Page 86 - Veterinary Laser Therapy in Small Animal Practice

72 Veterinary Laser Therapy in Small Animal Practice

about 100 times better through the tympanic mem-
brane than through the mastoid portion of the tempo-
ral bone. [223]
The first benefit you will notice from adding LT is a
faster resolution of inflammation and pain. Some mild
cases will not need any treatment other than LT, but
others will definitely require topical medications, and
sometimes also oral. A severe, purulent, and ulcerative
otitis does need other treatments. Plus LT is never a
substitute for a local ear cleaner. My advice is that when
you first start to work with LT, you do not change your
usual treatment protocol; just add the laser. Once you
become more used to it, you will feel more confident Figure 7.11 Direct exposure of the vertical ear canal.
in predicting its clinical effects. Please, remember the
importance of antibiograms.
Before you start treating, eliminate debris and secre-
tion to a reasonable extent and remove topical prod-
ucts to a reasonable extent – full removal is usually not
possible in this location. The pinna can be treated as if
it was an acute/chronic wound, in non-contact mode,
with quite similar considerations for dose and power
– usually acute wound settings are enough (Table 7.4).

• Use 2–6 J/cm : start with the lower dose, but con-
2
sider increasing it if by the third treatment you don’t
see a response, especially if it is a chronic case.
• Use 1.5–3 W of average power.
• This area can be more sensitive than a wound in Figure 7.12 Contact treatment of the ear canal through the
some dogs and keeping a low power density is skin.
important. Depending on the patient’s tolerance,
2
use 0.2–0.6 W/cm . In an acute flare-up, with very from a caudolateral position, aiming down the canal as
inflamed skin, choose a lower power density; for you do when you move the ear to explore it with an
chronic refractory cases with not so much reactiv- otoscope (Fig. 7.11). To reach within the ear canal from
ity, you may choose the higher end of the range. the lateral, cranial, and caudal aspects, more power,
Nevertheless, the patient will tell you if it is too dose, and power density are used (about double for
much, for example by flinching the ear. each) to penetrate skin and cartilage, and contact, if tol-
erated, improves penetration (Fig. 7.12). It is advisable
With proper positioning of the ear, light can be to combine both direct exposure and treatment from
focused inside the vertical ear canal in non-contact outside, and to include the projection area of the bulla
mode (remember to keep moving your hand-piece), in the outer treatment.

Table 7.4 Recommended parameters for otitis.
2
Dose (J/cm ) Power (W) Power density (W/cm )
2
Acute, pinna 2–4 1–3 0.2–0.6
Acute, canal 4–6 3–4 0.6–1
Chronic, pinna 4–6 2–3 0.2–0.6
Chronic, canal 6–12 4–8 0.8–1.2

REDONDO PRINT (4-COL BLEED).indd 72 08/08/2019 09:47