Head shaking and/or ear scratching

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Approximately 6–7% of feline patients presented at the veterinary surgery have ear disease, which can present as head shaking and/or ear scratching. The most common cause of head shaking and ear scratching in cats is otitis. This chapter deals with diagnostic approach, treatment, when to refer and what to do if finances are limited. : Ear flushing; Ear cytology.

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5.15.1 Anatomy of the feline ear, showing the presence of a septum in the bulla of the middle ear; this septum is not present in the dog Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. I = incus; M = malleus; S = saccule; St = stapes; U = utricle.
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5.15.2 A polyp in the horizontal external ear canal of a young cat that presented with unilateral purulent otitis. The polyp was only visualized after flushing the ear canal with copious amounts of saline whilst the cat was anaesthetized.
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5.15.3 Coccoid bacteria (blue arrow) and degenerate neutrophils (white arrow) can be seen on this ear cytology smear from a cat with bacterial otitis. The coccoid bacteria are not often intracellular but their presence in large numbers indicates a problem. (Diff-Quik; original magnification X1000)
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5.15.4 These organisms have a distinctive peanut or snowman shape. Cats can also have different types of from those found in dogs, with some having an oval or round appearance, as shown here. (Diff-Quik; original magnification X1000)
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5.15.5 An approach to investigating otitis in cats that do not have neurological signs; for investigation of vestibular disease see Chapter 5.16.
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5.15.6 mites may be found in Henry’s pocket at the base of the ear. The six-legged larvae cause a seasonal pruritic and papular dermatitis in cats. Mites can be seen from July to October in the UK. They are commonly found on the pinna, interdigital skin and face, and are easily seen with the naked eye as bright red-orange dots, which are tightly adherent to the skin, usually in clusters (black arrow). Treatment requires killing the mites and providing anti-inflammatory treatment if appropriate. Fipronil spray can be applied directly to affected areas and is usually effective at controlling the mites.
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Image of Otodectes mite from a cerumen smear. (Courtesy of University of Bristol Veterinary School)
Otodectes mite from a cerumen smear. (Courtesy of University of Bristol Veterinary School) mite from a cerumen smear. (Courtesy of University of Bristol Veterinary School)
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