title: A pilot study to develop an objective clinical score for canine otitis externa.
abstract: BACKGROUND
  The lack of an accepted clinical scoring system in canine otitis externa makes it difficult to compare clinical trials.
  
  
  OBJECTIVE
  To develop a score that is clinically relevant, reliable and sensitive to change.
  
  
  METHODS
  Client-owned healthy dogs (n = 55) and dogs with otitis externa (n = 60).
  
  
  METHODS
  We compared 0-3 and 0-5 assessments of erythema, oedema/swelling, erosion/ulceration, exudate and pain of the ear canals with a reference 0-2 scale. Additional data included odour, pruritus scores, tympanic membrane condition, treatment outcome and neutrophil, bacterial and Malassezia counts.
  
  
  RESULTS
  There were no significant differences between the vertical and horizontal canal scores (correlation coefficients >0.93). Correlation coefficients for the 0-3 and 0-5 scales were also >0.9 for all parameters, but the 0-2 scale was more variable. Pain and pruritus did not correlate well with the lesion scores and were associated with suppurative and erythroceruminous otitis, respectively. Neutrophil and microbial counts were variable and could not be used to generate cut-off values to differentiate healthy and affected ears or determine the response to therapy. Total scores ≥4 differentiated affected from healthy ears with 91.1% sensitivity and 100% specificity; scores ≤3 were 100% sensitive and 91.9% specific for clinical success. The intra- and interobserver reliability was high (intraclass correlation coefficients >0.95 and Cohen's kappa coefficients >0.65).
  
  
  CONCLUSIONS
  This pilot study showed that the 0-3 Otitis Index Score (OTIS3) for erythema, oedema/swelling, erosion/ulceration and exudate is suitable for further validation by a larger group of clinicians.
authors.affiliation: The Royal (Dick) School of Veterinary Studies, Easter Bush Veterinary Centre, University of Edinburgh, Roslin, EH25 9RG, UK.
authors.forename: Tim
authors.initials: T
authors.lastname: Nuttall
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Bensignor
mesh_terms: D000818:Animals; D016022:Case-Control Studies; D004283:Dog Diseases / Q000175:diagnosis*; D004285:Dogs; D015588:Observer Variation; D010032:Otitis Externa / Q000175:diagnosis / Q000662:veterinary*; D010865:Pilot Projects; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index