Video-otoscopy — endoscopy of the ear

What it involves

Video-otoscopy is an examination of the ear with a thin, rigid endoscope with a camera and a working channel. Compared with an ordinary otoscope, it gives a magnified, illuminated image on a screen, reaches the eardrum itself and allows work to be done at the same time: flushing the canal, suctioning discharge, grasping foreign bodies, taking biopsies and removing polyps by traction.

The greatest value lies in assessing the eardrum — whether it is intact, reddened, or bulging because of fluid in the middle ear. This determines which medications are safe and whether the inflammation has extended into the middle ear. In a dog with recurrent ear infections, the canal can be so narrowed, thickened and filled with discharge that it cannot be seen without an endoscope and flushing.

We perform the examination under sedation or a short anaesthetic with monitoring, because the ear is painful and manipulation around the eardrum requires a motionless patient. Photographs and video document the condition of the ear and allow it to be compared at follow-up visits.

When it is used

We suggest video-otoscopy for ear infections that recur more often than 2–3 times a year or last longer than 1–2 months, when the canal is too painful or too full to be assessed during a visit, when a damaged eardrum or middle-ear infection is suspected (head tilt, pain on opening the mouth), when a foreign body or polyp is suspected, and before a decision on ear surgery.

In cats with one-sided discharge, head tilt or noisy breathing, the examination can detect and often immediately remove an inflammatory polyp.

Indications: symptoms that should prompt a visit

• The dog's ear infections come back every time the drops are stopped, despite treatment guided by cytology.
• The ear is so painful that the dog will not allow it to be examined, and the canal is filled with thick discharge.
• The dog tilts its head, has pain when yawning and eating, and has a drooping eyelid or lip on one side.
• After a walk in grass, the dog suddenly shakes its head and yelps — a grass awn in the ear is possible.
• The cat has one-sided purulent discharge, tilts its head or snores — a polyp is suspected.
• The vet cannot assess the eardrum and does not know whether the drops are safe.
• The ear canal is narrowed and thickened, and conservative treatment has stopped working — an assessment is needed before surgery.

Conditions for which we use it in particular

Diagnostics beforehand

Before the examination we perform otoscopy in the consulting room as far as pain allows, cytology of the discharge from both ears (in-house laboratory) and a neurological examination if there are vestibular signs. In otitis media, a skull X-ray with views of the tympanic bullae shows advanced changes.

Sedation assessment according to STD-01: clinical examination, blood tests in older patients and those with other conditions, and, in patients with allergies or hormonal problems, a discussion of treating the underlying cause, because without it the ear infections will keep coming back.

How it proceeds

Aftercare

Give the drops and systemic medication exactly as set out in the discharge instructions, usually for 2–4 weeks; do not clean the ears for the first few days, and afterwards follow the instructions. After removal of a polyp in a cat, a temporary Horner's syndrome (constricted pupil, drooping eyelid) is possible and usually resolves.

Follow-up with otoscopy and cytology after 10–14 days, and then again after treatment ends; with otitis media, follow-up is longer. In parallel we treat the underlying cause (allergy, hormonal disease). Call if there is a marked head tilt, vomiting, severe pain, bleeding or a sudden worsening of hearing.

Frequently asked questions