My vet's colleague looked at Otis' ear on Monday, and said he thinks this is a polyp:
(That greasiness on his fur is from the ointment). It is a flesh-colored 'knob' that almost looks like one of those little plastic ear-plugs swimmers use. The vet swabbed it and said it tested positive for yeast. Gave me a tube of Tri-Otic (gentamicin sulfate, USP betamethasone valerate, USP and clotrimazole, USP ointment) to use twice a day for week, and said if it doesn't show improvement, the next step would be to have the polyp removed via laser surgery.
I was left wondering how Tri-Otic would help a polyp, or what yeast has to do with it, but the vet (who is not our usual vet) was not in a particularly chatty mood and darted out before I could get any clarification on it.
So I have a few questions. First of all, does this look like a polyp to you? I have been reading some articles on ear polyps in cats and dogs, and the few photos I found don't seem to resemble this thing at all. It also doesn't seem to be located in the right place - apparently most ear polyps aren't clearly visible (and this thing obviously is). An article on PetEducation.com says:
'Diagnosis is usually based on a thorough exam of the ear canal with an otoscope. Some cats may need to be sedated to properly examine the entire ear canal. The polyps are usually located in the horizontal part of the ear canal, which is difficult to visualize without an otoscope...Because a veterinarian can only diagnose them with a thorough otoscopic exam, we recommend that a veterinarian examine all cats with ear infections before any treatment is started.'
'The symptoms of polyps include those of an outer or middle ear infection. The cat may shake or scratch at its head, have pain on palpation of the ear, or it may have a thick or bloody discharge from the ear canal. Cats may also present with a head tilt and inability to walk in a straight line, or they may also have a droopy eyelid or the third eyelid may partially cover the eye."
Otis isn't having any of those symptoms so far. There is no discharge, no blood, and it doesn't appear to be painful (although he doesn't like having his ears messed with, so it's a little hard to tell). He has never had a URI or ear infection - we adopted him when he was a month old, and he's now 4 ½ - although he has always had a lot of ear wax. He is behaving normally, seems otherwise fine. I'm really baffled by this.
What are the chances it's something other than a polyp? Does it look more like a tumor? The fact that it's skin-colored is strange to me. If you didn't know better, you'd think it's just a natural part of his ear because it "matches" the rest of his ear. It's raised, but does seem to be narrower at the base, and it can be moved around a little bit with your finger.
Assuming it is a polyp, is laser surgery the correct protocol? Is there any other treatment that could shrink the polyp without surgery? What is involved in laser surgery of this type? Cost? Recovery time?
Also, as a sidenote, is Tri-Otic (generic of Otomax) okay to use? As I'm looking at the box, it says 'For use in dogs only.' Could I use something like a Nolvasan Otic flush in addition or instead of?
Any feedback appreciated.
Thanks. I did several searches on "polyp" on the board, but didn't see those pictures. Can you direct me to the actual threads? They do look similar to what Otis has.
I'm not sure about the culture. Vet looked at the sample under a microscope and said he was seeing yeast. ? Makes sense, though, about the moisture.
That being the case, wouldn't we want to keep the eye clean and dry, vs. using an ointment?
ETA: I found the Graid thread. That was apparently an infection, though. This doesn't look infected.
What has me really confused, is that this vet said to use the ointment 2x daily for a week and, "...if it doesn't shrink any, the next step would be to go ahead and remove it via laser surgery." How would an anti-fungal/AB ointment shrink a polyp?
- Little Jo Wheek
Polyps can be caused by many things, including viral infections in cats. Not sure what would cause one in a cavy. It does make sense to me if he did cytology that there could be a yeast infection or bacterial infection. The "Tri-otic" is indicated for yeast. Nolvasan flush wouldn't have a yeast killer in it per se, but it would help to cleanse and dry things out, making the area less habitable for yeast. Pretty good regular preventive maintenance on a regular basis, but it is fairly harsh and drying.
The one thing is that gentamiacin is in the Tri-otic. It can cause hearing loss. So, if anything seems amiss, I would discontinue it and contact your vet. It doesn't happen very often, and when it happens, it is generally in chronic users (long-term daily use). It is a good drug when indicated. Tri-otic also contains a steroid that may help reduce the inflammation. It won't shrink it to nothing, but it might reduce in size some. Of course, it should be used with care and not on a regular basis due to potential for steroid-related problems and antibiotic resistance.
Yes, I would think laser removal and histopath would be indicated. Then you know if you are dealing with a malignant mass or a polyp and can treat accordingly. If it is a polyp, they have a tendancy to multiply if it is viral. They also may come back if not properly removed with good margins. Again, I'm gleaning from cat info, since I regularly see this problem in cats and no other species.
Additionally, polyps often trap bacteria and yeast inside the ear, causing chronic ear infections if not removed.
Sounds like we're doing the right things, then. Would a diluted vinegar wash be better than the harsher Nolvasan? I also have this product at home and Epi-Otic.
Her complete treatment (which I started with my own vet's knowledge prior to her appointment the following weekend) was: She had a Nizoral bath and received TMS/Bactrim twice a day and Metacam once a day (just for a couple of days for the toenail) and Oxbow's Vitamin C. In addition, the inflamed toe was soaked twice a day. She received a standard-intake preventative dosing of Ivermectin: once a week for three weeks for any mites.
A week later she was assessed by her vet since the ear was still draining and there was blood splattered around her cage. The ear mass had returned aggressively, was bleeding, and causing extreme pain so she was humanely PTS. I do have photos in an online album but they do not show the mass that was removed from the ear while she was at the shelter. I did not take my camera with me when I had her checked after hours at the vet's.
- Little Jo Wheek
But that may not even be necessary. With all pigs, I recommend cleansing their ears a minimum of once monthly.
I would say Otis had gone a month or so before I noticed this thing...it's a good lesson about staying on schedule with this stuff. :(
Looks like my Epi-Otic (with the nasty "fresh apple blossom" fragrance) just expired, so I will order a new bottle tonight.
Thanks again for the info.
Jo, may I butt in here and ask what you think of Epiotic sold at pet stores? My local supply shop carries that and Nolvasan.
- Little Jo Wheek
Ugh, I hate the fragrance of Epi-otic also. Apple blossom, my foot!
You wanna know what I like TONS better? Oxyfresh Pet Ear Cleaner. WAY better. I used it about 4 years ago and haven't looked back. And I've tried tons of stuff. It's even good for general skin cleansing (for abrasion type things, not wounds).