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Otitis - Sales Meeting


Inflammation of the external and middle ear are common among pets. Here are some things reps should know in order to make successful sales calls.

Otitis externa is a complex condition characterized by inflammation of the external ear canal. It can occur anywhere along the ear canal from pinna (outer part of the ear) to tympanic membrane. Otitis externa is one of the most common diseases encountered in veterinary practice, affecting an estimated 5 percent to 20 percent of dogs, and 4 percent to 6 percent of cats. Otitis media is inflammation of the middle ear structures.

Because ear canals are an extension of skin, primary causes of otitis externa include many diseases that affect the skin, such as atopy (allergy), food hypersensitivity, and keratinization (skin) disorders. Parasites and foreign bodies can also cause otitis externa.

Otitis externa complicated with bacteria, yeast or both, commonly occurs secondarily to the primary causes that initiate inflammation within ears, and perpetuate the disease. The most frequently isolated microorganisms in dogs with otitis externa are Malassezia pachydermatis, Staphylococcus pseudintermedius, Pseudomonas aeruginosa, Proteus spp., beta-hemolytic streptococci, and Escherichia coli. Otitis media usually results from an extension of otitis externa through the tympanic membrane to the middle ear structures.

Clinical signs of otitis externa include pruritus (itching) of the ear, head shaking, exudate (discharge) present in and around the external ear canal, and malodor (bad smell) from the ear. With otitis media, head shaking, rubbing or scratching at the ear may be noticed, with or without signs of facial nerve palsy, which can include ear droop, lip droop, and inability to blink.

Predisposing factors – including some conformational, congenital and obstructive ear conditions – and certain environmental factors make some animals more susceptible to otitis externa than others. Predisposing factors that put dogs and cats at risk include ear canal stenosis (constriction of the canal), excessive cerumen (ear wax) production, excessive ear canal hair, excessive exposure to moisture, and trauma.

Dogs may be more prone to otitis because of the structure of their ear canal, which actually has a bend in it, points out Dave Manley, sales manager, special markets, Welch Allyn. The problem is especially noticeable in dogs with floppy ears, adds Tiffany Moon, marketing communications specialist for Welch Allyn. “The ear flops over, creating a warm, moist environment,” conducive to such things as yeast infection. Dogs that swim are more prone to otitis as well.

Although otitis is more frequently seen in dogs than in cats, it occurs in both species. Clinical signs are generally similar in dogs and cats. Head-shaking, ear scratching, ear exudate, and signs of inflammation are evident in both species.

Veterinarians should look for erythema (redness or rash), swelling, crusts, exudates, hyperpigmentation, excoriations (abrasions) and signs of pain associated with the pinna and surrounding areas. Signs of facial palsy, including loss of the blink reflex, are another clue. Thorough physical and otoscopic examination along with complete examination of the skin (for primary causes) and ear cytology (to identify perpetuating factors) is critical for accurate diagnosis and effective treatment.

To minimize the occurrence of otitis, owners should keep their pet’s ears clean and dry, closely following their veterinarian’s instructions on what to use, when, and how. Veterinarians can help prevent otitis by educating clients on treatment administration, ear health maintenance regimens, and the need for regular follow-up examinations.

It is important to note that if the primary causes and perpetuating factors are not addressed, otitis externa and media will frequently recur. Improper treatment of the initial case can lead to recurrence.


Sales considerations

Regarding otitis, distributors have much to offer their veterinarian customers. If prevention is the best approach, pet owners can take home any of a number of acidic cleaning solutions on the market. These solutions – which can prevent blockage of the ear canal by cerumen – are applied at home on a regular basis, usually several times a week.

The veterinarian’s primary diagnostic tool for otitis is the otoscope. Welch Allyn has been manufacturing veterinary-specific otoscopes for at least 15 years, says Manley. The veterinary scope has a longer depth of field than those used on humans, hence, it can operate better in the much longer ear canals of dogs. What’s more, optics are set up so they operate at a greater distance.

The company’s MacroView Otoscope has a set of two lenses, offering greater depth of field and a 35 percent wider field of view. The Digital MacroView Otoscope allows the vet to clearly show the pet owner, on a screen, what their pet’s inner ear looks like. “With this greater understanding, the pet owner is more likely to comply and follow through with treatment,” says Moon.

Indeed, compliance is a big factor in treatment of otitis, she says. And distributors can play a role here. “One of the largest frustrations that veterinary practices have is client compliance. If distributor reps are able to convey that they can help increase client compliance, which in turn directly helps the pet, [veterinarians] should be apt to listen. A thorough demo of the product should be provided to increase the understanding of the product and how it can effectively help the veterinarian communicate the severity of the issue to the client.”

Compliance in this case means that the owner strictly adheres to the medication regimen prescribed by the veterinarian, as well as make the necessary follow-up visit.

In October 2010, Intervet/Schering-Plough launched POSATEXTM Otic Suspension, a topical otic medication indicated for the treatment of canine otitis associated with susceptible strains of yeast (Malassezia pachydermatis) and bacteria (coagulase positive staphylococci, Pseudomonas aeruginosa, and Enterococcus faecalis). Like Mometamax®, another otic medication from Intervet/Schering-Plough Animal Health, POSATEX contains 0.1 percent mometasone, a potent and safe corticosteroid proven effective in reducing inflammation associated with otitis externa with once-daily dosing. But unlike Mometamax, POSATEX contains 1 percent orbifloxacin, designed to locally deliver this fluoroquinolone antibiotic at up to 1,000 times the MIC of most veterinary otic pathogens, thereby minimizing the risk of microbial resistance, according to the company. POSATEX also contains 0.1 percent posaconazole, an antifungal new to veterinary medicine and which is said to be particularly effective against Malassezia pachydermatis.

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