PSPP System for Otitis Externa by Craig Griffin Name Date Determine and Assess Treatment T / S AB/AF/GC/EC/AllRx/D/Ot Causes and Factors Cyt/Oto/CR/Ot C LTM LLRx Identified imary Secondary Perpetuating Factors edisposing Factors C cureable, LTM long term management, LLRx life long treatment required T topical. S systemic, AB antibiotic, AF antifungal, GC glucocorticoid, EC ear cleaning AllRx allergy treatment, D diet, Ot other, Cyt cytology, Ot otoscopy, CR clinical response Drawings with permission. Pfizer Atlas of Infection in Dogs and Cats. The Gloyd Group, 2008
Table 1PSPP Classification System Causes of Otitis Externa imary Causes Disease Category Specific Diseases/Examples P c P c or LLRx P LTM OR LLRx Allergy Auto immune Adverse food reaction Atopic dermatitis or Atopic otitis no skin disease associated Contact allergy Flea allergy Dermatitis Bullous pemphigoid P LTM OR LLRx Epidermolysis bullousa Lupus erythematosus P LTM OR LLRx Pemphigus foliaceous Endocrine / LLRx Epithelializatoin Disorders Cushings Hypothyroid Sex hormone abnormalities (adrenal or gonadal elevated progesterone most typical) Lipid responsive seborrhea imary idiopathic seborrhea Sebaceous adenitis Vitamin A responsive dermatosis Zinc responsive dermatosis
Foreign Bodies / LTM/LLRx / LTM / LTM/LLRx P c/ltm Glandular disorders Immune mediated Micro organisms Miscellaneous Parasites Hair Plant awns, foxtail Sand, dirt Altered secretions (rate, or type) Sebaceous gland hyper or hypoplasia Drug reactions (topical or systemic) Erythema multiforme Vasculitis, vasculopathy Fungal rare, Dermatophyte, Sporthrix, Aspergillus Aural chondritis Eosinophilic granuloma complex Idiopathic Inflammatory/Hyperplastic Otitis of the Cocker Spaniel Juvenile Cellulitis oliferative perforating otitis of cats
Chiggers (Eutrombicula) Demodex Otodectes cynotis Ticks (especially Otobius megnini) Viral Canine distemper Secondary Causes Bacteria Medication reaction Overcleaning Yeast Cocci (Staph, Strept, Enterococcus) Rods (Psudomonas, oteus, E. coli, Klebsiella, Corynebacteria) Topical irritant that occurs in inflamed skin only (alcohol, low ph, propylene glycol) Excessive moisture and maceration Physical trauma (cotton tipped applicators) Budding (Malassezia sp) Pseudohyphae and round (Candida sp)
Table 2 PSPP Classification System Factors contributing to otitis externa Perpetuating Factors Anatomic site Changes/Examples Epithelium Excessive production of debris Altered migration Failure of Migration or surgery or surgery or surgery or surgery edisposingfactors Ear canal Tympanum Glandular Peri cartilaginous fibrous tissue Middle Ear Conformation Edema oliferative changes Stenosis Acanthosis Dilation Diverticulum or Pocket Rupture Apocrine blockage and dilation Hidradenitis Sebaceous hyperplasia Calcification Fill with debris Otitis media Osteomyelitis
LTM LTM LTM LTM/surgery LLR surgery surgery c/surgery c c Excessive moisture Obstructive ear disease Systemic disease Treatment effects Excessive hair growth in canals Hairy concave pinna Pendulous pinna Stenotic canals Environment (Heat and high humidity) Water (Swimmers ear, grooming) Apocrine cystadenomatosis Neoplasia Polyp Catabolic states Debilitation Immune suppression Altering normal microflora Trauma from cleaning