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From an article clipping in “The Columbia Record” , from the 1950’s or ‘60’s about being “proud, though not haughty” about South Carolina:
South Carolina is a small state.
Yet I wonder if any state could stack up historic “firsts” comparable to the list of 45 our district agent, A.H. Ward of Aiken, has compiled for South Carolina.
Here are a few of them:
First museum in America
First Chamber of Commerce
First man to pilot a steamship across the Atlantic
First long railroad
First train to carry mail
Oldest railway junction in the world
First submarine ever built
First musical society
First state hospital for the mentally ill
First orphan’s home
First monument to women
First agricultural society
Largest earthen dam
First Bible society
First YMCA in America
First girls’ 4H Club
First home demonstration club
First public library
First special library building
First to observe Memorial Day
First normal training school
First inoculation given for small pox
First native American to receive a degree as doctor of medicine
First monument erected to honor slaves
First high school with military training
First botanical gardens in America
First in textiles
It’s rivers carry more water into the Atlantic than any other state
First hydro-electric plant
Highest percentage of native born Americans
History’s mightiest industrial enterprise…the Savannah River Project
The first county fair
And so on.
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 diagnose 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 easy to treat.
3. The third type is one we vets frequently have to deal with and are very frustrating to both the pet and the owner. 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 floppy ears and/or underlying allergies.
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 fleas, and signs of atopy (inhalant allergies) such as paw licking.
Also, of course, we will inspect the ear canal closely under magnification, looking for foreign objects (like cotton balls or ticks), growths and dermoids (cysts with ingrown hair), and for pus, inflammation, and canal wall changes. We will try to evaluate the ear drum.
Microscopic smear of the ear wax: With this simple smear we can see ear mites, demodex, and pus.
Ear Wax/Discharge Cytology: If we go to the trouble of fixing and staining the sample we can identify yeast and tell if the ear infection is a typical staph infection or an infection with other types of bacteria in the sample. This will determine which antibiotic is most likely to be successful. This is an especially important step if your pet has had a history of hard to treat ear infections.
Bacterial Culture & Sensitivity: Recommended for those ears that are infected but haven't responded well to antibiotics previously...that implies a resistant organism like pseudomonas etc.
Food Trial: About 20% of dogs with frequent ear inflammation and infections have underlying food allergies. Your vet may recommend a therapeutic test diet to find out if your pet is allergic to certain foods. It's important to do these food trials correctly ... not just switch brands. Click here to go to our page about food allergy trials.
How we treat these problems:
1. Treating Ear mites. If we find ear mites under the microscope when we examine the ear discharge, we rejoice because this problem is easy to treat than other ear problems.
What you need to know is that some ear mites have become resistant to pyrethrins, thiabendazole, and sevin...the chemicals in most over the counter ear mite treatments.
But, luckily there are now several brands of Ivermectin based ear mite treatments available at your vet and they tend to work well.
Revolution, The multipurpose once a month spot on for fleas, flea larvae, heartworms, intestinal worms, and sarcoptic mange mites also kills ear mites 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 survive the Ivermectin.
It's important to treat all the cats and maybe any dogs you have in the household for best results.
2. How we treat first time, minor ear infections: If mites aren't the problem, then we usually 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 all better. Note: certain antiseptics and antibiotics common in many such liquid ear medications can occasionally 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. Most vets will dispense a topical ointment containing a combination of antibiotics, anti-inflammatories, and an agent able to kill yeast. There are several brands all of which tend to work well with minor to moderate ear infections but tend not to be adequate for more severe infections.
While most vets use topical ointments like Panalog, Tresaderm, or Mometamax, I prefer Zymox Otic Drops which contains enzymes that break down the cell walls of bacteria, yeast, and wax and works AMAZINGLY well at soothing and cleaning up an infected ear canal. Click here for more information about Zymox
C. Oral Antibiotics may or may not be recommended depending on the severity of the infection.
D. I will often dispense a very short period of prednisone and/or an antihistamine to reduce the irritation and itch to make the patient more comfortable. 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 perseverance until the job is done.
3. What we do with Chronic, Recurrent Ear Infections:
For these types of ear infections, successful treatment requires aggressive care against all the major underlying causes. To repeat; these causes include:
Infection due to bacteria. The bacteria involved is usually Staph, but sometimes the bacteria is pseudomonas or proteus or other types of bacteria that require long term treatment with potent antibiotics.
Secondary infection from yeast. Yeast organisms thrive in infected ear canals and cause severe irritation. Most of the topical ear treatments that vets use kill yeast well in the ear canal but MAY NOT kill yeast deep in the tissue. A systemic anti fungal may be needed
Allergic inflammation due to fleas. Some pets are so sensitive that just a few flea bites can cause severe skin and/or ear allergies. Aggressive flea control may be needed.
Allergic inflammation due to pollens, molds, dust mites, etc. Dogs and cats are allergic to the same air born allergens we humans are sensitive too, but whereas most sensitive people develop respiratory symptoms, most dogs and cats develop skin, anal gland, and/or ear allergies.
Pain and discomfort. Ear infections are very uncomfortable. Treating the pain not only makes your pet feel better ... it speeds healing.
How I Treat severe ear infections:
A. Keep the ear canal clean. I recommend gentle ear cleaners that remove the wax and make the ear canal acidic or basic depending on which type of bacteria is found on cytology or culture. If Pseudomonas bacteria is suspected, then I often add Baytril antibiotics, Benadryl, and dexamethasone to the ear cleaner.
If the ear drum is intact, I also flush the ear canal with Chlorhexidine 4% to kill the yeast.
If the patient has ears that are so tender that the owner has trouble putting in medications, we often "pack" the ear canal with a lanolin based medicated gel that stays in the canal about 7 days over which time, if successful the painful, swollen ear canal tissue will have greatly improved afterwhich regular treatment can be started.
B. Most vets dispense topical antibiotic ointments to put in the ear canal after cleaning.
I recommend Zymox as a first choice because it works so well in most cases, and it's quite a bit less expensive than Mometamax or Posatex. (These are the two ear treatments used by most vets, and they also tend to work well. They are fairly expensive because they contain very potent, new generation antibiotics. I use these products too, but usually not as a first choice ) Click here for more information about Zymox.
C. High quality oral antibiotics for at least 3 weeks.
For most ear infections I use cefpodoxime ( a new generation once a day cephalosporin antibiotic). For pseudomonas infections I use one of the fluoroquinolone antibiotics. Other vets may prefer different antibiotics.
D. Antihistamines to help control the underlying allergies and irritation.
E. Short term steroids to help reduce the swelling and inflammation and to give the poor patient some relief from the allergies. Other vets avoid steroids even for short term use or substitute Atopica which works as well as prednisone without the side effects. (But very expensive)
2014 Update: a new anti-inflammatory medication called Apoquel will soon be available. It is reported to work as well as prednisone or other steroids without the the risk of so many potential side effects
F: Sometimes a hypoallergenic diet is needed.
G. Pain control. I often use Duralactin which is very safe and effective. Other vets use other products. But ear infections hurt.
H. Laser Therapy: This is new at our clinic in 2014. Laser therapy is at least somewhat helpful with almost any tissue that is swollen, red, painful, or inflamed. It also helps fight infection and speeds healing. Results have been mixed; great and obvious results in some cases and only modest improvement in others.
I. Possible referral to an allergy specialist for allergy testing and desensitization.
J. Recheck if not better. Life time control of allergies.