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My Dog Has an
                              Ear Infection!
                                                  Now What?
By Jacquelyn H. Burns, DVM



                             Copyright © Jacquelyn H. Burns
                             2012
                             All rights reserved
Otitis Externa
aka “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
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
Tests to determine causes of
Otitis Externa
Oil 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
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
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 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
Vertical
      Canal


                Ear Drum




Understanding Ear Anatomy
   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 drum
you can
 reach               (tympanic membrane
                     is very deep and
           Ear       protected around a
          Drum       nearly 90 degree
                     curve

 Ears are difficult to damage!
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!
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 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
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.
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
•   Odor – this ear
           smells somewhat
           sour
       •   Lichenification
             •   Thicker skin
             •   Roughened skin
       •   Hyperpigmenation
             •   Dark
                 discoloration of
                 the skin




An itchy ear!
•   Raise pinna up
                                  over the head
                              •   Insert the
                                  applicator tip into
                                  the top of the
                                  vertical canal
                              •   Direct it downward




Inserting applicator tip of ear ointment
into the vertical canal
Advancing the applicator tip in deeper
•   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




Applicator tip is fully inserted into the
vertical canal
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 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)
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!
What if I can’t do it?
No ear drop,
ointment,
cleanser or oral
medication will
work if you can’t
administer it.
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
“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 mites
 Other causes
    ◦   Atopy
    ◦   Food Allergy
    ◦   Demodex mites
    ◦   Bacterial infections
    ◦   Polyps
   Inflammatory polyps!
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
If you are frustrated beyond
belief…
   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
Slide presentation courtesy of
Jacquelyn 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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My Dog Has Otitis! Now What?

  • 1. My Dog Has an Ear Infection! Now What? By Jacquelyn H. Burns, DVM Copyright © Jacquelyn H. Burns 2012 All rights reserved
  • 2. Otitis Externa aka “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. 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. Tests to determine causes of Otitis Externa Oil 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. 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
  • 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. Vertical Canal Ear Drum Understanding Ear Anatomy
  • 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 drum you can reach (tympanic membrane is very deep and Ear protected around a Drum nearly 90 degree curve Ears are difficult to damage!
  • 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. 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. 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. 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. 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. Odor – this ear smells somewhat sour • Lichenification • Thicker skin • Roughened skin • Hyperpigmenation • Dark discoloration of the skin An itchy ear!
  • 16. Raise pinna up over the head • Insert the applicator tip into the top of the vertical canal • Direct it downward Inserting applicator tip of ear ointment into the vertical canal
  • 17. Advancing the applicator tip in deeper
  • 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 deeper Applicator tip is fully inserted into the vertical canal
  • 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. 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. 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. Like all other allergies, allergies affecting the ears have no magic cure! I've come to cure your ear allergies. Yeah, right!
  • 23. What if I can’t do it? No ear drop, ointment, cleanser or oral medication will work if you can’t administer it.
  • 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. “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. What about cats?  Most common cause of otitis is ear mites  Other causes ◦ Atopy ◦ Food Allergy ◦ Demodex mites ◦ Bacterial infections ◦ Polyps  Inflammatory polyps!
  • 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. If you are frustrated beyond belief…  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. Slide presentation courtesy of Jacquelyn 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