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I frequently see cats presented for wellness evaluations that have unilateral or bilateral ceruminous otitis externa. These cats’ aural pruritus ranges from none to severe; most cats have minimal or no pruritus. Cytologic examination often reveals Malassezia species. I often treat these cats with Otomax (Intervet/Schering-Plough Animal Health). Please comment on this problem—the cause, the therapy, and your views.
Regarding the cause and treatment of ceruminous otitis externa in cats, remember that otitis externa, regardless of the type of discharge, is a sign of an underlying disease. So you need to consider both primary and perpetuating factors.
Primary factors—such as Otodectes species, cutaneous adverse food reactions, environmentally triggered atopic dermatitis, and aural polyps—cause otitis externa. Perpetuating factors do not initiate the problem but will cause the disease to continue unless they are also treated. Perpetuating factors include
With Otomax, you are effectively addressing many possible perpetuating factors. But remember that in recurrent cases, you also need to address the primary factor. Since most causes of otitis externa may also cause skin disease (and vice versa), I always inquire about previous skin disease in addition to documenting any previous episodes of otitis externa. If a cat has never had an episode of otitis externa or any skin disease in the past, treating the perpetuating factor may result in a cure or at least long-term remission (years). In those cases, I suspect the cat has subclinical or mild allergic disease (cutaneous adverse food reactions or environmentally triggered atopic dermatitis), and only under the right circumstance will the pruritus exceed threshold and cause clinical signs. This may be similar to cats that vomit every three or four months. They probably have mild low-grade inflammatory bowel disease that causes only infrequent clinical signs.
So when I diagnose otitis externa in a cat that has never had skin or ear disease in the past, I eliminate Otodectes species as the cause and always treat the perpetuating factor. I also discuss with the owner the possibility of needing to perform other diagnostic tests if the otitis recurs or does not resolve. In those cases, I investigate the primary factor in addition to treating the perpetuating factor.
Paul Bloom, DVM, DACVD, DABVP
Allergy, Skin and Ear Clinic for Pets
31205 Five Mile
Livonia, MI 48154
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