C10025536 / invoice 10000

13/03/2026 Presenting Complaint: Bilateral ear infection, left ear worse than right.

Hx: Chronic bilateral ear infection, left ear more problematic. Seen 2-3 weeks ago, subjectively more comfortable now but still discharge in the left ear. Owner has been attempting ear cleaning at home. Normally only eats in evenings.

PEx: 
Temperament: Happy in herself, leaning into left ear during examination.
Vitals wnl 
ears: Left ear - discharge present, clumped hair noted in left ear. Brown waxy d/c in both ears, left ear worse than the right. 

Laboratory results: Ear cytology revealed: 
- Right ear: ~3-4 yeast per HPF
- Left ear: ~6-8 yeast per HPF 

Assessment: 
Bilateral otitis externa, left ear worse than right. Yeast infection not responding to current topical therapy. Possible contributing factor is the excessive hair within the left ear canal. 
Differential diagnoses for chronic otitis externa: Malassezia dermatitis, allergic otitis, foreign body, ear canal stenosis.

Plan: 
Heavy sedation and ear flush scheduled for Monday. Pre-anaesthetic blood test recommended to check liver and kidney function. Estimate approximately $1000 including blood test.
Continue ear drops in both ears until Sunday, last dose Sunday evening, withhold Monday morning.
Fasting from 8pm Sunday night, no food Monday morning.

Consult Summary: 
Presented for ongoing bilateral ear infection with left ear more affected. Yeast burden has increased despite topical treatment. Heavy sedation and ear flush scheduled for Monday with pre-anaesthetic blood test recommended. Continue ear drops until Sunday then fast overnight.