C10014258 / invoice 10000

Reason: Video Otoscopy + Ear FlushFill ears with otoflush at admissionPre-GA bloods WNL Premed methadone/medetomidine IM Induction alfaxan IV Intubated and maintained on isoflurane IVFT hartmanns @ sx rate Ketamine CRI Cytology: both ears yeast 3-4+, WBC present Both ears large amount of brown watery discharge, biofilm covering the entire external ear canal, large amount of hair sitting just in front of the TM both ears so unable to see if TM intact, both ears marked glandular hyperplasia and chronic inflammatory changes Flushed both ears with saline until clear FNA lumps on back Routine recovery Treatment: In house made ear drops with dex/enrofloxacin/methopt tears - apply 1ml to each ear twice daily for 3 weeks - to clear biofilm and treat inflammation Clean at home with otoflush as needed Pred 20mg SID 5 days then EOD 5 dosesPlan: Once finish the ear drops recommend repeating the cytology then recommend changing to compounded Silver sulfadiazine 0.3% (using a silver sulfadiazine powder) + Dexamethasone 0.1% in methopt tears base twice weekly as maintenance    Vital Signs