My Dog Has an

Ear Infection!Now What?

By Jacquelyn H. Burns, DVM

Copyright © Jacquelyn H. Burns 2012All rights reserved

A good many aren’t really infections! Otitis externa is an itchy inflammation of the external ear canal.

It is not like an earache (otitis media), which is on the inside of the eardrum. Otitis externa involves the ear canal outside of the eardrum.◦ Inflammation and itch can occur without infection

Itches and burns Does not always include infection, but can

◦ Yeast◦ Bacteria

Often results from allergies (Atopy or Food Allergy)◦ Greater than 80% in this practice are caused by allergies◦ Less than 20% other causes

Mites Foreign bodies Trauma Tumors, polyps

Otitis Externa aka “ear infections”

Signs of Otitis Externa

Shaking headRubbing ears on floor or furnitureWhining/crying when ears are rubbedDischarge from earsOdor from ears

◦Sour most often means yeast infection◦Foul most often means bacterial infection

Thickening or swelling of pinna (ear flap)◦Lichenification◦Aural hematoma

Tests to determine causes of Otitis Externa

Oil Smear Ear Cytology

Veterinarian looks at a sample of ear wax or discharge in mineral oil under the microscope

Screening for ear mitesCan be difficult to

interpret if you’ve used an over-the-counter ear mite med prior to seeing your veterinarian

Veterinarian looks at a stained slide of ear wax or discharge

Seeing whether there are◦ Yeast◦ Bacteria

Cocci Rods

◦ Neutrophils (pus cells) vs simple epithelials

Hygiene ◦Pluck hair from inside ears if present◦Clean with the veterinarian-recommended ear

cleaner◦One to two times weekly for about two weeks◦Weekly or every other week as “maintenance”

Topical medications◦Ointments, drops, sprays◦Sometimes hunt and peck to see which works best

Symptomatic Care◦Antihistamines◦Fatty acid supplements

Management for Otitis Externa

Cleaning the Ears

Ear Cleaners

Some are contraindicated◦Especially if it is not known whether or not the

ear drum is intact◦ In these cases, the veterinarian prefers that you

use saline solutionAre not interchangeable

◦Different ear conditions respond to different pH’sSome cleaners are low pH (acidic)

◦Best for yeastSome cleaners are high pH (basic)

◦Best for bacterial infections such as Pseudomonas

Understanding Ear Anatomy

Vertical Canal

Horizon

tal

cana

lEar Drum

Pinna

Ears are difficult to damage!

The only parts of your dog’s ears you are likely to see are the Pinna and the top portion of the vertical canal.

The ear drum (tympanic membrane is very deep and protected around a nearly 90 degree curve

Ear Drum

Deepest you can reach

Outdoors or in shower/bathtub! It’s messy.Don’t wear anything you would mind being spattered with

ear goo and ear cleaner Hold the pinna up over the top of the dog’s headFill the ear canal to overflowing with ear cleaning solutionMassage the base of the ear for 60 secondsAllow your dog to shake his head

◦ Don’t forget to duck! Wipe away grime that comes to the top and solution with

a plain cotton ballRepeat

How to clean your dog’s ears

Never use Q-tips! They can pack wax and discharge down deeper, and make the problem worse!

For everyday cleanups

Grime in the top part of the ear (pinna and into vertical canal) is not always an indicator of what goes on deeper within the canal

Baby wipes or personal cleansing moist towelettes can be used as needed to wipe away everyday dirt around the pinna and into the upper vertical canal

We recommend unscented towelettes

Ear MedicationsTopical drops or ointments are the

mainstay of therapyMany medications for dogs are in an oily

base, which is believed to be more difficult for the dog to shake out of the ears◦These are a bit tricky for some owners to get

into the ears◦Can also leave the pet’s head greasy while

being treatedSome are aqueous (water) based drops

Ear OintmentsHave an applicator tip that can be inserted to

deposit the ointment deep into the vertical canal. ◦ Don’t be afraid to insert it as deep as it will reasonably go!

Contain a mixture of pharmaceuticals◦ Anti-inflammatory/anti-itch◦ Antifungaladdress yeasts ◦ Antibioticaddress bacteria

Directions may say “3 to 5 drops” but most of the time we guesstimate since the applicator tip is deep in the vertical canal when we squeeze the tube.

After squeezing the tube, massage the base of the ear to work the ointment in deeper.

Ear DropsAre designed to be

dropped into the vertical canal

You will count drops as directed on the label, then massage the base of the ear.

Some have to be refrigerated; some don’t

An itchy ear!

• Odor – this ear smells somewhat sour

• Lichenification• Thicker skin• Roughened skin

• Hyperpigmenation• Dark

discoloration of the skin

Inserting applicator tip of ear ointment into the vertical canal

• Raise pinna up over the head

• Insert the applicator tip into the top of the vertical canal

• Direct it downward

Advancing the applicator tip in deeper

Applicator tip is fully inserted into the vertical canal

• Fully insert the applicator tip into the vertical canal

• Gently squeeze the tube to deposit ointment into the canal

• Ointment is usually deposited about where the horizontal canal meets the vertical canal

• Massage the base of the ear to work ointment down deeper

Other Ear Therapies…

Are much the same as dermatology therapies◦See “My Dog Has Allergies! Now What?” by Dr. Burns

and review symptomatic care of itching under Atopy. A majority of our otitis cases are caused by Atopy and can be addressed in part by Atopica Antihistamines orally Anti-inflammatories (corticosteroids) orally Fatty Acid Supplements orally Weekly bathing & wipe off when coming in from outside

No ear drop/ointment/cleanser will work if you can’t administer it◦ It may take training—of both you and your dog◦Confess to the vet if you can’t do it

Stubborn CasesThere are many!May require

◦Oral antibiotics◦Drops mixed up by the veterinarian with a

mixture of different drugs (TrisEDTA+enrofloxacin+dexamethasone for Pseudomonas bacterial infections)

◦BNT, a lanolin-based antibiotic/antifungal/steroid preparation that is melted and poured into the ear canal under sedation—can be repeated every 14 days.

◦Oral corticosteroids (prednisone)

Realistic Expectations…

Our goal of treatment is to make your dog more comfortable

We usually cannot stop all ear problems “once and for all” because so many are caused by allergies◦Allergies are not curable◦Allergies will come back◦Allergies may require ongoing care

Like all other allergies, allergies affecting the ears have no magic cure!

I've come to cure your ear

allergies.

Yeah, right!

No ear drop, ointment, cleanser or oral medication will work if you can’t administer it.

What if I can’t do it?

Training…

Ideally starts in puppyhoodSet up for success rather than failure

◦Waist high◦You set yourself up for failure attempting it on the

floor, couch, bed or chairUse Dr. Burns’ “Special Place” concept

◦A place you only put your pet when you are going to do something (that may or may not be unpleasant) to him…and he gets rewarded each time.

Reward, reward, reward!◦Your dog knows every time he gets down, he is going

to get a reward

“Special Place” Training

Put your dog in his special place◦ Waist high with non-skid surface (bath mat)◦ Top of a washing machine, clothes dryer or countertop

Give a steadying command such as “Still” or “Whoa” Handle him all over, including touching in the ears, under

tail, eyes, lips, mouth, privates, feet Release command, such as “Okay!” or “Alright!” Reward!

◦ Should be a treat he goes wild over◦ Can be a “not your everyday treat” for training purposes

Repeat often, until he is accustomed to and excited over being put in the special place

Advance to doing nail trims, ear ointment, tooth brushing, administering oral medications or whatever

What about cats?

Most common cause of otitis is ear mitesOther causes

◦Atopy◦Food Allergy◦Demodex mites◦Bacterial infections◦Polyps

Inflammatory polyps!

Inflammatory Polyps

Usually in young(er) catsWatery discharge that doesn’t respond to topical

or oral treatmentsBenign polyps can form in the Eustachian tubes,

tympanic bulla, ear canal, throatProblem won’t resolve until the polyp is surgically

removedPolyps high in the vertical canal may be “pulled”

out under sedationDeeper polyps require referral to a surgical

specialist

Ask yourself if you are compliant with all of your family veterinarian’s prescriptions and advice.

If you are not compliant, ask yourself why…and try to start doing EVERYTHING your veterinarian recommends

If you are compliant and things are not working out, ask your veterinarian for a referral to a board-certified veterinary dermatologist

If you are frustrated beyond belief…

Holmes Veterinary Hospital1001 Church StreetLaurens, SC 29360www.holmesvethospital.com

Slide presentation courtesy of Jacquelyn H. Burns, DVM

Copyright © Jacquelyn H. Burns 2012All rights reserved

Material in this slide presentation is intended to help veterinary clients understand one practice’s approach to ear disease. It is not intended to be a substitute for assessment and treatment by your pet’s veterinarian.