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What is otitis?
The word “otitis” refers to inflammation of the ear canal. It may involve the external ear canal (otitis externa), the middle ear (otitis media), or the inner ear (otitis interna). Most of the time, the inflammation is accompanied by an infection with either bacteria or yeast. It is much more common in dogs than in cats. Symptoms of otitis are usually obvious, and include ear pain, head shaking, or ear scratching. Some pets have an obvious smell or discharge emanating from one or both ears. Rarely, otitis causes a head tilt or difficulties maintaining balance. Otitis can be a short-term problem that resolves promptly with therapy, but we often see cases of otitis that have been present for months or even years.
What causes otitis?
Most cases of otitis are complicated by bacterial and yeast infections. Although these organisms greatly increase the itching, discomfort, smell, and build-up of material within the ear, they are not the true “primary” cause of the otitis. In fact, most of these organisms can be found in low numbers in the ear canals of normal dogs. Factors that allow these organisms to proliferate excessively and cause problems in the ear canal include allergies, excess moisture or hair in the ear, tumors, or ear mites. Once the bacteria or yeast begin to proliferate, their numbers can rise rapidly in a short time.
How is otitis diagnosed?
We usually base a diagnosis of otitis on the clinical signs noted by the owner at home, and on our examination. We use an instrument called an otoscope to view the deeper parts of the ear. By performing a microscopic examination of the ear discharge (cytology), we can identify the type of organism (yeast or bacteria) present. In some cases we submit this material to a laboratory for more precise analysis, to find out which medications might work best to treat the infection. Sometimes, the material in the ear makes it difficult for us to see the entire canal, so we may recommend an ear cleaning under anesthesia to get a better look at the deeper parts of the ear, including the ear drum.
If the otitis is recurrent or long-standing, identifying the organism involved may only be the first step. In these cases, we like to try to uncover why the infections are persistent. This may mean further testing for allergies or other conditions.
How is otitis treated?
The treatment of otitis consists of therapy for the existing infection and also for the underlying condition that allowed it to develop.
The infection in the ear is treated in one or more ways. An ear cleanser is generally prescribed for you to use at home. This helps to remove the material that builds up in the ear canal which serves as a source of nutrients for the organisms. A medicated ear drop or lotion is used, after cleaning, to kill the organisms found in the ear and to reduce inflammation. Lastly, we may prescribe an oral medication to penetrate the deeper parts of the ear.
Long-standing infections are often accompanied by a large amount of discharge that can be difficult to remove by routine ear cleaning. This material is most effectively removed by performing an ear “flush” under general anesthesia. During this procedure, we use a video otoscope for a detailed look in the ear canal. This allows for a thorough assessment of the eardrum and canal, and removal of the material that is present.
If we can determine the underlying cause of otitis, we address it in order to prevent relapses. Because allergies are so common, we may recommend an allergy management program consisting of immunotherapy and/or Atopica®. In some dogs, the infections seem to occur due to excessive moisture or wax build-up in the canal. Regular ear cleaning at home may suffice to keep the infections at bay in these patients.
How to clean your pet’s ears at home:
If a cleanser has been prescribed, it should be used 30 minutes before any medication. It can be used twice daily for a severe infection and once weekly during “maintenance” therapy.
- Lift the earflap and fill the canal to the opening with the cleanser.
- Gently massage the vertical part of the ear canal (immediately below the opening) for about one minute. You should hear a sound somewhat like a washing machine, indicating that the fluid is moving around the canal.
- Remove the excess fluid from the canal using cotton balls. Do not use cotton-tipped applicators, which may drive more wax into the deeper parts of the canal.
- Allow the pet to shake the head to remove the excess cleanser.
- Always clean the ears after your pet swims or is bathed. Most ear cleansers help to dry out the canal if it is excessively moist.
Medicating your pet’s ears:
If an ear medication has been prescribed, it should be used after the cleanser. It is best to wait 30 minutes after the cleaning so that most of the cleanser has been removed.
- Place the recommended number of drops or volume in the ear canal that is to be treated. Try not to get the medications on your own skin. Use approximately 5 drops in a small pet, but up to 10 drops in a large dog.
- Massage the ear canal to promote the downward movement of the medication.
- Never use the medications longer than the recommended period. Many medications contain ingredients that are absorbed into the circulation and can be harmful in the long term.
- Allow us to recheck the infection in the recommended period to make sure that the infection is clearing up as well as it should. We can assess the response in the deeper parts of the ear canal using an otoscope or a microscopic examination of the material remaining in the ear. Sometimes the infection can change its character, necessitating a change of medication. An incomplete response may tell us that we need to be a bit more aggressive with our therapy.
If we have scheduled a video otoscope examination and ear flush:
This procedure is performed under general anesthesia. Your pet will be continually monitored during the procedure.
- Please do not feed your pet after 9 PM the night before the procedure. You can still offer a small amount of water until the morning of the procedure.
- Complications from the procedure are rare. If the eardrum is ruptured (as it often is with chronic infections), the flushing procedure can irritate some of the nerves that run through the middle and inner ear. This may cause problems with balance (including a head tilt), or the nerve supply to the face. Fortunately, these side-effects are uncommon and usually transient.
- It is normal for the ears to be more tender than usual after the procedure, but do still try to administer the prescribed medications.
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