision to treat Malassezia depends on a combination of cytologic findings, severity of clinical signs, past history of yeast otitis, and response to previous therapy in that individual patient. Most commonly ear cytology in veterinary practice is used to determine the cause of inflammatory processes, usually infection and/or allergy-related. In case of Malassezia infection the number of yeasts is higher than 5–10 / HPF. Cytology . Kitten And Cat Ear Mites And Complications, Ringworm/Dermatophytosis In Dogs And Cats. In order to obtain the best diagnostic slide, be prepared to collect the sample prior to introduction of any cleaning agent or other therapy. Therefore, ear conformation should not influence interpretation of cytologic findings. The presence of stenosis, inflammation, and voluminous exudate makes the exercise difficult and potentially dangerous if the patient moves suddenly or unpredictably. Because culture does not differentiate between normal resident bacteria, bacterial overgrowth, and bacterial infection, cytology is the best tool to determine the relative significance of bacteria present in the external canal. oil-immersion lens (100× objective, 1000× magnification) for detailed evaluation. The aspirated fluid is brown and oily. Cats. After examining several fields with the high-dry objective, switch to the high-magnification, oil-immersion lens (100× objective, 1000× magnification) for detailed evaluation. Microbiology of the Ear of the Dog and Cat, Factors that Predispose the Ear to Otitis Externa, Simple Diagnosis and Treatment of Pruritic Otitis. Hope this helps, and thanks for reading, Dr. Randolph. eClinpath helped 1.2 million visitors last year from 220 countries find important information on animal health. Cytology can also help us find cancerous cells growing in the ear canal(s). Figure 3-4 Malassezia pachydermatis with occasional paired coccoid bacteria in background. Leukocytes are not found in the normal ear canal. This level of detail permits either the primary clinician or any colleague following the case to determine accurately whether the “bacterial otitis” is resolving, changing, or worsening. In general, heavy colonization of the canal by opportunistic pathogens is reflected in the number of bacteria seen per high-powered field. Ear conformation has not been shown to influence cytologic findings.10. I usually have pet owners clean weekly, or, at the most, twice weekly during treatment. They are sometimes found on the surface of exfoliated squamous epithelial cells in surface cytology samples from affected ears. A separate cytologic specimen should always be prepared from both the right and the left ear canals, even if the patient presents for unilateral disease. For cats, fewer than four bacteria per 40× field (1.6 per 100× field) was consistent with normal conditions, and more than 15 bacteria per 40× field (6 per 100× field) was abnormal. Cytology, however, is not the only test that should be performed when evaluating bacterial otitis externa. Insert a cotton-tipped applicator into the ear canal to the junction of the vertical and horizontal canal 2. Large numbers of neutrophils indicate acute inflammation and often are accompanied by smaller numbers of macrophages. Because Malassezia can be found in normal patients or mixed in with predominantly bacterial infections, veterinarians need to determine the clinical significance of Malassezia for each patient. and Proteus spp. The higher magnification is necessary to identify smaller or lightly stained bacteria that may be easily missed with the high-dry objective. In addition to a detailed history and physical examination, otic cytology should be considered part of the minimum database for all patients with clinical signs of ear disease. Because cerumen has high lipid content, briefly heat the slide with an open flame to fix the material to the glass. Precise breakpoints for maximum acceptable number of yeast vary from patient to patient. “Cyto” comes from the Greek kytos, meaning “cell.” Logos is Greek for “science.” So, cytology is the science (or study) of cells. Precise breakpoints for maximum acceptable number of yeast vary from patient to patient. F, Allow to air dry. The high-dry, 40× objective (400× magnification) is adequate for identification of leukocytes, red blood cells, cornified epithelium, and neoplastic cells. Figure 2: Cytology preparation of the exudate obtained from the dog shown in Figure 1. The higher magnification is necessary to identify smaller or lightly stained bacteria that may be easily missed with the high-dry objective. Each cytologic description should contain information regarding the morphologic characteristic of bacteria (cocci or rod), the presence or absence of. It’s personal preference. Yeast otitis typically responds well to topical therapy that includes an antifungal and steroid to help reduce inflammation. St. Louis: Elsevier EBook; 2005:41-75. In the case of otitis media, systemic therapy and bulla infusions of antibiotics should be directed at organisms colonizing the middle ear rather than the external canal. Intermediate values are considered a gray zone (Table 3-1). Today we are only concerned with cytology of canine and feline ears. The external ear canals of dogs and cats contain small numbers of normal resident bacteria. Exudate samples can be smeared onto a slide with mineral oil to look for mites. Thus, cytology is rarely performed on normal asymptomatic ear canals. Samples were collected from both ears of each dog … Alternatively, using one slide with a frosted end, holding the frosted end toward oneself, roll the sample from the left ear on the left part of the slide and the sample from the right ear on the right part of the slide. Place a coverslip directly onto the mineral oil and examine the specimen with low magnification (4× or 10× objective). Linkedin. Every technician and assistant needs to be skilled at making slides of ear and skin cytology, and technicians need to be adept at microscopic evaluation. The absence of leukocytes does not rule out the role of bacteria or yeast as pathogens. Malassezia is not a normal resident of the tympanic cavity; therefore, any finding on cytology from this space is considered abnormal, and systemic antifungal therapy is indicated. In contrast, debris and precipitate vary in size and may be asymmetrical, irregular, and granular in appearance. Treatment depends on the specific diagnosis. Total Ear Canal Ablation and Ventral Bulla Osteotomy (TECA) for End-Stage Ears in Dogs and Cats. Once the sample is collected, roll the swab or curette onto a clean glass slide, evenly distributing a thin layer of material (Figure 3-1). can be found on cytology from up to 96% of dogs and 83% of cats with normal ear canals. Because cerumen has high lipid content, briefly heat the slide with an open flame to fix the material to the glass. If the material from an ear is particularly moist, the slide might be air-dried, hair-dryer dried or placed atop a source of gentle heat. Some doctors provide a written examination report, others don’t. Classically, dry, grainy, black discharge is most often associated with. Diseases -Otopyorrhea: Pus discharge from the ear -Otodectes: Parasites that infiltrates the ear -Otomycosis: Fungal infection of the ear -Malassezia: Yeast infection Steps to Performing an Ear Cytology Preparation of Ear Cytology for Dogs/Cats HOSA West-MEC Veterinary Science Reported as Mean Number of Organisms per High-Dry Field (40× Objective). B, Paired coccoid bacteria with neutrophils and an eosinophil (400× objective). In a study comparing isolates from the horizontal canal and the tympanic cavity of dogs with chronic otitis externa and media, differences were noted in the species or antimicrobial susceptibility of bacteria isolated in 89.5% of the cases. Because organisms from the middle ear may be coated in mucus, which prevents adequate uptake of stain, cytology from the middle ear should always be accompanied by a sample for culture and sensitivity obtained at the same time. The cone shields the swab from contents of the vertical canal, which may contain numerous, irrelevant commensal organisms. Suggested medical record insert for documenting cytologic findings. Ask your current veterinarian to have another look, because only incurable ear conditions should last so long. E, Rinse slide by placing unstained side of slide under gentle water stream; this permits laminar flow of water to remove excess stain. Even with these guidelines, laboratory culture is necessary to make a definitive speciation; clinicians should record findings as pairs of cocci or chains of cocci rather than attempt to make a specific diagnosis based on cytology. Performing a gram stain is necessary to obtain this additional information, but extra staining is often an unnecessary and time-consuming task. In a study by Ginel et al,22 three of 24 dogs (12.5%), and two of 22 cats (9.1%) with clinical signs of otitis externa had cytologic and culture evidence of Candida spp. 2 nd ed. Thanks for reading, Dr. Randolph. Insert needle (25 - 27 ga.) into the pustule holding the needle parallel to the skin so that only the pustule is punctured, no deeper cells or blood are required, top is lifted off and slide impressed onto the ruptured pustule . Finally the highest magnification is used, oil immersion. Both gram-positive and gram-negative bacteria, as well as yeast, will appear blue or purple. Each cytologic description should contain information regarding the morphologic characteristic of bacteria (cocci or rod), the presence or absence of Malassezia and leukocytes, whether bacteria were phagocytized by leukocytes, and a semiquantitative estimation of the relative numbers of each type of organism seen. You might also be cleaning too often, but ask your veterinarian for guidance. Cytologic samples can be collected from the lumen of … Material and methods: In a study evaluating dogs with otitis externa, five ear swabs (one for culture and four for cytology) were taken from the horizontal part of the external auditory canal of 224 affected ears and compared semi-quantitatively. I like to take samples from the junction of the vertical and horizontal canals. The presence of larger cocci arranged in pairs or tetrads is typical morphology for Staphylococcus spp; small cocci in short chains are characteristic of Streptococcus and Enterococcus spp. Clinically significant organisms should be symmetrical, have a distinct smooth edge, and be uniformly stained; they are typically present in pairs or chains of bacteria equal in size (Figure 3-3). Your veterinarian will look under a microscope at material from the ear canal, also known as an ear cytology. The value of cytology exceeds simple identification of organisms. However, cats are more susceptible to ear mites than dogs. A modified Wright’s stain, such as Diff-Quik (Baxter Scientific Products, McGraw Park, Illinois) is recommended. 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