A common problem in dogs and cats is ear infections. A consistent cause of recurring ear infections is an underlying allergy called atopy. Another name for atopy is allergic dermatitis. Food allergies are also a cause of this recurring ear infection. Some pets have both as the cause.
There are many different causes and numerous treatment regimens to effect a cure. Since the causes tend to be multifactorial we need to address all of them for a successful outcome. Dogs tend to have more of a problem with ear infections as compared to cats.
Hygiene is of major importance both in curing the problem and prevention of recurrence. Ear infections can easily become chronic in nature, so proper therapy early in the course of the disease is important, along with long term commitment to keeping the ears clean.
Long term problems with the external ear can progress to problems with middle (otitis media) and inner (otitis interna) ears. This can cause substantial pain, equilibrium problems, and even hearing loss.
Dogs and cats ears differ from human ears in several significant ways. The main difference is the shape and length of the ear canal. It is longer in animals and has a downward and then inward direction. Also, their ears are more sensitive than ours. Cleaning them requires more effort than in people.
This picture shows normal dog and cat ear canal anatomy. The arrows show the downward and inward path of the external ear canal. The tip of the arrow to the left is pointing to the ear drum. When you clean the ears you will gently be pulling up on the external ear to straighten this canal out and allow deeper penetration of medication.
A normal dog ear has glands lining it they contain cilia to remove normal debris. This self cleaning mechanism works well for a healthy ear, not so well for an inflamed and infected ear. Cleaning this debris out of the ear canal is imperative for the bodies normal cleaning mechanism to work.
Pets commonly give their owners a clue that their ears are bothering them. Most pets will either have discharge, redness, swelling, odor, or will be shaking their head. The ears can be sensitive or painful, and your pet will be reluctant for you to pet it or touch it around the head or face. When these symptoms are present it is called otitis externa.
Sometimes the ear flap will become extremely swollen-this is called an aural hematoma. Pets that have a foreign body in their ear like a fox tail will be shaking their head extensively and frequently paw at the affected ear.
These problems might be seasonal due to allergies. In dogs there are many immunes and inflammatory cells in the ears and skin, which is why they exhibit problems in these areas. In people these cells are in the respiratory passages, which is why humanoids get runny noses and sneezing.
Ear disease is caused by many different and predisposing factors, some of them working in combination:
Anatomy – deep ear canals, hair filled ear canals, and long floppy ears are predisposing causes because they set up a warm and moist environment that bacteria and fungi thrive in. Cocker Spaniels, Labradors, Miniature Poodles, and Schnauzers are some of the dogs with this situation.
Breed – Some breeds like Cocker Spaniels are commonly effected because of allergies, long floppy ears, and inbreeding.
Allergy – In addition to causing itchy skin and hair loss in general, allergies can also cause ear problems. Food allergy and atopy are common causes.
Low Thyroid – On occasion low thyroid hormone can cause ear problems.
Parasites – Ear mites are also a cause of ear disease, especially in cats. Also chiggers and sometimes ticks.
Drug reactions – Any drug can cause a reaction that inflames the ear, including some cleaning agents.
Hygiene – Debris and excess hair in the ear canal can cause an infection.
Auto immune system diseases
Bacteria – Staph, Strep, Proteus, E. coli, and especially Pseudomonas.
Yeast – Candida and Malazzezia.
Foreign bodies – debris, hair, foxtails (plant awns).Since there are many causes to ear disease an accurate diagnosis is essential to relieving the problem.
A routine physical exam is used on every pet that is presented with ear problems because ear infections can be a sign that there are problems elsewhere in the body.
This exam is an essential part of the Diagnostic Process, and might include routine blood work
Ear swabs are used to obtain a sample of discharge for microscopic analysis
Microscopic analysis of the discharge helps us determine if your pet’s problem is bacterial or fungal related. This analysis is performed in our office by taking some of the discharge from the ear canal, staining it blue with a special stain, and observing how many bacteria or fungi are noted.
A culture of the discharge from the ear is sometimes used as an aid to determine what bacteria or fungus is causing the problem. Since many organisms are usually grown in a culture, and some of them are normal inhabitants, this test is not always advantageous.
This picture shows a culture that grew out a staph infection and a fungal infection called Malassezia
The otoscope is an important tool that allows us to visualize the anatomy of the external ear canal, including the ear drum. It is also used to retrieve foreign bodies, usually foxtails, from the ear canal, and to check for tumors. Ear infections are painful, and some pets need to be sedated before they let us examine their ears.
There are different sized cones depending on the size of the ear canal. The cone in this picture is one of our smaller ones.
In addition to these tests, allergy tests are utilized when they are suspected as the cause of the problem. A blood sample is taken that tests for allergies to food, commonly found material inside of your house, and plant like materials found throughout our area in the outdoors. Your doctor will let you know if this test is needed.
Each ear infection requires specific treatment depending on the results of the physical exam and diagnostic tests. If there are underlying problems your doctor will prescribe medication to prevent them. In the overwhelming majority of cases medical care is all that is needed. Surgical correction of an ear infection is usually used only after medical care has been unable to control the problem.
If your pet has recurring ear problems we need to control the allergy that is likely causing this. If it is atopy, there are many things we can do to either prevent exposure to the allergen causing the problem. Food allergy is a common cause of recurring ear infection, so a trial of Hill’s Z/D or D/D will be indicated. Our Allergic Dermatitis page has all the details.
For the majority of ear infections proper cleaning and routine topical medication will correct the problem. Learning how to clean your pet’s ears is crucial. Once you have an ear infection under control, which takes 3-7 days in most cases, your goal should be to clean your pet’s ears once or twice each week in order to prevent recurrence. Infections that continually recur are very painful and substantially decrease your pet’s quality of life.
In many mild cases we are able to clean the ears in our office without sedation. After we perform the initial cleaning in our office your job at home will be much easier. You will need to clean them at home to effect a cure and prevent recurrence. You do not clean them if our doctor is using Osurnia. Our nurses will demonstrate exactly how to do this with your pet. To learn the technique click here.
For pet’s with ears that painful to clean we will anesthetize them and thoroughly, yet gently, flush the debris out and instill medication. This is a huge start in your hygiene protocol at home.
Your doctor will routinely prescribe two medications. The first is used to gently clean the ear canal and remove debris and infection. The second medication is a combination preparation that kills either bacteria, fungi, or parasites. These medications usually contain an anti-inflammatory preparation to soothe the ear also. Occasionally your doctor will prescribe oral medication to clear up the infection and to decrease the inflammation in the ear canal.
Topical medications like this one are routinely used to treat. They have medication to treat bacteria and fungi, and also to decrease inflammation.
This is another topical medication that is used, especially for resistant bacteria
There is even a gel that is placed in the ear canal that lasts up to 45 days for pets that are difficult to medicate
Once we clean the ears we place this medication in the ear using the premeasured single-dose tube. It contains three ingredients that are beneficial to clear up the infection, both bacterial and fungal, and also sooth the ear. That is all you have to do for one week. In one week we recheck the ear to make sure the infection is getting under control, then we place another tube of medication in the ear. If your pet has no underlying problems as described above the infection is usually cleared up, and you don’t need to clean and medicate the ears daily. The ears are not cleaned again until 45 days have passed.
Many dogs have excessive hair inside of the ear canal. If this hair is causing a problem it is removed to facilitate cleaning and to let air circulate into the ear canal. This should be done routinely, which for most dogs is at least once monthly. If you or your groomer are reluctant to remove this hair, we will do it for you.
These ears are typical of a pet that needs the hair removed from its ears and a thorough cleaning. Sometimes just removing the hair from the ear canals completely corrects any problem, so please keep them hair free at all times.
These are the same ears after one of our nurses has cleaned them. It is obvious from the picture that this pet will feel much better from this treatment. It is a common-sense approach, and does not require any medication.
The dirty ears on this cat predispose it to an ear infection
It’s hard to believe these clean ears are from the same cat.
In some pets the ears are so inflamed that its painful to clean the ears. In these severe cases we use sedation and flushing. A warm cleansing solution is used to remove debris and infection from deep within the ear canal by flushing action only. These ears are painful and we need to go gently so as not to cause more pain and damage to an already severely inflamed ear canal.
A soft and flexible tube, with a warm cleansing solution, is used.
This ear has had recurring infections for so long that it is no longer possible to clean the external ear canal. The canal is swollen shut, infected and very painful. The only adequate remedy in this case is surgical correction to completely remove the ear canal. This surgery is called a total ear canal ablation. This surgery requires a surgeon with specialized training and expertise. The goal of long term ear care is to never let the disease progress to this point.
The ear canal is swollen shut, and cannot be cleaned. Surgery is the only option, and it works very well. Your dog will feel dramatically better after this procedure, although it will not be able to hear any sounds out of this ear.
Here is another dog with the same problem as it is prepped just prior to surgery for correction of the problem.