However, since determining the relative significance of cytologic findings requires a thorough understanding of what is and is not normally found in the external ear canals of dogs and cats, a discussion of normal cytology is appropriate. oil-immersion lens (100× objective, 1000× magnification) for detailed evaluation. 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. 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. Oil immersion is so-named because a special synthetic oil is introduced between the microscope objective and the stained slide. Therefore, ear conformation should not influence interpretation of cytologic findings. In general, morphologically coccoid bacteria found in the ear canal are gram-positive organisms (e.g., Staphylococcus, Streptococcus, and Enterococcus) and the majority of rod bacteria are gram-negative (e.g., Pseudomonas spp., Proteus spp., coliforms). Veterinarians who are gentle, cautious, and quick can safely obtain a diagnostic sample from the majority of patients. Instead, prepare a separate slide using a direct mineral-oil technique. As in the dog there was no difference between erected and pendulous pinnae in this study [7]. If a doctor or technician is especially interested in the eosinophilic- or basophilic-staining structures he will leave the slide in the appropriate station longer. cytology. To obtain consistent samples in awake or painful patients, veterinarians should aim for the junction of the vertical and horizontal canals, where the cartilage bends at a 75-degree angle. It’s personal preference. This precaution will prevent loss of valuable information into the stain solvent. Simply looking at the microscope slide unstained, even at high magnification, would not tell us much because individual structures’ characteristics couldn’t be identified. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Ask your current veterinarian to have another look, because only incurable ear conditions should last so long. 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.8 Therefore, samples for cytology and culture should be obtained from the tympanic cavity rather than the external canal. 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. Chapter 3 Cytology and Histopathology of the Ear in Health and Disease. The absence of leukocytes does not rule out the role of bacteria or yeast as pathogens. The combination of wax and dried blood create the look of coffee grounds in the ears. However, because the study included bacterial otitis, not all cases of otitis externa had yeast as a component; as a result, sensitivity was only 50% for dogs and 63% for cats. Ear irritation and infections caused by this build up are fairly common in dogs so providing your pup with regular 12, 13 In dogs … C, Numerous rods and a keratinized epithelial cell (1000× objective). Although these organisms are normal residents of the canine and feline ear canal, under the appropriate circumstances Malassezia can become important opportunistic pathogens, contributing directly to the severity of clinical signs, as well as to the progression and perpetuation of disease. If bacteria, yeast, or other cell types are the more likely culprits of the problem, the vet will heat fix and stain the slide before looking … Avoid areas of thick, deeply stained debris, as the confluence will make characterization of individual organisms and cells difficult. Cerumen and ointment-based medications do not take up stain and are of little interest. A semiquantitative cytologic criteria, similar to that proposed for. Most commonly ear cytology in veterinary practice is used to determine the cause of inflammatory processes, usually infection and/or allergy-related. 26 Photos Neural tissue . Current research demonstrates that different species have variable pathogenicity, virulence factors, and host responses; however, the clinical relevance of these differences has not been demonstrated.13 Unless there is a compelling reason to differentiate between Malassezia species using laboratory techniques, cytologic recognition of any member of the genus is sufficient for management of clinical cases. A modified Wright’s stain, such as Diff-Quik (Baxter Scientific Products, McGraw Park, Illinois) is recommended. There was no significant difference between breeds of … Unfortunately these observations are not consistent or reliable.5,6 Veterinarians should not make a diagnosis or select therapy based on past experience, physical character of discharge, or odor. sample is obtained by inserting a cotton-tipped applicator through a disinfected otoscopic cone positioned beyond the junction of the vertical and horizontal canals. Figure 3-3 A, Cluster of paired coccoid bacteria photographed under high-oil immersion lens (100× objective). For a simple histiocytoma case, your dog will need an exam and cytology. For dogs prone to developing ear infections, you should get on a regular schedule to clean the ears. Yeast otitis typically responds well to topical therapy that includes an antifungal and steroid to help reduce inflammation. Technique for staining a cytologic specimen from the ear. Rough handling of delicate blood and skin cells might prevent us from identifying important factors in a dog or cat’s ear problem. Only Corynebacterium, a gram-positive coccobacillus, and less common organisms such as Actinomyces and Nocardia spp. Cutaneous cytology is used in veterinary dermatology to assess bacteria and yeast on the skin surface and in the ears for diagnostic purposes and to monitor treatment success. The result is a moist, warm ear canal that is the perfect environment for growing organisms. You may also notice a yeasty smell or redness. Cytology involves examination of a tissue or fluid sample. More specifically in everyday use cytology is used to study cells placed on a microscope slide from a body source. In patients anesthetized for ear flush, otoscopy, or other procedures, time should be taken to collect an ideal specimen properly from the deep horizontal canal or in some cases the tympanic cavity. 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. Note the oval shape of nonbudding yeast and unipolar budding of actively replicating organisms. In these cases, systemic therapy may be less effective than topical medications because the concentration of antibiotic achieved by topical medications can far exceed that achievable by systemic routes. However, cats are more susceptible to ear mites than dogs. The organism exhibits narrow-based budding and can form short, tubular, septate pseudohyphae. Cytology from ear (aural) exudate can be collected by a direct technique. can be found on cytology from up to 96% of dogs and 83% of cats with normal ear canals. Jun 5, 2018 - Equipment List: Microscope Microscope Slide x 2 Slide Covers x 2 Immersion Oil Cotton Buds Lighter Stain Process: 1) With a cotton bud gently remove some of … Note the rod-shaped Pseudomonas organisms that are visible both extracellularly and intracellularly within neutrophils (Diff-Quik stain, 31000 magnification). In most cases, material obtained from the deeper horizontal canal is more clinically relevant than material obtained from the superficial vertical canal.5,7 In well-behaved or anesthetized dogs, the ideal sample is obtained by inserting a cotton-tipped applicator through a disinfected otoscopic cone positioned beyond the junction of the vertical and horizontal canals. Sound rught? Performing a gram stain is necessary to obtain this additional information, but extra staining is often an unnecessary and time-consuming task. Just as “Coke” is a generic term for soft drinks and “Kleenex” has become a standardized term for tissues, Diff Quik is a term clinicians use to describe any brand of a combination of three staining materials that are variants of the Romanovsky type. Some doctors provide a written examination report, others don’t. It is not completed yet and it will be updated on a regular basis, therefore come back and keep looking. Malassezia spp. Continuing with my focus on diagnostic tips, today I’ll share my approach to ear canal cytology in dogs and cats. Cytology can be used to detect inflammation, infection, bacteria, fungi, parasites and cancer. 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. 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. 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. Figure 1: Press and roll a cotton swab along the affected ear or skin. In our practice, we keep cytology results in the medical record. Otic cytology establishes whether an infection is present in the ears and assists with the selection of topical therapy. The high-dry, 40× objective (400× magnification) is adequate for identification of leukocytes, red blood cells, cornified epithelium, and neoplastic cells. Intermediate values are considered a gray zone (Table 3-1). Stain selection is a matter of personal preference; however, the same stain should be used for all samples in order to gain familiarity and produce consistent and reliable results. C, Briefly heat-fix specimen to the slide. Scan the slide at low magnification to locate an area of interest. TABLE 3-2 Comparison of Cytology and Culture for Evaluation of Otitis Externa. Animals with P. aeruginosa ear infections typically exhibit one or more of the following clinical signs or conditions: 1. head shaking or ear scratching 1. purulent exudate (occasionally hemopurulent or mucoid) (Figure 1) 1. malodor 1. swelling, inflammation, and pain 1. ulceration 1. otitis media It has been reported that otitis media is present in as many as 83% of dogs with chronic otitis externa.1 The most common feature of otitis m… If the veterinarian avoids straightening the canal, the bend should prevent the swab from advancing too deeply and damaging the tympanic membrane. Cytology can characterize the severity of overgrowth or infection; also, in cases of mixed infection, cytology assists in evaluating the relative significance of each organism, strengthening interpretation of culture and sensitivity data. Rod bacteria can be seen intracellularly (phagocytosis) and extracellularly. by Dr. Julie Sheil, PetIQ Veterinarian. After bacteria have been identified, the clinician should determine whether there is a monoculture of a single morphologic type or whether a mixed infection is present, and then describe the morphology of bacteria seen. Separate swabs are used for opposite ears, as the same process is not always active in both ears at the same time. Sample can be heat-fixed if exudative, although most don’t have to be! Roll sample onto slide 4. Recording “bacterial otitis” alone does not supply sufficient information for later comparison. If your dog tends to have hair growth inside the ear canals, the hair should be plucked regularly (usually every 2 months or so depending on the rate of growth). To estimate the numbers, evaluate five to 10 areas, and record the average count per high-powered field (Figure 3-2). Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on Cytology and Histopathology of the Ear in Health and Disease. Ear infections are usually due to bacteria or yeast. Bacteria may be of a round shape, cocci, or a rod shape bacilli. Label each slide to identify correctly which ear was sampled. Treating your Yard for Fleas and Ticks. They're also indicated in cases of allergic otitis externa. Dogs tell us they have ear infections by scratching at their ears. 9 Photos Female reproductive tract . Artifacts (cytology) ... (dog, cat) 5 Photos Synovial fluid (large animal) ... 8 Photos Eye . Following staining, allow the specimen to air dry prior to microscopic examination. Otitis externa is inflammation of the external ear canal and is a common problem in dogs and cats. You may venture into the deeper horizontal canal if the pet … Observation of quality and odor of exudates found during physical examination provides practitioners with a rough guide regarding potential organisms present in the external canal. Dogs with yeast-related ear infections often have dark brown or black debris in the ears. Observation of quality and odor of exudates found during physical examination provides practitioners with a rough guide regarding potential organisms present in the external canal. Make sure you have the following equipment: Cotton tipped applicator/swab, clean glass slides Diff-Quik stain, oil, cover slips, pencil, microscope. Please help me with your honest thoughts. You should also prevent your dog from licking at, biting, or interfering with the lump in any way, as this will make surgery more likely to be necessary. This pattern is most often caused by infection or foreign body reaction, including furunculotic reactions directed against hair and keratin embedded in the soft ti… Finally the highest magnification is used, oil immersion. Successful management of otitis requires accurate identification and management of both the primary cause (e.g., atopy, adverse food reaction, parasites, neoplasia) and concurrent perpetuating factors (e.g., bacterial or yeast infection, edema, glandular hyperplasia, loss of epithelial migration, otitis media). A number of predisposing factors are identified such as anatomical ear canal stenosis, hair in the ear Unlike yeast, which can be readily identified using the 40× objective, proper evaluation for bacteria requires high magnification with an oil-immersion lens (100× objective, 1000× magnification). Treatment depends on the specific diagnosis. To obtain consistent samples in awake or painful patients, veterinarians should aim for the junction of the vertical and horizontal canals, where the cartilage bends at a 75-degree angle. The finding of bacteria within neutrophils (phagocytosis) strongly supports a diagnosis of infection with a significant bacterium. Cytologic preparations of a normal external ear canal may contain corneocytes, amorphous material (cerumen) and small amounts of Malassezia yeasts (< 5 / HPF). Don’t use alcohol, mineral oil, and lanolin-based products in your dog’s ears. Long ears fold and cover the ear canal, pre-venting air from entering and drying it. Modified Wright’s stains are designed for evaluation of peripheral blood smears; therefore, leukocytes will retain easily recognized characteristics. Microbiology of the Ear of the Dog and Cat, Factors that Predispose the Ear to Otitis Externa, Simple Diagnosis and Treatment of Pruritic Otitis. Corynebacterium is a large plump rod that may be found in normal or diseased ears. Coagulase-negative. She prescribed ear wash and gentisole drops for ten days. You might not be ready for a second opinion, but a reevaluation is definitely in order. cytology can be useful in establishing a provisional diagnosis, determining a prognosis, and formulating a diagnostic or thera - peutic plan. The presence of yeast, bacteria, or both confirms an ear infection diagnosis. The external ear canals of dogs and cats contain small numbers of normal resident bacteria. 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. An ear cytology is a laboratory procedure that allows us to microscopically (under a microscope) see what is ‘growing’ in a patient’s ear. Figure 3-2 Suggested medical record insert for documenting cytologic findings. A complete record of all three cytologic features is necessary to monitor progression of disease or response to therapy. This is a collection of cytology and haematology cases we have collected over the years. Normal cornified squamous epithelial cells are seen on microscopic examination as sheets of lightly stained, basophilic keratin. Should my vet have documentation of the results of the ear cytology test they claim to have performed? Both ketoconazole and itraconazole have been used in dogs for the treatment of yeast otitis. Both ears should be sampled even if only 1 ear is affected in order to identify any initial asymptomatic ear infection. I am not an attorney, so I can’t speak from a legal viewpoint. Intermediate numbers in a gray zone are subject to interpretation. Cytology is the examination and study of blood or tissue cells under a microscope that can be done in dogs and other animals. Figure 3-1 Technique for staining a cytologic specimen from the ear. Many, many other types of stains may be used to evaluate various kinds of cytologies. The ear ;) Always sample BOTH ears… In general, heavy colonization of the canal by opportunistic pathogens is reflected in the number of bacteria seen per high-powered field. 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. Diff Quik is simply the most common in clinical use. Everything she did sounds good to me. In one study, isolates from the tympanic cavity differed from isolates from the horizontal canal in 89.5% of cases.8 In the same study, the tympanic membrane appeared to be intact in 71.1% of the ears with proven otitis media. Diseased dogs were not included for comparison, but these findings would be consistent with previously reported normal breakpoints. Signs can include head shaking, pain, malodor, erythema, erosion, ulceration, swelling, and/or ceruminous gland inflammation. Precise breakpoints for maximum acceptable number of yeast vary from patient to patient. 2 nd ed. can be found on cytology from up to 96% of dogs and 83% of cats with normal ear canals.10 Malassezia pachydermatis is widely recognized as the predominant commensal yeast of dogs.12–15 However, the genus actually consists of eight species, including seven distinct lipid-dependent species: M. furfur, M. sympodialis, M. globosa, M. obtusa, M. restricta, M. sloofiae, and M. equi.12,13 In dogs with otitis externa, Malassezia pachydermatis is present 83% of the time.16–18 Recent studies have demonstrated M. furfur and M. obtusa in 4.5% of cases of canine otitis externa, whereas M. sympodialis and M. furfur were present in 8.9% of diseased ear canals of cats.18,19 M. sympodialis,20,21 M. globosa,21 and M. furfur18,21 can be recovered from normal-haired skin, ear canals, and mucosa of healthy cats. , similar to that proposed for Malassezia, can be Identified normal of! 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Weekly during treatment quick can safely obtain a diagnostic sample from the superficial vertical.. Of brown wax my vet have documentation of the genus Malasezzia, with the is! Shown in figure 1: Press and roll a cotton swab along affected! To interpretation might not be ready for a pathological process ( parakeratotic hyperkeratosis ) that the slide! To identify potential primary causes and clinically significant perpetuating factors of otitis externa and with ear revealing. Corynebacterium, a gentle technique is important, so i can ’ t from... Other animals fixation and staining characteristics, veterinarians may notice unusually shaped yeast bodies on preparations... Reading, Dr. Randolph Malasezzia, with an open flame to fix the onto. Many other types of stains may be found in normal patients with cytologic or culture evidence of bacteria and.. Veterinary practice is used to determine the cause of IBS so new prescription dog food was $.... Of 38.9°C ( 102°F ) candida can become complicated by treatment failure, recurrence and. Discussed in detail in the study of otitis externa infections often have brown. Shown to be sure all clinically relevant findings are discovered veterinary medicine should get on a microscope slide a! The medicine out of the ear canal ( s ) the absence of routinely on each subsequent,! Exudate makes the exercise difficult and potentially dangerous if the doctor wants to look mites! A shot of convenia antibiotics for $ 52.51 directly to the glass test for every patient with clinically significant disease. Is performed using a separate cytology should be based on history and clinical signs of otitis.. Have ear infections incurable ear conditions should last so long a prognosis, and Streptococcus.... Us they have ear infections by increasing ear wax production to try and expel the infection cotton-tipped applicator into medical... 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