My Dog Has an                              Ear Infection!                                                  Now What?By Jac...
Otitis Externaaka “ear infections”    A good many aren’t really infections!    Otitis externa is an itchy inflammation o...
Signs of Otitis Externa   Shaking head   Rubbing ears on floor or furniture   Whining/crying when ears are rubbed   Di...
Tests to determine causes ofOtitis ExternaOil Smear                    Ear Cytology Veterinarian looks at a     Veterina...
Management for Otitis Externa   Hygiene    ◦ Pluck hair from inside ears if present    ◦ Clean with the veterinarian-reco...
Cleaning the Ears
Ear Cleaners   Some are contraindicated    ◦ Especially if it is not known whether or not the ear      drum is intact    ...
Vertical      Canal                Ear DrumUnderstanding Ear Anatomy
   The only parts of                     your dog’s ears you                     are likely to see are                   ...
How to clean your dog’s ears Outdoors or in shower/bathtub! It’s messy. Don’t wear anything you would mind being  spatte...
For everyday cleanups Grime in the top part of  the ear (pinna and into  vertical canal) is not  always an indicator of  ...
Ear Medications   Topical drops or ointments are the    mainstay of therapy   Many medications for dogs are in an oily  ...
Ear Ointments   Have an applicator tip that can be inserted to    deposit the ointment deep into the vertical canal.    ◦...
Ear Drops Are designed to be  dropped into the  vertical canal You will count drops  as directed on the  label, then mas...
•   Odor – this ear           smells somewhat           sour       •   Lichenification             •   Thicker skin       ...
•   Raise pinna up                                  over the head                              •   Insert the             ...
Advancing the applicator tip in deeper
•   Fully insert the                                    applicator tip into                                    the vertica...
Other Ear Therapies…   Are much the same as dermatology therapies    ◦ See ―My Dog Has Allergies! Now What?‖ by Dr. Burns...
Stubborn Cases There are many! May require    ◦ Oral antibiotics    ◦ Drops mixed up by the veterinarian with a      mix...
Realistic Expectations… Our goal of treatment is to make your dog  more comfortable We usually cannot stop all ear probl...
Like all other allergies, allergiesaffecting the ears have no magiccure!            Ive come to            cure your ear  ...
What if I can’t do it?No ear drop,ointment,cleanser or oralmedication willwork if you can’tadminister it.
Training…   Ideally starts in puppyhood   Set up for success rather than failure    ◦ Waist high    ◦ You set yourself u...
“Special Place” Training   Put your dog in his special place    ◦ Waist high with non-skid surface (bath mat)    ◦ Top of...
What about cats? Most common cause of otitis is ear mites Other causes    ◦   Atopy    ◦   Food Allergy    ◦   Demodex m...
Inflammatory Polyps   Usually in young(er) cats   Watery discharge that doesn’t respond to    topical or oral treatments...
If you are frustrated beyondbelief…   Ask yourself if you are    compliant with all of your    family veterinarian’s    p...
Slide presentation courtesy ofJacquelyn H. Burns, DVM   Holmes Veterinary Hospital    1001 Church Street    Laurens, SC 2...
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My Dog Has Otitis! Now What?

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One veterinary practice's approach to diagnosing and treating otitis externa (ear inflammations or "ear infections"), including training your dog to allow ear treatments.

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  • DOG with Gunky EARs ?

    DOG > Chronic EAR Issues ? = ALLERGY to Pollens, Mites & Molds.

    Connect the DOTs of ALLERGY > Chronic Dog EAR Issues.

    85% Allergy Itchy DOGs = Allergy to Pollens, Dust Mites & Molds = Allergy causes SKIN Irritation Immune / Histamine Response in Ear Lining > Irritated EAR Skin = Itching > Wax BuildUp in an “Attempt” to remove Irritation > Opportunistic Yeast “Moist & Warm Petrie Dish” Growth to Wax BuildUp > Yeast creates Itch Chemicals > Allergy Itch + Yeast Itch = SKIN Distress >> INFECTION = Antibiotics = GUT Bacteria MicroBiome DeStabilized = Opportunistic BAD Bacteria Populates GUT > Compromised / UnBalanced GUT = Poor GUT Functionality = Weakened / Compromised Immune System = Future Health Issues. + Chronic ALLERGY Issues + Chronic EAR Issues = Frequent Vet $$ Bills + Sad DOG  = Sad Pet Parent .

    Solution ?
    Neutralize SOURCE of ALLERGY with Sublingual Doggy GOO.

    Veterinary Dermatologist Formulated / 100% Natural / PET Friendly GOO-Licious Tasty Treat

    Sublingual Doggy GOO.

    Sublingually builds Immune System Tolerance >> Tree, Weed, Grass Pollens, Dust Mites & Mold Spore Allergy Sources.

    PLUS > Pre & ProBiotics = GUT Health & Response

    Solution > Chronic EAR Issues > Sublingual Doggy GOO = Allergy Neutrality = No EAR Issues

    Happy DOG
    Happy Doggy GOO Pet Parent !
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  • Hi, I found your slideshow via an internet search. My senior dog received a BNT treatment (though not under sedation as you mention), and within hours, lost all hearing. I am wondering if you have ever seen this happen? My vet cannot explain it to me and has never seen it happen. Internet info seems to be limited - I wonder if this might be temporary and if there is any way to speed up the 'melting' process of the medication. Many thanks for any insight you might be able to provide!
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My Dog Has Otitis! Now What?

  1. 1. My Dog Has an Ear Infection! Now What?By Jacquelyn H. Burns, DVM Copyright © Jacquelyn H. Burns 2012 All rights reserved
  2. 2. Otitis Externaaka “ear infections”  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
  3. 3. Signs of Otitis Externa Shaking head Rubbing ears on floor or furniture Whining/crying when ears are rubbed Discharge from ears Odor from ears ◦ Sour most often means yeast infection ◦ Foul most often means bacterial infection Thickening or swelling of pinna (ear flap) ◦ Lichenification ◦ Aural hematoma
  4. 4. Tests to determine causes ofOtitis ExternaOil Smear Ear Cytology Veterinarian looks at a  Veterinarian looks at a sample of ear wax or stained slide of ear wax discharge in mineral oil or discharge under the microscope  Seeing whether there Screening for ear mites Can be difficult to are interpret if you’ve used ◦ Yeast an over-the-counter ear ◦ Bacteria mite med prior to  Cocci seeing your  Rods veterinarian ◦ Neutrophils (pus cells) vs simple epithelials
  5. 5. Management for Otitis Externa 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
  6. 6. Cleaning the Ears
  7. 7. 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 solution Are not interchangeable ◦ Different ear conditions respond to different pH’s Some cleaners are low pH (acidic) ◦ Best for yeast Some cleaners are high pH (basic) ◦ Best for bacterial infections such as Pseudomonas
  8. 8. Vertical Canal Ear DrumUnderstanding Ear Anatomy
  9. 9.  The only parts of your dog’s ears you are likely to see are the Pinna and the top portion of the vertical canal.Deepest  The ear drumyou can reach (tympanic membrane is very deep and Ear protected around a Drum nearly 90 degree curve Ears are difficult to damage!
  10. 10. How to clean your dog’s ears 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 head Fill the ear canal to overflowing with ear cleaning solution Massage the base of the ear for 60 seconds Allow 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 ball Repeat Never use Q-tips! They can pack wax and discharge down deeper, and make the problem worse!
  11. 11. 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
  12. 12. Ear Medications Topical drops or ointments are the mainstay of therapy Many 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 treated Some are aqueous (water) based drops
  13. 13. Ear Ointments Have 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 ◦ Antifungaladdress yeasts ◦ Antibioticaddress 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.
  14. 14. Ear Drops Are 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
  15. 15. • Odor – this ear smells somewhat sour • Lichenification • Thicker skin • Roughened skin • Hyperpigmenation • Dark discoloration of the skinAn itchy ear!
  16. 16. • Raise pinna up over the head • Insert the applicator tip into the top of the vertical canal • Direct it downwardInserting applicator tip of ear ointmentinto the vertical canal
  17. 17. Advancing the applicator tip in deeper
  18. 18. • 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 deeperApplicator tip is fully inserted into thevertical canal
  19. 19. 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
  20. 20. Stubborn Cases There 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)
  21. 21. 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
  22. 22. Like all other allergies, allergiesaffecting the ears have no magiccure! Ive come to cure your ear allergies. Yeah, right!
  23. 23. What if I can’t do it?No ear drop,ointment,cleanser or oralmedication willwork if you can’tadminister it.
  24. 24. Training… Ideally starts in puppyhood Set up for success rather than failure ◦ Waist high ◦ You set yourself up for failure attempting it on the floor, couch, bed or chair Use 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
  25. 25. “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
  26. 26. What about cats? Most common cause of otitis is ear mites Other causes ◦ Atopy ◦ Food Allergy ◦ Demodex mites ◦ Bacterial infections ◦ Polyps Inflammatory polyps!
  27. 27. Inflammatory Polyps Usually in young(er) cats Watery discharge that doesn’t respond to topical or oral treatments Benign polyps can form in the Eustachian tubes, tympanic bulla, ear canal, throat Problem won’t resolve until the polyp is surgically removed Polyps high in the vertical canal may be ―pulled‖ out under sedation Deeper polyps require referral to a surgical specialist
  28. 28. If you are frustrated beyondbelief… 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
  29. 29. Slide presentation courtesy ofJacquelyn H. Burns, DVM Holmes Veterinary Hospital 1001 Church Street Laurens, SC 29360 www.holmesvethospital.com 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. Copyright © Jacquelyn H. Burns 2012 All rights reserved
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