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
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 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
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
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
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!
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 ◦ 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 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 skinAn itchy ear!
• 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
• 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
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, allergiesaffecting the ears have no magiccure! Ive come to cure your ear allergies. Yeah, right!
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 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 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