After gathering her pet's history and performing a complete physical examination, I took a swab of her pet's ear debris, applied a special stain, and looked under the microscope for presence of yeast, bacteria and mites. As you may have guessed, there were no mites. This pet had a terrible yeast infection.
This client was upset and embarrassed. She could not believe that she allowed her pet to suffer six months. "Good news," I told her, "today we will begin a new treatment plan to resolve your pet's yeast infection."
Why do ear infections happen?
Ear infections do not spontaneously occur. Some event or underlying disease must precipitate it. My top reason why pets get ear infections is allergies.
Allergies may be triggered by ingestion of certain foods, like beef, dairy products, chicken, lamb, fish, eggs, corn, wheat, and soy. Allergies may also be triggered by allergens your pet's skin, eyes, ears and nose may come in contact with - like tree pollen, grasses, house dust, molds, weeds, perfumes, aerosol home cleaning products, insects and wool.
In the unlikely event that allergies are not the underlying cause for your pet's ear infection, I would then suspect the following predisposing factors: high moisture (swimming), poor ventilation (big floppy ears), suppressed immune system (like pets with hypothyroidism and Cushing's Disease), mites, foreign bodies (like plant material) and poor conformation (like narrow ear canals found commonly in Chinese Shar-pei, Pug and Pekingese dogs).
How can I resolve it?
First, see your veterinarian for an accurate diagnosis. Your veterinarian will take a complete oral history before he/she performs a comprehensive physical examination. During this discussion, your veterinarian will ask you some key questions:
1. Have you noticed that your pet gets an ear infection around the same time every year? For example, "Does your pet itch and rub his/her ears every spring during peak tree pollen season?"
2. Does your pet have ear problems all the time? Food, house dust and mold allergies occur year-round.
3. Does your pet itch elsewhere? Pets with food allergies frequently scratch their ears and shake their head, rub their face, and lick their paws and anal area.
4. Is your pet on flea preventative? Pets with allergic reaction to fleabites will frequently scratch their hindquarters, but may also scratch around head and neck area. This is especially true in cats.
5. Does your pet get ear infections two to three days after swimming or being groomed? Increased moisture in ear canal may be an issue for this pet.
Second, your veterinarian will use a special instrument, called an otoscope, to closely examine your pet's ears. In a tolerant pet, your veterinarian will visualize the ear canal to see if it is swollen or ulcerated, debris or mass present, and if the tympanic membrane (a clear, curtain-like membrane that separates the outer ear from the middle ear) is intact. Sometimes, the pet is so painful; it is impossible or inhumane to examine the ear canal while it is awake. It is not unusual for us to sedate pets with severe ear infections to properly diagnose, clean, and treat the ears.
If a ruptured tympanic membrane is discovered, the outer ear will then directly communicate with the middle ear and may result in temporary hearing loss. Pets with a ruptured tympanic membrane will require special ear cleaning instructions and medication.
A swab of debris will be collected and evaluated under the microscope for yeast, bacteria, and mites to help characterize the problem and allow for proper selection of medication. A bacterial culture and sensitivity may be recommended if the infection is severe, reoccurring and/or tympanic membrane is ruptured to insure the best treatment protocol.
How do I treat the ear infection?
In order to properly treat the ear infection, your veterinarian first must properly clean the ear canal. It would be foolish to apply topical antibiotics or antifungal agents into an ear that is filled with debris. Debris traps the organism and provides a safe environment for it to thrive and avoid contact with the ear medication. Sometimes it is not possible to clean a dog's ear when he/she is awake and painful, and sedation is required. Many times, however, it can be performed with minimal restraint of your pet.
To clean your pet's ears effectively requires the proper selection of ear cleaning products. Recently, there has been an explosion of ear cleaning products available for your pet. Please ask your veterinarian for the best ear cleaning solution for your pet. Please do not ask a pet store clerk or groomer for advice. They are not medically trained to deliver veterinary medical advice.
At Animal Medical Center of Chicago, if my patient's ears are full of waxy debris, I frequently recommend a gentle product, called Cerumene by Vetoguinol, to soften and loosen the earwax. For pets with a bacterial ear infection, I frequently select a product that has antimicrobial and anti-inflammatory properties, like Douxo Micellar Solution by Sogeval. I tend to gravitate to alkalizing ear-cleaning solutions that contain triz EDTA if I am highly suspicious of a nasty bacterial infection called Pseudomonas. For yeast infection, I frequently recommend an ear-cleaning product that contains ketoconazole. Alternatively, for mild yeast infections I will recommend a homemade mixture of 1- part white vinegar to 2-parts warm water as a nice cleaning solution. Remember, before purchasing any ear cleaning solution, please contact your veterinarian for advice. Using the wrong ear cleaning solution may aggravate your pet's ear infection.
Additionally, to clean a pet's ears requires patience and respect. Do not use cotton tipped applicators to clean your pet's ears. Cotton tips are abrasive and feel like a coarse pad on the surface of your dog's sensitive ear canal. In addition, these tips can push ear debris further down into the canal making the ear infection worse. I recommend gently squirting the veterinary recommended ear cleaning solution directly into your pet's ear canal and let it sit for 5 to 10 minutes before wiping it out with a lightly moistened gauze or cotton ball. It is advisable to do this activity outside or in a bathroom where the walls can be easily wiped clean after your pet shakes its head.
After your veterinarian cleans your pet's ears, he/she will prescribe topical ear medication. The exact selection of medication will be based on your pet's history, physical examination findings, and ear swab results. Topical ear medication is almost always recommended for ear infections because of the high local active drug concentration it can achieve. In some situations, I will prescribe oral antibiotics or anti-fungal agents if I believe that topical therapy will not be sufficient, a middle ear infection is suspected, or the owner cannot properly administer it. A new favorite ear medication of mine, called Osurnia by Elanco, was recently introduced. This product is designed to help pets with bacterial and yeast ear infections. Your veterinarian will apply one medication-filled tube in each ear on first and seventh day of treatment, and that's it! It works really well and my clients are happy that they do not need to medicate their pet's ears at home.
How long do I treat the ear infections?
This is a great question to ask your veterinarian for it is dependent on the cause and severity of the infection. I strongly recommend before you stop the medication to schedule a recheck appointment with your veterinarian. Don't incorrectly assume after 10-14 days your pet's ear infection has resolved. Often my clients think the ear infection has resolved completely and I discover at their recheck appointment that it's only dramatically better not 100% resolved. Failure to resolve the ear infection completely only guarantees your pet will suffer from reoccurrence.
How to avoid ear infections?
One must first discover and control the underlying cause of the ear infection to avoid reoccurrence. If inhalant or contact allergies are suspected, then you must address the allergy issue to break the cycle. This may include allergy testing via single blood sample collection or intra-dermal skin testing by your veterinarian. Once your pet is diagnosed with inhalant or contact allergies, you may begin symptomatic treatment with avoidance, antihistamines, steroids, immune modulating products, shampoos and/or topical spray products to help minimize your pet's signs of allergies. Specific desensitization to the offending allergen(s) can be performed and should be discussed with your veterinarian.
If food allergies are suspected, your veterinarian will recommend that you feed your pet a single, unique protein diet exclusively for 8 to 12 weeks. Only a veterinary prescribed prescription diet or a homemade diet will meet this allergy food trial criteria. Even though there are numerous over-the-counter labeled single protein source diets at pet and grocery stores, these diets are frequently contaminated with other protein products by virtue of how they are processed.
If there is an underlying thyroid issue, I recommend a thyroid blood test for your pet. If there is an underlying metabolic issue, like hyperadrenocorticism, this must be pursued.
If you find that your pet gets ear infections after swimming, bathe the pet with a hypoallergenic shampoo after swimming or, at the minimum, rinse your pet's coat with water and then, dry out the ears with a cloth. There are a few topical ear-drying products available for purchase to decrease moisture in your pet's ear. Please discuss this concept with your veterinarian before using one.
Finally, inspect your pet's ears bi-monthly. If you see mild waxy debris, clean it out with appropriate cleaning solution. In most patients, I strongly recommend not to clean your pet's ears more than once every 2-3 weeks otherwise you disrupt the normal self-cleaning mechanism that naturally exists in the ear. In fact, I can't remember the last time I cleaned my own dog's ears. If all is well, leave the ears alone. If your pet's ears are red and inflamed, substantial debris present, or a pungent odor exists, see your veterinarian.
Are ear infections painful?
Absolutely. Please discuss appropriate pain medication with your veterinarian. Most ear medications delivered topically include an anti-inflammatory drug in its composition to reduce your pet's discomfort. For pets who have swollen ear canals and it is impossible for you to deliver topical ear medications properly, it is not uncommon, that I send the pet home with pain medication and oral steroids for a few days. Then, I have the client and patient return for re-evaluation, ear cleaning and topical drug therapy.
Ear infections are almost always the result of another disease process, like allergies, thyroid or adrenal disease. Please schedule an appointment with your veterinarian as soon as your pet starts shaking or rubbing his/her ears. Pets with ear infections are uncomfortable and your veterinarian can help relieve his/her pain immediately. Please don't dismiss your pet's chronic ear infections with the comment, "He always has one". Instead, ask your veterinarian, "Why does my pet have an ear infection?" This knowledge will allow you to begin an effective treatment plan to break this annoying and painful ear infection cycle in your pet.
Dr. Donna Solomon is a veterinarian at Animal Medical Center of Chicago and invites you to email her your questions or future topic ideas to doctors@animalmedicalcenterofchicago.com
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