C10028787 / invoice 10000

Sedate for ear clean & treatment - bilateral yeast otitis externa 

Hx
Swimming last weekend 
Has not had an ear infection for a while. 
Head shaking and itching his ear. 
Started antihistamines - seasonal itching. Loratidine 10mg SID 
EDDU WNL 
Has had breakfast this morning 
No other current medications (just antihistamines). 
Has been tilting his head a little. 

BAR - highly excitable, better in treatment room. Can become aggressive with restraint & ear sampling - muzzled. 
Eyes/nose NAD 
MM P+M
Thoracic ausc NAD 
Rectal temp not taken 

Ears - 
Grossly mildly erythematous bilaterally, moderate ceruminous debris (R>L), mild stenosis. 
Cytology yeast 0-20 yeast per HPF (R>L); nil rods/cocci. 
TM exam not tolerated conscious. 

Discussed - 
- Preferable to performa TM exam prior to medicating due to ototoxicity risk, esp with possible head tilt.  
- Preferable to remove debris from ear prior to the medication to improve efficacy. 
- Options to keep in and sedate/ear clean/adminsiter LA medication OR administer LA medication, r/c 1mo, sedate & ear clean & medicate again if not resolving. 

Client elected to keep in for sedation --> est $660-$700. 

Sedation 
Butorphanol 0.1mg/kg IM 
Medetomidine 10mcg/kg IM 

IVC placed R cephalic 

Both ears flushed copiously with Otoflush - significant volume of ceruminous debris removed from R ear. 
Otoscopic exam of both ears unremarkable - no FB's. L ear TM visualised, NAD. R ear TM unable to be entirely visualised due to small amount of remnant debris that could not be removed. 

Neptra instilled in both ears. 

PLAN 
Neptra instilled in both ears --> keep dry for 30d (no swimming/bathing), represent for a recheck in 30d to ensure resolution of infection.