General Comments and Information about Ear Problems in Pets
From a treatment and frustration view point, there are 3 types of ear problems...
1. Those caused by ear mites. This is my favorite because it's easy to diagnois and easy to cure. This is also the most common ear problem in cats.
2. First time ear problems or pets with a history of occasional ear problems that readily respond to simple treatment, and the ear tissue is normal except for being a little irritated. These are generally rewarding to treat.
3. The third type is one we vets frequently have to deal with and are very frustrating to the pet and the owner too. This is the chronic ear infection that makes the dog miserable and smelly and even though it gets improved with treatment...keeps coming back. And the ear tissue changes to become thicker, spongier, and more productive...secreting large amounts of inflammatory glaze and goo.
This is not a common problem of cats, but a very common problem in dogs, especially dogs with flop ears and/or underlying allergies.
Some comments about the real problem leading to many chronic ear infections; Allergies:
When dogs have repeat ear infections it's often because of underlying allergies. Here's the deal: Either flea allergies, food allergies, bacterial allergies,or inhalant allergies (also known as atopy) ...or any combination of these allergies irritate the mast cells that are concentrated in the canals of the dog's ears.
These are just like the mast cells humans have concentrated in their respiratory system that release histamine, prostaglandins, and other inflammatory chemicals.
These itchy, inflammatory chemicals released by the mast cells stimulate the glands in the ear to over-produce ear wax and other secretions.
These waxy, gooey ears then become infected by skin bacteria which thrive in such an environment. Bacteria does especially well in flop ear dogs where the increased temperature in the ear canal is just right for bacterial incubation because of that cozy flap.
An ear canal with a fermenting vat of skin bacteria and ear wax then attracts yeast spores to germinate. This whole process is very irritating to the ear canals which become thickened, puffy, and ever more productive.
It's a frustrating cycle that often is broken only if you fight off all the main components: Get the underlying allergies under control. Get the bacterial infection under control. Get the yeast under control. Get the damaged ear canal tissue to heal.
Here's what to expect if your pet has an ear problem at our Clinic:
(Of course, other veterinarians may do things differently)
A good examination and history: It always starts here. Our exam includes looking closely at the rest of the body, especially for skin lesions, signs of atopy (inhalant allergies) such as paw licking, lymph nodes etc.
Also, of course, a good visual look under magnification, of the ear canal looking for foreign objects (like cotton balls or ticks), growths and dermoids (tufts of hair that can irritate or ingrow). Inspection of the ear drum.
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Microscopic smear of the ear wax: With this simple smear we can see ear mites, demodex, and pus. If we go to the trouble of fixing and staining the sample we can also identify yeasts. If the problem is ear mites we usually skip right to treatment; see below.
Yeast Culture: If the look and smell of the ear and the history indicate a possible yeast infection, we may take a culture. If it's positive, we'll know to aggressively treat with Chlorhexidine 4% followed by clotramizole ointment.
The culture results takes 10-14 days. I perfer Malotic brand ointment which contains a great new topical antibiotic, clotramizole, and a topical steroid for the itch. Other vets perfer Baytril Otic, Panalog Ointment or other brands.
Sometimes flushing the ear with diluted, distilled vinegar is enough to control yeast problems...but remember that yeast is usually not the sole problem.
Possibly a Bacterial Culture: Recommended for those ears that are infected but haven't responded well to antibiotics previously...that implies a resistant organism like pseudomonas etc. Results take 7-14 days.
How we treat these problems:
1. Ear mites. If we find ear mites on the ear wax smear, we rejoice because this problem is much easier to treat than other ear problems.
What you need to know is that ear mites have become resistant to pyrethins, thiabendazole, and sevin...the chemicals in most ear mite treatments.
But, luckily Ivermectin is working well, although it's potentially harmful unless diluted carefully. There is now an approved commercial product available...until recently we had to dilute our own from cattle preperations.
Revolution, whose main use is for flea control also works fairly well.
So what we do is clean out most of the thick accumulated ear wax and stuff. Then we massage in 0.1% ivermectin. Then we follow up with a revolution treatment in 2-4 weeks to get any mites or mite eggs that survived the Ivermectin.
It's important to treat all the cats and maybe any dogs you have in the household for best results.
2. Simple, first time ear infections: If the pet's ear is obviously infected and no mites are found, then we hope that allergies and secondary yeast infections are not a major factor. The treatment for such situations is straight forward: We'll clean out the affected ear gently. Then at home you'll:
A. Use a soothing ear cleaner, possible containing a topical steroid and antibiotic a couple of times daily until al better. Note: certain antiseptics and antibiotics common in many such liquid ear medications can occassionally cause harm...usually reversible...to the ear, especially if the ear drum is not intact. Your vet will knows this and will be careful.
B. Or, if there isn't too much wax, there are several effective ointments that are more soothing and in addition to a good topical antibiotic they are often effective against yeast infections
C. If the dog also has a fever or swollen lymph nodes, anitbiotics are appropriate. You and your vet can discuss whether or not the cost of cytology or a culture would be worthwhile prior to chosing an antibiotic regimen.
D. I will often dispense a very short period of prednisone and/or benadryl to reduce the irritation and itch. Other vets prefer to avoid steroids like prednisone
E. Recheck if not all better soon. Hey, this is important...getting things right requires follow up and perserverance until the job is done.
3. What we do with Chronic, Repeat Ear Infections:
If you've read most of what I wrote above, you'll know that these hard to cure ear problems are caused by several things going on at once, namely any combination of allergies, bacterial infection, and an over riding yeast infection too. So successful treatment involves attacking all these problems more or less all at one time:
A. Clean out all the goo as needed. There are lot's of good products for this. My favorite is made up at the clinic with added Skin So Soft, Benadryl, Dexamethasone, and Gentocin.
Alternate this every other day with Chlorhexidine 4% in the ears to kill the yeast if it's suspected or found on culture.
note: both gentocin and chlorhexidine are potent and very helpful in many ear infections...but are not 100% safe. Your vet may want to avoid them in certain situations.
B. Fight the infection aggressively. With injectible antibiotics followed by at least 3 weeks of oral antibiotics. I start with less expensive cephalexin, but if it's not working soon or hasn't in the past on this patient, I use either Baytril or Zennequin. Other vets have their favorite antibiotics.
In addition, apply topical antibiotics two- three times daily. I like Malotic which combines a good antibiotic along with a topical steroid for itch relief and Clotramazole for yeast and fungus control.
C. Control the inflammation, irritation, and itching: In addition to the relief that the cleaners and ointments provide, I use a short course of prednisone and benadryl for 3-10 days
D. Control the pain. Consider use of Ectogesic or Rimydal for a while.
E. Get the allergies under control: this will involve some combination of:
2. A possible food trial.
3. Some combination of antihistamines and Omega 3 fatty acids.
4. Possibly the trial use of prednisone or methylprednisone for a
limited time.
5. Possible referral to an allergy specialist for allergy testing
F. Possibly consider the use of alternative medicine. My success rate with the ones I've tried so far has been poor.
G. Rechecks are often needed if not under control soon.
H. And as always; referral is an option.
I. Hold Everything; a new product is now available that sometimes works miracles on chronic ear problems. It's inexpensive. It's safe. So we're often using it in conjuction or instead of all the above. Click here for more info; I made a separate page to talk about Zymox
Information, comments, articles, and links about:
Ear Allergies
Yeast Infections
Ear Mites
Demodex Mites
Bacterial Infections
Injuries to the Ear Flap
Hematomas
Fly Strike
Canker
Frost Bite and Sunburn
I just read what I just wrote above. It's not quite bad enough to start over, and all the information is accurate, but I think I'll try again below. Maybe it will help you:
Another Try at Explaining Ear Infections in Dogs
Ear infections are very common in dogs. Why?
Because of the anatomy of the ear in some breeds of dogs. It's longer and deeper than in humans, for example. And in some breeds, covered by an ear flap that makes the inside of the ear canal warm and moist. Like an incubator.
Another reason: dogs have a lot of mast cells that can release histamine and other allergic chemicals. In other words, it's common for dogs with allergies to have itchy, irritated ears. It all comes together; the allergies irritate the ears and in response they produce more ear wax. Because of the extra ear wax and inflammed ear canals, and because the ear canals in many dogs are extra warm and moist because of anatomy, you can understand why so many dogs keep getting ear infections over and over again.
It's pretty easy to tell when your dog has an ear infection. They shake their head. They whine. And when you give hugs, you can smell the special odor of a yeasty, bacterial, ear infection. And, of course, if you take a close look, you will see that the ear canal is hot, red, inflammed, and full of goo. If you touch the ear it will often hurt. Or elicit groans. I went to vet school to learn this great stuff.
In case you didn't see my smile, that was a little joke. But here's something serious. You can't just assume what I just told you is true ... for your particular pet. Each case is different. Or complicated by other factors.
Possible other causes include foreign bodies in the ear canal, masses in the ear canal, drug sensitivities, food allergies (which are different from other allergies), thyroid disease, immune disorders, parasites (there are several different types besides the common ear mite), metabolic disorders including diabetes and cushings disease. Other factors include "swimmers" ear, excessive hair growth in the ear canals, excessive hair removal from the ear canal, excessive bathing, sensitivity to harsh ear wax cleaners. Oh I forgot to mention yeast and fungus in addition to bacteria. And sometimes the bacteria is the type that doesn't cooperate and die even when you're using a powerful antibiotic. Hoo Boy.
I bring this all to your attention to underscore the importance of a good exam and probably some lab work to try to narrow down all the possible causes. Your vet will want to have a good look down the ear canal. It may be necessary to sedate your pet in order to clean out the ear well enough to get a good look. Or maybe he or she will have you come back after a few days of treatment to look again when hopefully the ear will be improved.
Treatment: (a summary):
Treatment of any under-lying problem that might be discovered
Cleaning of the ear canal. My favorite product for this in most cases is Zymox. Often this is all that's needed! Click here to go to the page I wrote about Zymox.
Application of topical antibiotics and anti-inflammatories
Oral medication if needed. Antihistamines and/or omega 3 fatty acid supplements are often very helpful. Oral antibiotics may be needed for deep seated infections. Long term antibiotics are often needed.
As a rule, we try to avoid systemic steroids, at least for long term use, but sometimes the results are worth the possible problems. Your vet will talk to you about this if they're needed.
A diet change is not often the answer, but sometimes it's exactly what's needed. It takes a little bit of intelligent detective work to figure this out. You can't expect to get success with switching to just any different food.
Repeated cultures are sometimes needed. There's a bacteria called pseudomonas that's particularily difficult to control and cure.
And finally, sometimes it's necessary to surgically open up the ear canal in order to get long term relief.
Ear Allergies
We'll keep this simple for now. Dogs, and sometimes cats, have inhalent allergies to things like molds, yeast, and pollens that show up as ear allergies. Actually, this is a very common problem and frequently the underlying cause of other ear problems. Sometimes the problem is a food allergy or contact allergy. And sometimes it's a combination of allergies. Depending on the severity of the allergy, your vet will likely offer the following treatments: Before we start a list, remember that in general, there's no "cure" for allergic problems; just control.
1. Treatment of secondary/additional problems like infection, yeast, wax build up, hematomas, and self mutilation wounds.
2. Ear cleaners as and if needed to remove excessive wax. I'm a big fan of Zymox Drops for this job as well as a treatment-preventative.
3. Trial of different anti-histamines; typically diphenydramine, chlorpheniramine, or hydroxizine.
4. Trial of Omega 3 Fatty Acids. They often help.
5. Possible food trial to see if a big part of the problem is diet related.
6. Possible blood work to rule out hypothyroidism
7. Whenever there are problems for which we don't have a reliable cure...just treatments like those listed above that often work but often don't...then we can expect to have lots of alternative treatments touted too, often accompanied by many testimonies and diatribes against traditional medicine. I'm not necessarily saying "don't waste your time or money" but do understand that there is a lot of bamboozlement going on right now in the "alternative" medicine business. One alternative treatment that may have some merit is olive leaf extract; I simply don't know enough about it to say one way or the other. At any rate, I just wanted you to know that there are other possible treatments available out there.
Yeast Infections
Yeast organisms are rarely the primary cause of ear infections, but they certainly are common invaders of ears that are already red, moist, and irritated from other causes. But once the yeast infection is established it not only makes the ear much more painful and odorous, but it's difficult to solve the ear problem without also treating the yeast problem. Here's what to expect:
Some vets will diagnois yeast based on the smell and usually be correct. Other vets will recommend a yeast culture to confirm the possibility.
This bears repeating: Yeast is rarely the main problem, so expect to also need to treat additional problems. Just cleaning out your pet's ears with vinegar is NOT likely to be enough.
Treatments:
1. Diluted vinegar. Inexpensive and often adequate as a treatment. Vinegar is mildly acetic; yeast doesn't survive well in an acid environment. Here's the possible problems with vinegar as a treatment:
a. often not successful; probably because the pH change isn't extreme
enough or long enough in duration
b. vinegar can sting quite a bit making this a very disaggreable treatment
for your pet.
c. vinegar treatments are possbily dangerous as a treatment if the
eardrum is damaged.
2. Zymox. If you've read much of the rest of this page, then you know I'm a big fan of this product. It's seems to be very effective at treating both bacterial and yeast infections.
3. Chlorhexiderm products. Especially the stronger strengths (4%).
Sometimes it's important to shampoo the whole dog to get the yeast infection under control.
4. Other shampoos and topicals that have varying degrees of success at killing yeast. At our clinic, we've been using a shampoo called "Universal shampoo" that's been working well when we need to treat the whole pet and not just the ears.
5. There are several brands, but many vets sell an ear cleaner/flush that lower the pH of the ear canal which successfully kill the yeast. These prescription products tend to work better than vinegar treatments and are less irritating to the ear canal.
Ear Mites
Ear mites are very common in cats but are also seen in dogs occasionally
There are several different types, but in general, like fleas, ear mites have become resistant to most of the over the counter treatments. Despite the label claims, they simply are not working well.
Revolution works fairly well at killing ear mites in cats.
Even more effective are topical applications of ivermectin which you need to get from your vet. A lot of you know that Ivermectin products are sold for use in livestock and as a heartworm preventive in dogs and cats, but you risk some fairly severe side effects if you apply these stronger products directly into the tender ear canals of cats and especially kittens.
Demodex Mites
More info coming soon
Bacterial Infections
More info coming soon, although most of what you need to know is more or less covered above
Injuries to the Ear Flap
This is an interesting subject in the sense that we vets are presented with some pretty interesting stories about what happened to their pets when they stuck their noses...or in this case ears... into places and situations they shouldn't have. Our biggest problem is figuring out ways to keep our patients from scratching at their newly repaired ears until they've healed.
More info coming soon
Fly Strike
Canker
More info coming soon
Frost Bite and Sunburn
More info coming soon
