Case Study

Patient and Case Overview

  • Eevee: 8-year-old female spayed (FS) shepherd/lab mix

  • Presenting complaint: 3-day history of shaking head and rubbing at ears

  • Context: Case study focusing on history-taking, cytology, and management workflow in a veterinary clinic

Key Concepts and Definitions used in the Case

  • Ear anatomy abbreviations commonly used in reports:

    • AD = auris dextra = right ear

    • AS = auris sinistra = left ear

    • AU = auris utrique / auris utrisque = both ears

  • Ear cytology: cytology sampling from the ear canal to identify infectious organisms (bacteria, yeast) and inflammatory cells; used to guide therapy

  • CLARO Otic: commercial combination therapy for otitis externa

    • Composition: extflorfenicol+extterbinafine+extmometasonefuroateext{florfenicol} + ext{terbinafine} + ext{mometasone furoate}

    • Route/usage: otic solution for use in dogs only; do not use in cats

    • Regulatory note: CAUTION – Federal law restricts this drug to use by or on the order of a licensed veterinarian

Page 3: History-Taking and Questioning Skills

  • Objective: Gather essential information from the owner to inform diagnosis and treatment

  • Emphasis on technique:

    • Practice asking open-ended questions to gather a broad history

    • Example prompt: “What changes have you noticed at home and when did they begin?”

    • Strategy: Take 5 minutes to write down questions first, then share with doctor

  • Types of information to collect (implied by context):

    • Onset and progression of symptoms

    • Ear-specific symptoms (shaking, rubbing, discharge, odor, pain)

    • Previous treatments or medications and responses

    • Recent exposures or environmental factors

    • General health and concurrent illnesses

Page 4: Post-History and Cytology Consent

  • After obtaining history, the technician may need to obtain owner permission to obtain an ear cytology sample

  • Responsibilities of the technician:

    • Seek consent for cytology sampling

    • Discuss the collection and preparation process with the owner (what will be done, why it’s helpful, potential discomfort)

  • Process to discuss (implied):

    • The collection method (e.g., sampling from ear canal)

    • How the sample will be prepared and analyzed (staining, slide prep)

  • Ethical/operational note: Ensuring owner understanding and consent is essential before sample collection

Page 5: Gross Ear Descriptions (Left vs Right)

  • Instruction prompt: “How would you grossly describe these?”

  • Left Ear: AS gross appearance (not explicitly described in the transcript)

  • Right Ear: AD gross appearance (not explicitly described in the transcript)

  • Takeaway: Be prepared to document gross morphology such as redness, discharge, debris, odor, swelling, cerumen consistency, presence of lesions, and secondary changes

  • Practical note: In actual practice, gross description guides sample quality and differential diagnoses

Page 6: Microscopic Views (Left vs Right)

  • Microscopic views are listed for Left Ear and Right Ear (images or slides labeled but specific findings not provided in transcript)

  • Importance in practice:

    • Microscopic examination helps identify organisms (bacteria, yeast) and inflammatory cells

    • Guides antibiotic/antifungal selection and anti-inflammatory therapy

  • In this transcript, the detailed cytology findings are not provided; the exercise emphasizes recognizing that both ears have separate microscopic assessments

Page 7: Ear Cytology Report (Template and Fields)

  • Report sections (structured template)

    • Patient Name:

    • Client Last Name: ___

    • Date: _

    • AS Gross Appearance:

    • AS microscopic findings: ____

    • AD Gross Appearance: _

    • AD microscopic findings: ___

    • Tech:_

  • Key point:

    • The template differentiates findings for each ear (AS = left, AD = right) and captures gross and microscopic observations separately

  • Practical use:

    • Systematic documentation supports traceability of findings and follow-up decisions

Page 8: Doctor Evaluation and Plan (DVM Communication)

  • After a thorough physical exam and case discussion with the owner, the doctor relays the treatment plan to the technician:

    • Clean AU thoroughly (both ears)

    • Instill CLARO Otic AD (right ear)

    • Repeat ear cytology in 30 days

  • Workflow detail: Doctor may move on to the next appointment, leaving the technician to finish up tasks

  • Clinical implication:

    • Follow-up cytology helps assess treatment efficacy and guide adjustments

Page 9: Ear Cleaning Process (General Discussion)

  • Statement: You thoroughly clean both ears; the class prompts discussion on the cleaning process

  • Discussion prompts presented in the slide:

    • Who can describe the cleaning process?

    • What if the doctor does not specify which cleaner to use?

  • Practical notes (inferred from standard practice):

    • Use veterinarian-recommended cleaner and technique per ear anatomy

    • Steps typically include gentle drying, debris removal, and avoiding trauma

    • If cleaner is not specified, seek clarification from the supervising clinician before proceeding

Page 10: CLARO Otic Preparation and Usage Details

  • Product depiction and labeling highlights:

    • CLARO Otic Solution

    • Composition: extflorfenicol,extterbinafine,extmometasonefuroateext{florfenicol}, ext{terbinafine}, ext{mometasone furoate}

    • Indication: Otic solution for use in dogs only

    • Contraindication: Do not use in cats

    • Regulatory note: CAUTION – Federal (USA) law restricts this drug to use by or on the order of a licensed veterinarian

    • Manufacturer/Brand: Elanco

  • Practical takeaways:

    • Ensure correct ear (AD) is treated unless directed otherwise

    • Observe for any adverse reactions and monitor response

    • Counsel owner on administration technique and safety

Page 11: Wrapping Up – Owner Instructions and Follow-Up

  • Highlights for owner:

    • It is normal for the animal to rub or shake its head for up to 24 hours after cleaning and medication application, depending on the procedure and medications used

    • Do not clean or medicate the ears until the recheck appointment unless instructed otherwise

    • Do not allow the animal to swim or bathe until cleared or as advised by the veterinarian

    • Recheck cytology is important – reasons include:

    • Assessing response to therapy (clinical and cytologic)

    • Confirming resolution of infectious agents or inflammatory processes

    • Guiding continuation, modification, or cessation of therapy

  • Implicit clinical rationale:

    • Rechecking cytology helps ensure eradication of pathogens and reduces risk of relapse or resistance

    • Documentation and owner education support adherence and timely follow-up

Connections to Foundational Principles and Real-World Relevance

  • Diagnostic workflow in otitis externa:

    • History-taking informs differential diagnoses and sampling strategy

    • Cytology provides rapid, cost-effective information to tailor therapy (antibiotic, antifungal, anti-inflammatory)

    • Post-treatment recheck with cytology ensures objective assessment of treatment success

  • Therapeutic rationale for CLARO Otic:

    • Combines antimicrobial (florfenicol), antifungal (terbinafine), and anti-inflammatory (mometasone furoate) actions to address common mixed infections and inflammation in otitis externa

    • Dog-specific use with cat contraindication minimizes cross-species safety concerns

  • Ethical and practical considerations:

    • Informed consent for procedures (cytology sampling)

    • Accurate documentation and adherence to the owner’s understanding of treatment plan and follow-up

    • Emphasis on welfare: minimizing discomfort during ear sampling and cleaning, prompt management of pain and inflammation

Quick Reference: Key Numbers and Formulas

  • Follow-up interval for cytology: t=30extdayst = 30 ext{ days}

  • Post-treatment observation window for early adverse signs: extwatchforupto24exthoursaftercleaning/medicationapplicationext{watch for up to } 24 ext{ hours after cleaning/medication application}

  • CLARO formulation components in abbreviated form: extCLARO=extflorfenicol<br>ightarrowextterbinafine<br>ightarrowextmometasonefuroateext{CLARO} = ext{florfenicol} <br>ightarrow ext{terbinafine} <br>ightarrow ext{mometasone furoate}

Practical Takeaways for Exam Preparation

  • Be able to describe the typical clinical workflow in a case of otitis externa:

    • History collection with open-ended questions

    • Decision to perform cytology and obtain consent

    • Documentation of gross and microscopic findings per ear (AS vs AD)

    • Implementation of a bilateral cleaning step with targeted topical therapy (AD) and plan for recheck cytology

  • Understand the purpose and components of CLARO Otic and its regulatory notes

  • Recognize the importance of owner education and follow-up for successful outcomes

  • Appreciate the role of recheck cytology in antimicrobial stewardship and treatment optimization