A step by step guide to a video otoscopic ear flush

Video otoscopy is increasingly being used as a useful tool in the diagnosis and treatment of canine and feline otitis (Paterson and Tobias, 2012). The KarlStorz (Slough, UK) and OTOPet-USA (Potomac, MD, USA) are the two commonly used systems in Europe and the USA respectively. When approaching an otitis case, clinicians should always seek to identify the primary and secondary causes of otitis, as well as predisposing and perpetuating factors (Table 1). This is essential for appropriate therapy, and to prevent a vicious cycle of increasingly resistant microbial infections and progressive pathological changes that may lead to requirement for total ear canal ablation and bulla osteotomy.

Traditionally, general practitioners have flushed ears using a low magnification handheld otoscope and a cut down 8 French polypropylene urinary catheter. A video otoscope offers numerous advantages to this method, as it uses a highly magnified (x25–30) bright light fibre-optic camera that can be used to assess the ear canal structures in fine detail and perform minor surgical procedures (Cole, 2004). Deep cleaning allows complete examination of the canal. Retrograde flushing removes microbes and discharge from the vertical and horizontal canal. This improves the access and efficacy of topical antimicrobials that may be important for antibiotics that are inactivated in purulent discharge (such as gentamicin and polymyxin B). Procedures commonly performed with a video otoscope are summarised in Table 2. During the video otoscopy procedure, images and films of the ear may be taken as clinical records. These are also useful to educate the client and monitor otitis improvement over time.