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Prebiotics and probiotics
Prebiotics are complex carbohydrates which are fermentable, promote the growth of beneficial intestinal bacterial and decrease the growth of pathogenic bacteria, e.g. fructo-oligosaccharide and mannos- oligosaccharide’s. Probiotics containing non-pathogenic bacteria such as Bifidobacterum, or Enterococcus faecium, are used to increase the ratio of normal to pathogenic GI microbes, which have a variety of effects on the intestine.
Cobalamin (Vitamin B12) and folate
Many animals with CE are cobalamin deficient11,12. Cobalamin is needed for GI epithelial cell turnover and repair, and in many feline GI cases signs won’t resolve until cobalamin has been repleted. Serum cobalamin concentrations are usually measured simultaneously with serum folate concentrations. Folate can become deficient when cobalamin is replaced and may also need to be supplemented. Cobalamin has previously been administered parenterally, although a recent study showed that oral cobalamin supplementation was effective in normalizing serum cobalamin concentrations12,13.
References available upon request
Your Singapore, the Tropical Garden City
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Recurrent unresponsive otitis is a frequent indication for aural surgery in the dog. Certain breeds are predisposed such as the spaniels due to their pendulous ears, shar peis with their narrow ear canals, and poodles due to excessive hair growth. Cavalier King Charles can develop secretory otitis media and cocker spaniels may have increased cerumen production.
Inflammation from otitis may be a precursor to tumour development and increased glandular dysplasia. Many aural tumours are linked to chronic inflammation. Benign lesions include cholesteatomas, inflammatory polyps, papilloma, basal cell tumour, and ceruminous gland adenoma. However, malignancies such as ceruminous gland adenocarcinoma and squamous cell carcinoma can also be seen. Cats will commonly be evaluated for inflammatory polyps or squamous cell carcinoma of the ear tip.
In addition to the otoscopic examination it is important to perform a complete neurological assessment and thorough external palpation of the external ear canal. Local extension of infection or neoplasia can cause facial nerve deficits, Horner syndrome, and/or peripheral vestibular signs. Intracranial extension of the process can cause forebrain, brainstem, cerebellar or central vestibular signs. Identification of neurological deficits warrants pre-operative CT or MRI. Differential diagnoses such as Chiari like malformation should be considered for at risk breeds.
In most cases of severe persistent otitis a total ear
canal ablation is the most practical management
option. Medical therapy should be based on culture and sensitivity and administered prior to surgery to optimize surgical conditions – however in most cases extensive delay is not prudent as this can result in development of multi drug resistant organisms while not addressing the underlying cause. A lateral ear canal resection is often reserved for disease processes limited to the lateral vertical canal (such as a focal neoplasia). Lateral ear canal resections for severe otitis typically will result in stricture due to the profound inflammation and inability to maintain an adequate aural opening.
Adequate analgesia should be provided prior to, during and following a total ear canal ablation and can include full agonist opioids, local blocks or infusions and anti-inflammatories. The surgical approach is
well described, attention should be given to avoiding damage to the retroglenoid/retroarticular vein (rostral), facial nerve and carotid artery and maxillary vein. Pre-

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