视频耳镜治疗犬的外耳炎

刘欣

Treatment of Canine Otitis Externa Using Video Otoscopy

翻译：By 林靖飞, 校对：张建康

ABSTRACT. Otitis externa in 27 toy poodles and 40 miniature dachshunds was treated using a video otoscope. A distinct concavity (external tympanic concavity) was observed at the junction between the ventral part of the external surface of the tympanum and the ear canal to which a considerable amount of hair and debris had adhered. All hair and debris adhering to the external tympanic concavity were removed, and systemic antibiotic and antifungal agents were administered, after which all of the dogs recovered. The pattern of hair growth observed in the external tympanic concavity could be characterized according to the breed of dog. All of the toy poodles presented with curly hairs, while the miniature dachshunds had upright or flat-lying hairs.

摘要:使用视频耳镜治疗27个玩具贵宾犬和40个迷你腊肠犬的外耳炎。在鼓膜外表面腹侧部分与耳道的 交界处观察到明显的凹陷(鼓膜外凹陷)，大量毛发和碎屑附着在耳道上。所有粘附在鼓膜外凹陷处的 毛发和碎屑都被去除，并且施用全身抗生素和抗真菌剂，之后所有的犬都康复了。鼓膜外凹陷处的毛发 的生长模式根据犬的品种进行表征。所有的玩具贵宾犬都呈现卷曲的毛发，而小型腊肠犬则有直立或顺 直的毛发。

KEY WORDS: external tympanic concavity, otitis externa, video otoscope

关键词：鼓膜外凹陷，外耳炎，视频耳镜

Numerous studies have described methods to treat otitis externa, but the condition is prone to relapse and chronicity [1, 3, 5]. The most common method of treatment involves cleansing the ear canal by applying a cleansing solution or ceruminolytic solution into the ear canal and manually massaging the outer ear, followed by application of ear drops. Examination and treatment are typically performed using a hand-held otoscope. It has been suggested, however, that it is difficult to closely examine the area around the tympanum with these devices due to their numerous blind spots [4].

许多研究描述了治疗外耳炎的方法，但通常是慢性且易复发的。最常见的治疗方法包括将清洁液或耵聍溶解液涂在耳道中并手动按摩外耳来清洁耳道，之后使用滴耳液。检查和治疗通常使用手持耳镜。然而有人提出，由于有许多盲区，很难用这些装置仔细检查鼓膜周围的区域。

This study describes the successful treatment of otitis externa with thorough cleansing of the ear canal and the area around the tympanum under direct vision (real-time imaging) using a video otoscope (Karl Storz Endoscopy Japan K.K., Tokyo, Japan).

本研究描述了使用视频耳镜（Karl Storz Nescopy Japan K.K., Tokyo, Japan）在直视（实时成像）下彻底清洁耳道和鼓室周围区域，成功治疗外耳炎。

The subjects were 67 dogs, 27 toy poodles and 40 miniature dachshunds, with otitis externa that were taken to Usui Animal Hospital in Utsunomiya between September 2006 and January 2010 with the chief complaint of otitis externa. The dogs’ ages ranged from 3 months to 15 years; there were 38 males and 29 females. All dogs underwent a physical examination, general blood tests and blood chemical tests to ascertain their overall conditions and were then administered general anesthesia (isoflurane inhalation). The following tests and treatments were carried out using a video otoscope with the video image shown on a monitor screen at >10 times magnification. First, the auricle was cleansed, the video otoscope was inserted into the ear canal, and hairs and debris were then removed using 3- or 5-Fr grasping forceps. The ear canal was then carefully washed using a 3- or 4-Fr catheter (Atom Medical Corporation, Saitama, Japan) and an ear cleansing solution of 0.5% polyoxyethylene octyl phenyl ether with other ingredients (Nolvasan Otic; Kirikan Ltd., Tokyo, Japan). After the area around the tympanum and the ear canal were thoroughly cleansed, ear drops were applied to the tympanum. Antibiotics and antifungal agents were also administered systemically. The drugs used for topical and systemic administration were selected separately for each case based on the results of cytology, cultures and susceptibility tests.

实验对象为67只患有外耳炎的犬:27只玩具贵宾犬和40只小型腊肠，于2006年9月至2010年1月期间被送往 Usui Animal Hospital in Utsunomiya，主诉为外耳炎。这些犬的年龄从3月龄至15岁不等，分别有38只雄性 和29只雌性犬。所有的犬都接受了体格检查、全身血液检查和血液化学检查，以确定它们的整体状况， 然后进行全身麻醉(异氟烷吸入)。以下测试和治疗使用视频耳镜进行，视频图像以 > 10 倍的放大率显 示在屏幕上。首先清理耳廓，视频耳镜插入耳道，使用3-5号的抓钳去除毛发碎屑。然后使用 3 或 4 Fr 导 管(Atom Medical Corporation, Saitama, Japan)和含有其他成分的 0.5% 聚氧乙烯辛基苯基醚的耳朵清洁 溶液(Nolvasan Otic;Kirikan Ltd.，Tokyo, Japan)彻底清洁鼓膜周围区域和耳道后，将滴耳液滴在鼓膜。 全身给予抗生素和抗真菌药。根据细胞学、培养和药敏结果，针对每个病例分别选择用于局部和全身给 药的药物。

The topical antibiotic and antifungal agents were as follows: ofloxacin/ketoconazole/triamcinolone acetonide (Wellmate L3, Meiji Seika Kaisha, Tokyo, Japan), tobramycin (Tobracin ophthalmic solution, Nitto Medic K.K., Toyama, Japan) and amikacin sulfate (Amikamycin, Meiji Seika Kaisha, Tokyo, Japan). Systemic antibiotics were as follows: cephalexin (Larixin, Taisho Toyama Pharmaceutical, Tokyo, Japan), cefpodoxime proxetil (Simplicef, Pharmacia & Upjohn Company, New York, U.S.A.), sulfadimethoxine/ormetoprim (PRIMOR, Pfizer Inc., New York, U.S.A.), orbifloxacin (Victas S, Dainippon Sumitomo Pharma, Osaka, Japan), ofloxacin (Tarivid, Daiichi Sankyo Company, Tokyo, Japan) and amikacin sulfate (Amikamycin, Meiji Seika Kaisha, Tokyo, Japan). The systemic antifungal used was ketoconazole (Feoris, Mutual Pharmaceutical Co., Inc., Philadelphia, PA, U.S.A.). Treatment using the video otoscope was carried out once or more, depending on the condition of the case [6].

局部抗生素和抗真菌药物如下:氧氟沙星/酮康唑/曲安奈德(Wellmate L3, Meiji Seika Kaisha, Tokyo, Japan),妥布霉素(Tobracin ophthalmic solution, Nitto Medic K.K., Toyama, Japan)和硫酸阿米卡星 (Amikamycin, Meiji Seika Kaisha, Tokyo, Japan).全身用抗生素如下:头孢氨苄(Larixin, Taisho Toyama Pharmaceutical, Tokyo, Japan)。头孢泊肟 (Simplicef, Pharmacia & Upjohn Company, New York, U.S.A.),磺胺 二甲氧嘧啶/甲氧苄啶 (PRIMOR, Pfizer Inc., New York, U.S.A.),奥比沙星 (Victas S, Dainippon Sumitomo Pharma, Osaka, Japan), 氧氟沙星 (Tarivid, Daiichi Sankyo Company, Tokyo, Japan) 和硫酸阿米卡星 (Amikamycin, Meiji Seika Kaisha, Tokyo, Japan).全身抗真菌药物的使用有酮康唑(Feoris, Mutual Pharmaceutical Co., Inc., Philadelphia, PA, U.S.A.).根据病例情况，使用视频耳镜进行一次或多次的治疗。

Examination of the area around the tympanum with the video otoscope showed that, in all cases, hair and debris were adhering to the junction between the ventral part of the external surface of the tympanum and the ear canal. The debris was viscous, and the secretions were congealed together with hair. When the hair and debris were removed using grasping forceps, this area was seen to be concave. This area was provisionally named the external tympanic concavity (Fig. 1). An external tympanic concavity was found in every dog that was treated. The concavity was observed even more clearly by rotating the video otoscope's light source 180 degrees. In contrast, conventional procedures performed with a handheld otoscope do not permit confirmation of this concavity due to their inability to remove hair and debris.

用视频耳镜检查鼓室周围区域表明，在所有病例中，毛发和碎屑都附着在鼓膜外表面腹侧部分与耳道之 间的连接处。碎片是黏腻的，分泌物与毛发结合在一起。该区域暂时命名为鼓室外凹(图1)。在接受治 疗的每只犬中均发现了鼓室外凹。通过旋转视频耳镜的光源180度，可以更清楚地观察到凹面。相比之 下，传统的手持式耳镜检查方法由于无法去除毛发和碎片，无法确认这种凹陷。

Hair was seen growing from the external tympanic concavity, and the pattern of this hair growth was broadly divided into curly (group A), upright (group B) or flat-lying (group C; Fig. 2). In cases where the severity of the inflammation made classification of the hair pattern difficult, the pattern was determined after treatment had progressed. In group A, the hairs grew crookedly and became entangled in the secretions in the indented external tympanic concavity, and so they adhered to that area (Fig. 2A). In group B, there were cases in which the upright hair sticking out pushed against an ear wax ball, holding it in place (Fig. 3B), and cases in which debris became entangled in the hair, causing it to build up and become stuck between the hair and tympanum (Fig. 2B). In group C, the hair lay lengthwise along the ear canal, and debris was entangled with and adhered to the hair (Fig. 2C).

从鼓室外凹处可以看到毛发生长，毛发生长模式大致分为卷曲型(A组)、直立型(B组)或平卧型(C 组;图2)。如果炎症的严重程度使毛发类型难以分类，则在治疗进行后确定毛发类型。在A组，毛发弯 曲生长，并缠绕在凹陷的鼓室外凹的分泌物中，因此它们粘附在该区域(图2A)。在B组中，有一些病例 中，直立的毛发伸出，顶着球状耳垢，将其固定住(图3B)，还有一些病例中，碎片缠绕在毛发上，导 致毛发堆积，并卡在毛发和鼓膜之间(图2B)。在C组，毛发沿耳道纵向排列，碎片缠绕并粘附在毛发上 (图2C)。

The hair pattern was investigated by breed. The toy poodles were all in group A. The miniature dachshunds were divided between group B (55%) and group C (45%), with none in group A. A difference was observed between the toy poodles and the miniature dachshunds in the characteristics of the hair on the external tympanic concavity (Table 1).

按品种对毛发模式进行研究。顽具贵宾犬都在A组。小型腊肠被分为B组(55%)和C组(45%)，A组没 有。观察到玩具贵宾犬和小型腊肠犬鼓室外凹处的毛发特征存在差异(表1)。

Ear wax balls in the miniature dachshunds were then investigated. Of the 40 miniature dachshunds examined, otitis externa with the formation of ear wax balls in the ear canal was found in 17 cases (42.5%); these cases accounted for 15 of the 22 cases in group B and 2 of the 18 cases in group C (Fig. 3). The x2 test showed that there was a relationship between the formation of ear wax balls and hair pattern (group B or group C; Table 2, P<0.05). These findings demonstrate that the group B hair pattern contributes to the formation of ear wax balls inside the ear canal.

对小型腊肠犬的球状耳垢进行了调查。40只小型腊肠犬中，17例(42.5%)为外耳炎伴有球状耳垢的形 成。这些病例占B组22例中的15例，占C组18例中的2例(图3)。 测试表明球状耳垢的形成与毛发形态相关 (B 组或C 组;表2，P<0.05)。这些研究表明，B 组的发毛模式有助于耳道内球状耳垢的形成。

In groups A, B and C, the hair combined with secretions to form viscous debris that adhered to the external tympanic concavity. Cytology of debris on the external tympanic concavity showed the presence of bacteria and Malassezia. Treatment in the manner described above, through removal of the hairs and debris, cleansing of the ear canal, application of ear drops to the tympanum and systemic administration of antibiotics and antifungal agents, resulted in relief and cure of otitis externa in all cases (Fig. 4).

在 A、B 和 C 组中，毛发与分泌物结合形成黏腻的碎屑，粘附在鼓室外凹处。鼓室外凹处碎屑的细胞学 显示为细菌和马拉色菌。采用上述方法，通过清除毛发和碎屑、清洗耳道、鼓室局部耳药以及全身使用 抗生素和抗真菌药，结果，所有外耳炎病例均得到缓解和治愈(图4)。

The difference between this video otoscope-based treatment and conventional treatment lies in the former's ability to remove hair and debris that have accumulated in the external tympanic concavity. Specifically, the technique enables removal of this build-up from the concavity using a grasping forceps and thorough cleansing of the area using a catheter under direct vision. Conventional methods, on the other hand, do not enable safe and thorough removal of hair and debris because the procedure cannot be performed while observing the forceps or catheter inside the ear canal (Fig. 5). This means that microorganisms such as bacteria and Malassezia remain in the area around the tympanum, creating a focus of inflammation.

这种基于视频耳镜的治疗方法与传统治疗方法的区别在于前者能够去除外耳道凹陷处积聚的毛发和碎 屑。具体而言，该技术能够使用抓钳去除凹陷处的上述堆积物，并在直视下使用导管彻底清洁该区域。 另一方面，传统方法无法安全彻底地去除毛发和碎屑，因为在观察耳道内的镊子或导管时无法进行手术 (图5)。这意味着诸如细菌和马拉色菌这些微生物仍然会存在在鼓膜周围，从而造成一个炎症区域。

Secretions in the tympanum are said to move gradually outward from the inner ear to the entrance of the ear canal by way of epithelial migration [2]. However, the hair growing in this region and the attached debris remain where they are, and the debris entangled in the hair becomes a breeding ground for bacteria and Malassezia, which perpetuates the inflammation. This hairs and debris must therefore be dislodged from the external tympanic concavity to reduce inflammation and treat the otitis.

鼓膜上的分泌物通过上皮迁移从内部耳道逐渐向外移动到耳道入又 [2]。然而生长在这一区域的毛发和附 着的碎片仍然留在原地，缠在毛发上的碎片会滋生细菌和马拉色菌，从而使炎症持续。因此，这些毛发 和碎屑必须从鼓室外凹处清除，以减少炎症和治疗耳炎。

In the present study, otitis was successfully treated by removing the hair and debris from the external tympanic concavity and thoroughly cleansing the area under direct vision using a video otoscope. The hair pattern observed in this concavity could also be characterized by the breed of dog, with all of the toy poodles having curly hair (group A), while the miniature dachshunds had upright (group B) or flat-lying hairs (group C), suggesting that the breed of dog and pattern of hair growth are related. Furthermore, miniature dachshunds in hair pattern group B were found to produce many ear wax balls inside the ear canal.

在本研究中，通过去除鼓室外凹处的毛发和碎屑并使用视频耳镜在直视下彻底清洁该区域，成功治疗了 耳炎。在这个凹陷处观察到的毛发模式也可以用犬的品种来表明，所有的玩具贵宾犬都中卷毛(A组)， 而小型腊肠犬有直立(B组)或平躺的毛发(C组) , 说明犬的品种和毛发的生长方式有关。此外，发现 毛发类型 B 组的小型腊肠犬在耳道内产生许多球状耳垢。

In conclusion, removal of hair and debris from the external tympanic concavity and complete cleansing of the area cannot be achieved using the conventional method. A video otoscope is essential for treating otitis externa.

综上所述，使用常规方法无法去除鼓室外凹处的毛发和碎屑并彻底清洁该区域。视频耳镜对于治疗外耳炎很重要。

ACKNOWLEDGMENT. The authors thank Assistant Prof. Kaori Ide of the Tokyo University of Agriculture and Tech- nology for valuable advice.

REFERENCES 参考文献

学习笔记（林靖飞）：

1、犬的品种和耳道内毛发的生长方式有相关性，直毛容易产生球状耳垢，形成一个不容易去除的因素，导致耳病。external tympanic concavity（鼓室外凹陷）

2、视频耳镜视野更好，能够更好的清楚掉耳道凹陷处的毛发，去除易感染的因素。视频耳镜的理论操作方法；通过旋转视频耳镜的光源180度，可以更清楚地观察到凹面。

3、外耳炎或中耳炎治疗通常需要局部给药+全身给药。

学习笔记-朱锋:

• 学习到了外耳道内部的鼓室外凹陷的结构是耳炎的一个潜在病因。而这个潜在病因是需要借助检耳 镜去检查并确认。
• 通过调查发现耳道内毛发生长方式与品种有一定的联系，尤其是迷你贵宾犬几乎都是卷曲型。
  

Ryohei

董婉君

犬的这个鼓膜外凹陷处都会长毛，也就是说本身这个结构导致了犬容易得外耳炎，是因为有毛挡着，分泌物不容易被排出去，容易滋生微生物。所以需要拔毛，但是拔了毛之后耳毛还是会继续长出来吧，那怎么办，定期拔毛嘛？

王帆

董婉君 发表于 2021-12-14 02:19
犬的这个鼓膜外凹陷处都会长毛，也就是说本身这个结构导致了犬容易得外耳炎，是因为有毛挡着，分泌物不容易 ...

这是易感因素，易感因素不是直接导致发病的原因，不要把重心总放在耳毛这个视角。多想想原发病因，那才是导致外耳道皮肤角化异常的根本原因。还有持久病因的存在（药物使用不恰当）也是推波助澜的另一帮凶。管理重心应放在改善原发病因和去除持久因素。人家那嘬毛在那本来挺好，毛不背锅。

董婉君

王帆 发表于 2021-12-14 03:56
这是易感因素，易感因素不是直接导致发病的原因，不要把重心总放在耳毛这个视角。多想想原发病因，那才是 ...

嗯～收到

Miaaaa

学习了学习了

南海

郑江涛

学习

氯丙嗪

猫奴