Tuesday, November 8, 2011

729. Right ear weeping in a Westie - an unusual case

"I have seen 3 vets. One of them said there might be a tumour inside the right ear," the young lady said to me. "The last vet advised ear surgery." From my impressions, the young couple wanted a permanent solution to this one-year problem of the Westie with the itchy right ear and they came to see me.

This dog had lots of "water" inside the ear canal. I palpated the right ear. There was some pain as the dog moved his head away. But not great pain. As I pressed the ear, more "watery" discharge come out. As I cleared the discharge with a piece of tissue and then pressed the ear, more "watery" discharge comes out. Not those thick yellow pus, but watery. Why?

It was as if the horizontal ear canal was a deep well with lots of water. "Did your father apply the commercial ear drops recently?" I asked.

"No," the young lady said. "No more ear drops left."
This was a most unusual case. It was as if there was "underground" water.
"This ear needed to be irrigated," I advised.

I collaborate with Dr Vanessa on this case as part of my mentorship and succession program for Toa Payoh Vets.

Each young vet has his or her own idea of treatment and I wanted to make sure that this dog had a treatment that I would be doing and to maintain a standard of care that would be satisfactory to dog owners who come to Toa Payoh Vets for second or more opinions.

TREATMENT
Domitor IV sedated the dog partly. Muzzled. Dr Vanessa put in the pink antiseptic solution into the ear canal, massaged it to clear the debri. That is the standard way and that would be what the other vets had been doing. Nothing wrong with that.
But it might not be effective compared to ear irrigation.

So I intervened and demonstrated how the ear irrigation ought to be done. There is a technique. I had shown this in my video at:
http://www.youtube.com/watch?v=xhZ5eGJdwnY

Dr Vanessa used the 20-ml syringe to flush the ear. "You need to exercise your thumb muscles," I said as she injected the water into the ear without much force. "The irrigation angle has to be at 45 degrees to the horizontal canal and with speed," I demonstrated. It is easier said and demonstrated than done.

White tissue pieces from the walls of the vertical canal came out. Large extensive ulcers. As I irrigated more, a small piece of brown tissue came out. Then a few more brown bits. Strange. No pus.

I left the room to talk to the couple. Then I returned to the room to continue working with Dr Vanessa. She had extracted a big amount of brownish fibres from deep inside the ear. Good work. "What are these brown stuff?" I asked her.
"It could be tumours," she said. We showed the brown fibres to the young couple who was equally as perplexed.

"Did your father use cotton buds to clean the right ear?" I asked.
"Yes," the lady said. Later she said that her father used cotton wool wrapped around a pair of forceps to clean this ear.
So, the clue was given. The father would have used lots of cotton wool over the past year to resolve the ear problem. The fibres loosened and got impacted inside the horizontal canal. The whole canal filled up. The fibres absorbed the "water" of the commercial ear drops. At the same time, the bleeding from the canal wall due to aggressive ear cleaning by the father stained the fibres into dark brown as red blood becomes brown over time. These were the fibres or "tumours" pulled out.

Is this hypothesis sound? It is an unusual case as there was no pus. No time for pus to form too as the father must be doing ear cleaning every day. Sometimes, the grown up children don't know what the father is doing in the care of the dog as they work long hours.

Dr Vanessa extracted as much as possible. Evidence shown. She showed the couple the ear canal via the auroscope.
Ear swab for bacterial culture. Blood test.

SOLUTION
My advice was to lateral canal resection to resolve the dog's problem once and for all. The impacted cotton wool is deep inside the horizontal canal and opening up the vertical canal to get the hidden wool is the best solution. Owners want one treatment not several visits. This is understandable for every one. I advise surgery one week later.

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